DEA crackdown hurts nursing home residents who need pain drugs

[phr]

DEA crackdown hurts nursing home residents who need pain drugs
Carrie Johnson
Washington Post
10.29.09


Heightened efforts by the Drug Enforcement Administration to crack down on narcotics abuse are producing a troubling side effect by denying some hospice and elderly patients needed pain medication, according to two Senate Democrats and a coalition of pharmacists and geriatric experts.

Tougher enforcement of the Controlled Substances Act, which tightly restricts the distribution of pain medicines such as morphine and Percocet, is causing pharmacies to balk and is leading to delays in pain relief for those patients and seniors in long-term-care facilities, wrote Sens. Herb Kohl (D-Wis.) and Sheldon Whitehouse (D-R.I.).

The lawmakers wrote to Attorney General Eric H. Holder Jr. this month, urging that the Obama administration issue new directives to the DEA and support a possible legislative fix for the problem, which has bothered nursing home administrators and geriatric experts for years.

The DEA has sought to prevent drug theft and abuse by staff members in nursing homes, requiring signatures from doctors and an extra layer of approvals when certain pain drugs are ordered for sick patients.

The law, however, "fails to recognize how prescribing practitioners and the nurses who work for long-term care facilities and hospice programs actually order prescription medications," Kohl and Whitehouse write. They conclude that delays can lead to "adverse health outcomes and unnecessary rehospitalizations, not to mention needless suffering."

Most nursing homes do not have pharmacies or doctors on site, adding to delays for patients who fall ill late at night or in transition from a hospital.

Justice Department and DEA officials had no immediate comment. The DEA sent out guidance last summer in response to some of the pleas, but it did not resolve the central issue of whether a nurse could serve as an agent of a doctor and administer pain medication with a verbal directive rather than a written prescription from a doctor.

The problem took on new urgency this year after the drug agents heightened their enforcement of the rules at pharmacies in Ohio, Michigan, Wisconsin and Virginia. The pharmacies face tens of thousands of dollars in fines if they deviate from strict controls that require doctors to sign paper prescriptions and fax them to a pharmacy before a nurse can administer them in the nursing home setting.

"The system is broken. It isn't working, and patients are suffering," said Claudia Schlosberg, director of policy and advocacy for the American Society of Consultant Pharmacists. "While we need to ensure there are proper controls on the medications, the overall law enforcement concern has to be compatible with meeting patients' needs, and right now it's not."

Doctors in nursing homes say the restrictions do not take into account that many more patients, with higher levels of illness and pain, are moving into long-term-care sites and out of hospitals.

William Smucker, medical director of the Altenheim Nursing Home in Ohio, said that the "delay is not what I would want for myself or my family, and it's not the way I practice in other settings."

Terence McCormally, a doctor who cares for patients in nursing homes in Northern Virginia, said the tug of war reflects "the tension between the war on drugs and the war on pain."

"For the doctor and the nurse, it's a nuisance," he said, "but for the patient it is needless suffering."

Link!

 

[Selfmeditaker]

disgusting. this is what the war on drugs is doing. my god, hospice patients are having a hard time getting their pain meds?! these people are dying from some of the most painful diseases and they cant get the adequate treatment that they deserve as well as need. jesus christ im at a lost for words reading that article. even thoe i know it happens....

 

[pukingcells]

Oh.. Please, DEA, save me from myself... I might ingest somethin that actually helps me....

It is really sad that they have more power than any other governmental agency and for what?? To save us from ourselves?

 

[stirfry]

disgusting. this is what the war on drugs is doing. my god, hospice patients are having a hard time getting their pain meds?! these people are dying from some of the most painful diseases and they cant get the adequate treatment that they deserve as well as need. jesus christ im at a lost for words reading that article. even thoe i know it happens....

I agree, the situation is totally ridiculous. My mother was a hospice home care nurse in a somewhat rural area for many years. under the law, if she were to pick up a controlled substance and deliver it to a patients house, she would be committing a felony crime, as would the pharmacist who dispensed it. Even though it's her job to administer those exact medications, and they are legitimately prescribed, she and the pharmacist would be guilty of delivery of a controlled substance.

It's sick to think that she and the pharmacist (obviously they were close and trusted one another) actually took this risk, on more than one occasion, just to do the humane thing and bring a suffering patient the pain medication they needed to ease their suffering in their last days of life.

I try not to be vengeful, but I actually hope the a-hole narcs and politicians who created this situation get cancer and have to die in agony, because they can't get adequate pain medications.

 

[drug_mentor]

This is ridiculous, its so fucked that they would rather have all these people suffer just to make it a little harder for recreational drug users to get pain pills. What do they really achieve with these controls from the standpoint of recreational drug use anyway? Make people pay more for pain pills and lead to increased crime, make people more likely to turn to heroin which isn't quality controlled but there is an ednless supply. They are so fucking ignorant, they will never make any difference on opioid abuse so why the hell make dying people suffer without their medication?

 

[Huaca]

Fucking DEA. Keeping pain killers away from sick or dying people is a sin. What do we need the DEA for anyway? For sure that agency only exists to harm people.

 

[jspun]

With adequate pain relief. I examined the issue. The attitude on pain management as a whole goes in cycles. My theory- and this is not just in the US but this country has always historically seemed especially prone to drug hysteria. A new pain med is in the pipeline. Good evidence based practice shows that peoples pain is poorly managed. Many studies are funded to prove the point, it becomes a major issue- maybe the topic of the keynote speaker at a medical conference for the American Academy of Internal Medicine or name your proffessional organization. This "new philosophy on pain managent" finds it way into medical school lectures, nursing school curiculums, hospital advanced practice counsels - that set policies, procedures, protocals for hospitals. Newsweek runs story that Americans are undertreated for pain.

News slow. Some high profile jackass overdoses. Patent running out. Federal agencies need additional funding. Drug panic in the suburbs- yesterdays wonderdrug is todays menace- litteraly. People with no training in medicine create severe restrictions that effect patient care, outcomes, patient satisfaction, overall create a clusterfuck in the real world. Its funny, how the hysteria you hear about is usually after alot of drug companies have juiced that particular drug for alot of profits- not to be a conspirary theorists, but maybe some of this is meant to clear the way for another new profitable brand name drug. At any rate, I could pull out examples from drugs stretching back to Heroin to various different hypnotics or stimulants, all the way to Oxy and Opana. Always better, less abuse potential, sometimes same evil drug released under new name and indication. The past is prologue

William Smucker, medical director of the Altenheim Nursing Home in Ohio, said that the "delay is not what I would want for myself or my family, and it's not the way I practice in other settings."

Terence McCormally, a doctor who cares for patients in nursing homes in Northern Virginia, said the tug of war reflects "the tension between the war on drugs and the war on pain."

"For the doctor and the nurse, it's a nuisance," he said, "but for the patient it is needless suffering."

However, its nice to see from this article that some patient advocacy is being done by some lawmakers- and the press are listening to the voices that actually work in that setting day to day.

In San Diego, one of the hospitals has a pain pharmacist that is able to titrate pain meds for patients with complex pain issues- this is the type of progress you see when evidence based practice is implemented- and wins out over bureacratic bullshit and institutional myopia.

Elderly people from the Golden Generation that made alot of the freedoms the narcoswine and other enemies of liberty and democracy get to enjoy possible- get repaid for their sacrifice- through needless suffering and substandard care.

By the way, on the topic of diversion, the drugs in the hospital suck by comparison with the drugs on the street- here locally, and would still be less of a hassel to obtain on the streets than in the hospitals- even if the DEA gave healthcare providers more breathing room than they had 10 years ago. They have failed all around

We still have a long way to go with palliative care/ comfort care at the end of life. I started a thread in OD regarding an old formulation called "Brompton's Cocktail." Brompton's. I included this for historic reasons. To get info anecdotally to see if cocaine has any central (apart from local anaesthesia properties), to initiate a debate that drugs of abuse that have gone into disfavor in medicine might have an important role in palliative care. To make people aware of the little known fact that amphetamines potentiate opiate analgesia, decrease sedation allowing lower effective doses to be used and counteracting alot of the profound sedation of a really effective dose. Morphine Gtts aren't a bad way to go based on my experience but I think there might be better alternatives that should atleast be explored with an open mind.

stirfry: I try not to be vengeful, but I actually hope the a-hole narcs and politicians who created this situation get cancer and have to die in agony, because they can't get adequate pain medications.

I was reading a book that mentioned the memoirs of Hairy Ass-slinger, the first administrator of the forerunner to the DEA (FBN?). Anyway, he jailed many ethical physicians for Rx narcs to patients in the course of their proffessional duties to make examples of them. However, he apparently admitted in his memoir that one prominent senator (rummored to be the facist Sen. Joseph McCarthy, no less), was addicted to morphine and when Aslinger found out he aranged that McCarthy or who ever it was was to receive narcotics from a pharmacy just outside DC. No wonder he and his budy Hoover had such staying power- they had a talent of getting people in compromising positions.

Karma- I hear you my friend. I have that fantasy too- get a taste of their own medicine, or lack of- but I'll settle that generation of heroes that's reaching its twillight continue to live, and when its God's time, die with a little dignity that they more than deserve.