NORMAN J CLEMENT RPH., DDS, NORMAN L.CLEMENT PHARM-TECH, MALACHI F. MACKANDAL PHARMD, BELINDA BROWN-PARKER, IN THE SPIRIT OF JOSEPH SOLVO ESQ., IN THE SPIRIT OF REV. C.T. VIVIAN, JELANI ZIMBABWE CLEMENT, BS., MBA., WILLIE GUINYARD BS., JOSEPH WEBSTER MD., MBA, BEVERLY C. PRINCE MD., FACS., LEROY BAYLOR, JAY K. JOSHI MD., MBA, ADRIENNE EDMUNDSON, ESTER HYATT PH.D., WALTER L. SMITH BS., IN THE SPIRIT OF BRAHM FISHER ESQ., MICHELE ALEXANDER MD., CUDJOE WILDING BS, MARTIN NDJOU, BS., RPH., IN THE SPIRIT OF DEBRA LYNN SHEPHERD, BERES E. MUSCHETT, STRATEGIC ADVISORS
A REPUBLICATION OF MS KATHERINE ROSENBURG-DOUGLAS’S STORY AND THE DRUG INDUSTRIAL COMPLEX WHICH WITHHOLDS PAIN MEDICATION PRESCRIBED BY YOUR DOCTOR
A REPUBLICATION OF MS KATHERINE ROSENBURG-DOUGLAS’S STORY AND THE DRUG INDUSTRIAL COMPLEX WHICH WITHHOLDS PAIN MEDICATION PRESCRIBED BY YOUR DOCTOR
Column: Condemn the opioid epidemic, sure. But remember those of us in chronic pain who need help.
CHICAGO TRIBUNE |JUL 12, 2019 AT 7:34 PM
“I broke my back while Rollerblading when I was 21. After three surgeries beginning at age 30, I’ve recovered enough that I’ve gone on to what looks like a normal life. I’m a married mother of twin 4-year-olds, so I am relatively stressed, but fortunately, I’m otherwise relatively healthy.
I’m also on a fentanyl patch delivering slow and steady pain relief to keep me feeling like I can get out of bed, and morphine for breakthrough pain when life requires more of me than merely getting out of bed — and anyone who has ever had a 4-year-old knows each day is far more demanding than that. Just driving my kids to school or sitting for longer than 20 minutes at a time is a struggle.”
Doctors don’t decide if you need it, pharmacists do!!!
Ms. Rosenburg-Douglas writes:
“Last month, I dropped off a prescription before I started work at 7 a.m. on a Sunday, and the pharmacist said she’d need to speak to the doctor so I probably wouldn’t get it until Monday. I had my doctor paged at 6:30 a.m. Agonizing hours passed before I called and pressed for the reason. She told me there were “great distances involved,” between my address, the doctor’s office, and where I was visiting my parents for the weekend — although they’re all about a 45-minute drive, pretty standard for Chicagoland.”
“It’s suspicious,” she said.
“I DON’T FEEL COMFORTABLE”
The previous month a pharmacist told me she wasn’t comfortable with the combination of fentanyl and morphine because, “It’s a lot of pain medicine.”
Joseph L. Webster MD SR., MD, MBA, FACP, BS. PHARMACY:
” It is not the purview nor is the pharmacist trained to ‘challenge the diagnosis of the physician and to do so verbally or otherwise with the patient. It erodes the ‘doctor-patient relationship and destroys the ‘confidence’ of the patient in his/her physician. At the very least it is ‘unethical’ and may very well be a HIPPA violation and beneath the standard of care as a pharmacist.”
“She filled the fentanyl patches but would not fill the morphine. When possible, I’ve used the same pharmacy chain for much of the past 10 years so there would be an easily accessible log of my prescription history, so I implored her to look. She said she had.”
“If anything were to happen to you, I would lose my license, not your doctor,” she told me. I mentioned that without the morphine I’d taken for so long, she was putting me in a more perilous situation than if she did. True, she admitted. “But I have the right to refuse to fill any prescription for any reason, and I choose not to fill this for you.” Then she gave me directions to a rival pharmacy chain’s store.”
THE PHARM.D PHYSICIAN WANT TO BE
‘THE MOST DANGEROUS TYPE OF PHARMACIST’
AND THEIR FAILURE TO UNDERSTAND THE PATHOPHYSIOLOGY OF PAIN
Pain and pain management is a very complex issue. More often than not in chronic (non-acute) pain which is considered a disease, comorbidities need to be addressed. The “uncomfortable pharmacist,” has failed to develop a basic understanding of pain pathophysiology and neuroscience and the basic structures and function of the Nervous System which is a complex structure that coordinates voluntary and involuntary actions by transmitting signals to and from different parts of the body.
The truth is that overprescribing has no definition, is not a medical term, and has not been proven that substance exposure alters any aspect of the “opioid crisis.” In fact, patients on long-term opiate therapy for pain stabilization are the least likely to overdose on their medications.
The practice of the “uncomfortable pharmacist” in withholding treatment of a patient by altering or denying medications is both dangerous and unacceptable in the field of medicine; it has resulted in patients’ suicide.
Richard Lawhern PH.D.___
“Morphine Milligram Equivalent Daily Dose (MMEDD) is not a useful measure in defining limits on opioid dosage, and as such, it has been repudiated by the American Medical Association(AMA). Instead, its major utility is as a rough guide to the clinician in making a safe transition from one opioid to another.”
However, what makes these Pharmacists even more dangerous is their opinions and reasoning are based on the foundation of CDC’s flawed Unscientific Opioid prescribing Guidelines developed under unreliable data. Their maleficence has resulted directly in pain care patients’ suicides and the increased use of illicit counterfeit street drugs.
A PHARM.D PHYSICIAN WANTS TO BE!!
Exposing “The Uncomfortable Pharmacists”
Furthermore, pharmacists’ attitudes have their etiology in a belief that they have a corresponding responsibility which in fact requires them to operate within the field of medicine in giving a second opinion; thus undermining the diagnosis and treatment plan of the prescribing practitioner.
Its origins have further become grounded in positioning hospital medical politics, “power-hungry egos” to elevate the pharmacy profession out from images of just being in the basement of a hospital dispensing and compounding to a clinical role on the healthcare team.
In these cases, the pharmacist acts by using no materials to support their “uncomfortable foundation.”
- The pharmacist does no physical examination on the patients.
- The pharmacist reviews nor orders any lab work.
- The pharmacist reviews nor orders additional radiographs and views no progress report.
- The pharmacist further fails by entering nothing into writing as to the decision of how they determine the prescription(s) to be illegitimate and why they’ve interjected themselves into the practitioner-patient relationship by withholding or denying patients their medications.
“ The American Medical Association strongly supports a pharmacist carrying out his or her corresponding responsibility under state and federal law, but the past few years are rife with examples of patients facing what amounts to interrogations at the pharmacy counter as well as denial of legitimate medications”
JOSEPH L.WEBSTER, SR., MD, MBA, FACP, BS. PHARMACY:
The respective regulatory bodies, including the various “Boards” of Pharmacy, Medicine, Dentistry, Nursing, etc., clearly outline the ‘scope of practice’ for each of those disciplines.
The orderly flow of a prescription “from” the doctor to the patient – via the Pharmacist – clearly outlines where the ‘diagnosis’ has to come from. It is statutorily the purview of the pharmacist to ‘inspect and assure’ that the drug that is being given is safe and has no known incompatibilities with the patient and its holistic environment.
It is not the purview, nor is the pharmacist trained to ‘challenge the physician’s diagnosis and to do so verbally or otherwise with the patient. It erodes the ‘doctor-patient’ relationship and destroys the ‘confidence’ of the patient in his/her physician. At the very least it is ‘unethical’ and may very well be a HIPPA violation and beneath the standard of care as a pharmacist.
Any healthcare provider that is licensed to ‘prescribe’ is governed by the set of conditions and circumstances under which a prescription can be written.
Thus it is illegal to prescribe for a person that the prescriber has not conducted the ‘chain of authority that would qualify them to write a prescription: history and physical examination, formulation of a diagnosis, and discussing such with the patient as well as the proposed manner of treatment in a culturally sensitive and ethically appropriate manner; and provision of an opportunity for the patient to ‘question and discuss alternative forms of treatment; etc.
Once the provider has met all of the aforementioned and other ‘requirements to write a prescription, then and then ONLY should a healthcare practitioner write a prescription. Furthermore, as stated above, a pharmacist IS NOT AUTHORIZED TO WRITE A CONTROL PRESCRIPTIONS by any of the health regulatory boards.
It is my professional opinion that the pharmacist in question had ‘no reason and more importantly the pharmacist had ‘no power’ to question or interrogate each provider on ‘each prescription’ that is received as long as the ‘safety, efficacy and convenience’ of the medications being prescribed meet the standards of Medication Dispensing.
Any given medication can be and certainly will be given for multiple different diagnoses and it is not even feasible for the pharmacist to ‘contact and question’ each and every diagnosis.
The American Medical Association wrote on June 16, 2020:
While the AMA understands that the apparent goal of the Centers for Disease Control (CDC) Guideline was to reduce opioid prescribing, we believe the proper role of the CDC is to improve pain care. Therefore, it follows that a dedicated effort must be made to undo the damage from the misapplication of the CDC Opioid Guidelines.
We are concerned that such a careful approach to identifying the precise combination of pharmacologic options could be flagged on a prescription drug monitoring program as indications wrongly interpreted as so-called “doctor shopping” and cause the patient to be inappropriately questioned by a pharmacist. The AMA strongly supports a pharmacist carrying out his or her corresponding responsibility under state and federal law, but the past few years are rife with examples of patients facing what amounts to interrogations at the pharmacy counter as well as denials of legitimate medication.”
Josh Bloom, ACSH’s Director of Chemical and Pharmaceutical Science:
In today’s anti-opioid climate, a “one-size-fits-all” mindset has become the foundation of government-dictated medicine. And it’s awful medicine. For example, the deeply flawed policies enacted as law all over the country are based on the “one-size-fits-none” concept of morphine milligram equivalents (MME) – the maximum amount of an opioid medication that is permitted per patient per day.
IN FACT, the CDC MME chart, the entire concept of morphine milligram equivalents may be convenient for bureaucrats. Still, because of differences in the absorption of different drugs into the bloodstream, half-life of different drugs, the impact of one or more other drugs on opioid levels, and large differences in the rate of metabolism caused by genetic factors are not only devoid of scientific utility but actually causes far more harm than help by creating “guidelines” that are based upon a false premise. When a policy is based on deeply flawed science, the policy itself will automatically be fatally flawed. It cannot be any other way.
While MME values are touted as useful predictors of the total “opioid load” that a patient can receive, they are nothing of the sort. And MME-based policies don’t just fail because of differences in the size of patients; they fail for multiple reasons.
1. Flawed science yields meaningless results
Morphine is normalized to 1.0 and the conversion factor reflects the relative potency of other opioid drugs. So, if the daily MME – the maximum dose of a drug allowed – is 90 mg. This assumption could not be less accurate. Once we see the profound differences in the properties of the drugs and the difference between individuals who take them it becomes clear that not only is the CDC chart flawed, but the MME is little more than a random number.
2. Not all opioids are created equal, especially in the body
Anyone with even a passing knowledge of pharmacology would immediately be skeptical of data in the chart. Bioavailability. One of the many pharmacokinetic properties required to establish how a drug will fare within the body is called bioavailability – a critical determinant for whether a drug will be effective if taken orally.
3. Bioavailability is a measure of how well a pill will be absorbed in the gut and subsequently enter the bloodstream.
4. Half-life and metabolism
Although critical, bioavailability is far from the only measure of an oral drug’s effect on people or animals is primarily metabolized by two different cytochrome P450 enzymes called 3A4 and 2D6.
The difference in metabolizing enzymes itself is a substantial concern when comparing two different drugs, but it becomes even more so when other drugs are part of the picture. The only certainty is uncertainty
“NOT AT WALGREENS”
THE RED FLAG – Distance
The DEA has developed criminal elements of free commerce by criminalizing distance travel as an element of criminal conduct. Whereby a pharmacist is a licensed practitioner who has advanced knowledge of the chemical-physical properties of medications, mechanism of actions, their dosage forms design, will likely not refer to GOOGLE MAPS as an element of patient treatments.
More dangerously, as a result of the DEA’s aggressive policing of community pharmacies many are reluctant to fill any legitimate narcotic analgesic medication prescriptions for non-acute pain patients.
In the exploring role and purpose of the DEA that acts as an unregulated medical agency policing the medical profession without legal standards and grounds.
The DEA Diversion Investigator claims in arbitrary reasoning; their actions are based on factors applied that “traveling long distances to fill prescriptions can be a red flag of abuse and diversion if a patient travels a significant distance to a particular pharmacy.
Some patients are known to spend days on end looking for a pharmacy to fill their prescriptions to no avail. This has caused massive concerns in the chronic pain disease medical/dental community, where one of the most important goals of any therapy is continuing staple treatment without disruptions.
It is well understood amongst medical/dental practitioners when disruptions in therapy occur, many of the deleterious effects are likely to happen. For example, patients diagnosed with Sickle Cell Anemia are many times profiled as addicts, rather than as persons with a chronic disease condition needing treatment for pain.
Other examples include persons who have survived traumatic accidents such as automobile accidents, gunshot wounds (civilian and military), notwithstanding leukemia, and other cancers.
Indeed, pain management becomes even much more difficult when anxiety and diminished mobility complicates the treatment plans.
Further, it is well understood, when both medical/dental practitioners and patients can locate a Pharmacy that will fill pain control prescriptions with dignity and respect, both parties will often share that information with others.
Pain you can’t see
Ms. Rosenburg-Douglas further wrote:
” I have a number of diagnoses. Failed back syndrome, a medical term that means just what it says and suggests surgery didn’t help. A “bone stimulator” was implanted during one surgery to encourage growth between pieces of cadaver bone and my own vertebrae, but too much bone grew in around my sciatic nerve, giving me sciatica, or a burning sensation from my rear down my left leg to my toes, which often are numb and tingling (I take another medication for nerve pain).
My left leg has so much atrophied muscle that it drags behind my right and I had a pronounced limp, but the fentanyl patch largely has eliminated that by providing more steady pain relief. I am disabled, but no longer outwardly appear so, which, along with my age, probably accounts for the daily dirty looks people shoot me when I park in handicapped spaces.
I understand why police, politicians, and many doctors want to combat the opioid epidemic, but I’m tired of people throwing around that term and lumping me in with a group of drug abusers.
I support the spirit behind their efforts, but can’t support any more regulation on controlled substances. We have now overcorrected, and anyone who requires pain medicine is looked upon as a criminal.
It was once hard to imagine being in more pain than I am, but the current regulations added a new layer of suffering. Please remember opioids exist for a reason and don’t let it get any more difficult for those already in agony”
FOR NOW, YOU ARE WITHIN