Chronic Pain Health — 31 October 2012

The U.S. Drug Enforcement Administration has expanded the war on pain patients from the shores of Florida to the shores of California — with a tsunami of confusion, pain and the inevitable deaths from their repressive policies.

Recently, the New York Times published an article on the DEA’s efforts to reduce the supply of opioid analgesics by bringing pressure on large pharmaceutical distributors. The agency, using heavy-handed tactics, is also targeting pharmacies they deem to have sold more analgesics than the DEA feels is appropriate.

The focus of the Times article was Mike Pavlovich, an award-winning pharmacist and owner of the Westcliff Pharmacy in Newport Beach, California. It was only after Pavlovich did not receive his usual shipment of opioid medicines from his distributor that he discovered the distinctive footprint of the DEA.

After making several inquiries, Pavlovich learned that the DEA had accused Cardinal Health, his distributor, of supplying too many opioids to Florida pharmacies and not having adequate controls to detect diversion. After being heavily fined, Cardinal Health started checking the records of its pharmacy customers in other parts of the country. The number of prescriptions Pavlovich was filling for opioids and other controlled substances was too high for their comfort level.

There’s a good reason for all those prescriptions. Pavlovich is a trusted pharmacist who works with doctors who specialize in treating patients who suffer from chronic, debilitating pain. He was the only pharmacist on the U.S. Olympic Committee’s medical  team to travel to China for the Beijing Olympics in 2008. He’s also a mentor and has tried to educate others on the safe filling of opioid prescriptions.

Pavlovich says he has never been cited by the State Board of Pharmacy or the DEA for any transgressions. He was not running a west coast version of an east coast pill mill.

Mike Pavlovich

In a phone interview Pavlovich told me how careful he is when filling opioid prescriptions. He regularly checks California’s prescription drug monitoring program, which alerts pharmacists to a patient abusing the system. If he has any doubts about a prescription or a patient, he investigates further.

Pavlovich discovered that no other large distributor would fill his entire prescription order. The DEA had cast a wide net. After further discussions he was able to secure only 15% of his oxycodone order from Cardinal Health. Other opiates are still available.

By putting the squeeze on his distributor, the DEA’s actions have affected Pavlovich in two detrimental ways.

First, the sudden reduction in his drug stock could cripple his business. He’s not only concerned about his own family but also the families of his employees.

Second, Pavlovich fears for patients who rely on opioids for pain control. Because of the reduced supply of  opioids he’s been unable to fill prescriptions for many of his customers. He has to turn away two or three of them daily.

Pavlovich is well aware of the misery that this crackdown is having on pain patients. For those who come to him when they are nearly out of their prescriptions, he and other pharmacists have little relief or hope to offer.

“DEA’s recent policy enforcement has made it virtually impossible for a pharmacy that serves patients with chronic pain as their primary niche to meet the needs of its patients,” says Pavlovich.

In his conversations with the DEA Pavlovich has tried to pin down exactly what the agency considers as excessive sales of opioids. It seems that regulators have come up with a slippery equation to determine how much a pharmacy can obtain from its distributors.

According to Pavlovich, the formula works something like this: If a pharmacy sells one hundred units or products; then that store will only be able to sell opioids anywhere from 15% to 40% of the total sales volume.

To meet that threshold, Pavlovich says he’ll have to increase his sales of other medicines and goods to expand his opioid supply.

All of this is a guessing game, however. Without a clear policy from the DEA, Pavlovich and other pharmacists are left in limbo, along with their suffering customers.

This has the proven potential of consigning these patients into the agony of withdrawal. As I’ve written in previous columns, this repression of a powerless class of citizens can and will have deadly effects on people with chronic pain.

Pavlovich points to the rising use of heroin and other street drugs. It is no wonder to him and to others that this is the direct result of restricting lawful opioid analgesics for legitimate pain patients.

We will witness a rise in overdoses and deaths. And it is likely that there will also be a spike in suicides among desperate pain patients unable to find relief from scalding torture.

The DEA is using a meat cleaver when a scalpel would do. To simply cut off pharmacies without first determining the nature of the customers being served suggests something more sinister.

Yes, the public needs protection, but no less than legitimate patients.

I believe that the repressive organs of our government ultimately want to make these lifesaving medicines available only for cancer patients and those with terminal diseases; other pain patients be damned.

I urge patients turned away from their pharmacies to tell your personal stories to your Congressional representatives. If you can, go to their offices and speak with the aides who follow health care issues. If not, a letter, email or call will do. .

We need to create our own tsunami to sweep away these egregious policies.

Damned I won’t be.

Neither should you.

Mark Maginn

Mark Maginn lives in the east bay of San Francisco where he is a poet, writer and social justice activist. Mark suffers from chronic pain and was a longtime volunteer with the American Pain Foundation. His blog can be found here

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About Author

Mark Maginn, Columnist

Mark is a poet, writer and social justice activist. Mark suffers from chronic pain and was a longtime volunteer with the American Pain Foundation.

(9) Readers Comments

  1. I am here in Tennessee also. I have just moved here and I can not even get a family doctor. I have called over 15 doctors and no one one wants a pain patient as a patient even though they don’t have to prescribe me the pain meds. Tennessee discriminates against pain patients. I made an appointment with my old pain doctor in Indiana and so they called my pain doctor in Tennessee to verify when I got my meds and such, and so now my pain doctor in Tennessee dropped me with only one week of fenatyl patches and said they don’t have to give me a 30 day supply or anything. I can’t get into my doctor in Indiana till March. This is why I am moving back to Indiana. If anyone lives in Tennessee and is a pain patient, you need to get out of there asap!

  2. This is happening in Texas now. I too am a long term Chronic Pain patient being treated by a pain management doctor at UT Physicians. I have been taking opiod pain medication for control of pain for years now, and only recently starting having problems with my pharmacy balking at filling my prescriptions. I always thought if you just stuck with one pharmacy you would be ok, but that simply is not the case any more. Every time an adjustment is made to my medication and a new script is written by my doctor the pharmacist questions me about it, never bothering to call the doctor. I even ran into one of the pharmacy staff who claimed they didn’t have the medicine in stock and could not tell me when it would be in stock, leaving me to call around to 8 different local pharmacies trying to get my pain medication filled. Every pharmacy I called said they didn’t have the medication and I found out later that this was just an outright lie. I was being told this because pharmacies now don’t want to fill a pain medication prescription if you haven’t been a long term customer. So where does that leave a person like me when your own pharmacy is too scared to fill your prescription because of these heavy handed tactics by the DEA? Where is our patient advocacy and recourse in this matter? I can’t tell you how many times my doctor has pulled her hair out with my current pharmacy CVS. Walgreens flat out will not even fill my medication prescriptions. So this is what it boils down to now, you have people in the DEA and at pharmacies now “judging pain patients” without knowing their medical background and issues, and treating anyone with opiod pain medication prescriptions as a “drug seeker” or potential drug addict. We have really caused such a fuss with the media hype now that we have created a monster for real pain patients. By the way, after my third spinal surgery, when I got home from the hospital I had a great deal of trouble trying to get my post operative care pain medication. Yes I can see how pain patients will commit suicide because honestly even I don’t want to live with this kind of pain without some real pain control medication. Where is the compassion? Who can we turn to now to get help? The answer is no one right now, the message is simple, deal with your suffering.

  3. My Mother has disintegrated discs in her lower back. Basically her spine is fallen onto her pelvis, and bone just rubs on bone and nerves. Her doctors have said she will need to be on pain meds her entire life. She’s 72 years old and just moved near me. All her care is on my shoulders and every month I go through an ordeal just getting her pain meds filled. I leave the pharmacy feeling like some kind of criminal because it’s now so bad that Walgreens won’t even tell her which of their locations have any stock. So, you drive everywhere trying to locate one. I will not see my Mother live in pain by God, something needs to be done. Someone needs to stand up and yell and scream about this. Thank you for your article. As my Mother is only one out of thousands that live with chronic pain.

  4. Why is the DEA not targeting physician’s offices who are administering epidural steroid injections? Patients are dying and countless patients have been irreparably harmed from these injections. The DEA should provide equal opportunity to their targets. I am aware of a physician who was targeted by the DEA because he took on the worst of the worst intractable pain patients – patients such as myself who suffer from adhesive arachnoiditis. Our patient community relies on opioids to function everyday. This physician can no longer help physicians because he was sanctioned. I wonder how many skilled pain physicians who prescribe opioids will be working at Home Depot or Walmart instead of helping patients such as me. The DEA is not in the business of understanding long term intractable pain. The American people are getting tired of government officials getting into their business when they have no business doing so – or worse – standing back and watching when it is time to step up to the plate. The FDA is a great example of this one — they are paid lots of $$ to approve many harmful drugs from very profitable pharmaceutical companies. They stand back and do nothing as physicians continue to inject harmful steroid products into patients’ spines. It is time for chronic pain patients to stand up and send a message to their US Senators that this racket needs to stop!

  5. I have a pain disorder that will not go away because no research is being done towards a cure. I depend on opoid pain medication to relieve enough pain for me to get out of bed. Without my medication, I would be bed bound and suffering even more than I already am. My disease was caused by an epidural needle being placed in my spine. I strongly believe the government needs to step out of our medical care, since they never see us as patients and don’t know our personal medical histories. I think that the patient doctor relationship is harmed when the doctor has to be afraid of writing prescriptions to his/her patients. Our physicians should have the right to write whatever they feel necessary to treat their patients without fear of harassment or punishment by our government. When a person doesn’t really need the medication, they are able to get it elsewhere or resort to street drugs. I feel eventually the government is going to control our medication to the point where a lot of patients will also resort to street drugs to avoid the hassles that go along with our legally obtained prescriptions for our legitimate illnesses.

  6. I am a responsible chronic pain patient. I have Tarlov Cyst Disease and Arachnoiditis. Without my pain medication I could not get out of bed each day. Even with my medication, it is a struggle every day. The pain I endure and those like me who have rare diseases, live with chronic pain 24/7. The pain never stops. If you don’t live with chronic pain, then you have no idea what it’s like to loose everything. Your independence most of all is the worse. The ability to play with your children or grandchildren, go shopping, walk, sit, stand, ride and most of all, loose your job because of your disease. So please don’t take away the one thing that does help us!

  7. IF YOU ARE FIGHTING THIS WAR TRYING TO GET YOUR OPIOIDS FILLED. PLEASE SIGN OUR PETITION TO STOP A SMALL GROUP OF DOCTORS, PROP, THEY HAVE SUBMITTED A PETITION TO FDA TO CHANGE LABELING ON OPIOID MEDICATIONS. THIS IS CHANGING MODERATE TO SEVERE PAIN, SLASHING MODERATE AND LEAVING SEVERE PAIN ONLY TO RECEIVE THESE MEDICATIONS. THEY ARE WANTING 100 MG DOSE PER DAY, WITH A 90 DAY LIMIT. PLEASE SIGN PETITION AT CHANGE.ORG…

    http://www.change.org/petitions/please-help-to-stop-prop-s-petition

  8. I’m not surprised Mark. I begged everyone to speak up and defend Florida. Many did, but what it really takes is for them see us in person. It makes it real when patients stand in front of the world and tell their stories. Unfortunately, I feel this kind of advocacy is what it’s going to take and a whole lot of it, to get a response and hopefully help for this continuing problem. These problems are spreading all over the country and I had hoped that we could have stopped this in Florida before it did go any further, but as the saying goes,”if it’s not your backyard? Then you don’t react?”I hope this isn’t too late.. I hope that many who read this take this idea seriously. If we ALL don’t get busy, soon we will have nothing for pain again like it was back in the early 1980’s. It’s really not fair to allow anyone to have pain relief and then yank it out of reach. Please.. everyone.. Start speaking up.. Show your face.. Organize rallies..If your pain or not. This needs to be done!! If you need some help? contact me. Donna Ratliff at goldenmain517@gmail.com. I organized a rally we had at the Florida state capitol in September. It was good but I really wished more would have came there. Hundreds of people would have made all the difference.. perhaps we wouldn’t be here posting if they did. There is nothing to be ashamed of if your a legitimate pain patient.

    Thanks Mark for your great articles!!

  9. I am so frustrated because here in Tennessee my pain Dr keeps saying the DEA requires all these test and everytime you come here. That is an open ended price added on to my already high priced no help from pain Dr anyway. I am price gouged every time I go to the pain DR for Chronic Pain. That is all the DEA is doing, allow pain Dr to charge whatever they want. I pay four times the amount I paid 4 years ago. DEA are you kidding me, they are looking for criminals not us.