Pharmacies at least partially responsible for opioid problem

Ohio jury has found that pharmacies Walgreens, CVS and Walmart are partially responsible for the opioid problem. Apparently, they should have done more to slow the flow of pills.

So, now pharmacies get to weigh in on your prescriptions? You go to the doctor, get a diagnosis and prescription and go to the pharmacy to get it filled. The pharmacy can just refuse to fill it? Then what do you do? Do you have to spend more time and effort going back to the doctor?

I don’t see how the pharmacies are responsible if they were not doing anything illegal.

They weren’t sued for filling prescriptions

The state’s lawsuit said the companies “consistently failed to comply with their federal, state and common-law obligations, despite knowing that their failures have led to prescription opioids being diverted from the legitimate supply chain to illegitimate channels of distribution and illegal, non-medical use.”

From the link:
Attorneys for the counties say the businesses failed to stop unusually large shipments of opioids — and those that were too frequent or broke from standard patterns from the companies’ distribution centers to their affiliated pharmacies.

I don’t see how they would be expected to judge what broke a standard pattern or was too frequent. Do the courts expect the pharmacies to cause people to continue in pain because some users abuse the distribution system? Has it been insinuated that more pills than were prescribed were sent to pharmacies to be sold illegally?

What there should have been was mandatory reporting requirements: for example pharmacies would report how many prescriptions each doctor prescribed and what percent of their total prescriptions were controlled substances to the DEA and the DEA would calculate overall statistics to find which doctors were the high opiate prescribers across different pharmacies and the DEA and local law enforcement would investigate.

Since pharmacists lack patients’ medical records and lab tests they really can’t determine if an individual patient is deserving of controlled substances and lots of prescriptions for a certain doctor could simply indicate a doctor specializes in certain types of patients.

IIRC, there’s some duty on the part of pharmacists to verify the prescriptions if they seem suspicious or out of the ordinary in terms of the recommended dosage, duration or frequency.

All that stuff is published and known to doctors and pharmacists. For example, one Norco every four hours for pain for a relatively short period would be reasonable, but 5 every 2 hours for months should raise the pharmacist’s eyebrows and have them verifying that prescription with the doctor, as I’m pretty sure that if that’s not an overdose, it’s pretty close. And probably shady as well.

As an example of how the pharmacies should have been aware that something was going on, here is an article from The Guardian about a couple of pharmacies in a West Virginia town of 3000 or so that were dispensing millions of opioid pills.

Agreed. 3 every 2 hours for norco is definitely an overdose. Before a patient reaches that point, they should be on some kind of other narcotic that doesn’t have acetaminophen mixed in with it. In my practice patients that reach that point are usually those on hospice, typically with pain from cancer. There’s a few others (failed back surgeries, severe arthritis, multiple major fractures, etc.) but that makes up the bulk of such narcotic use in my personal experience.

ETA. I could have sworn that 5 was a 3 when I started my reply :stuck_out_tongue_winking_eye:

I don’t know if that’s as much a case of being unaware, as much as it’s collusion with the prescribing doctors.

Pharmacists have a non-trivial role to play in this kind of thing. They’re not just pill-counters- they understand the pharmacology and interactions between drugs as well if not better than doctors do, and are qualified to actually compound medications as part of their professional training- say for some weird reason, a small child needs high blood pressure medication. That would be something that is not likely to be produced in child dosages, or in liquid form. The pharmacist would get to work preparing a liquid form of it in the appropriate dosage for the child. So they’re well aware of how these drugs interact with each other, etc… and should be aware if suddenly they’re getting a weird pattern of prescriptions for certain kinds of drugs (i.e., controlled substances) from specific doctors.

Now I don’t know what their professional obligations are- maybe the state didn’t require them to report stuff like that. But that doesn’t really matter in civil court; they can have some degree of liability assigned based on professional ethics, or whatever.

I watched Alex Gibney’s The Crime of the Century a little while ago. One of the stunningly cynical bits of corporate greed that stuck with me was committed by Cardinal Health. In response to being prevented by the DEA from continuing their uncontrolled, illegal distribution, they simply had the politicians that they finance pass legislation making it impossible for the DEA to close them down.

I take Tramadol for ankylosing spondilitis.
My Rheumatologist retired. A general practitioner cannot prescribe opiates in Arkansas. It was a scramble to find another Rheumatologist before my prescription needed to be refilled. It really sucks to wake myself up screaming. It would seem to lower the number of opiate prescriptions and cause Rheumatologists to dispense a suspicious amount of them. Are there similar laws in other states?