US opioid epidemic: it’s harder to get the painkillers I legitimately needBMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j784 (Published 15 February 2017) Cite this as: BMJ 2017;356:j784
- Kelly Young, president, Rheumatoid Patient Foundation, Cocoa, FL, USA
The crackdown on misuse of prescription drugs has had unfortunate consequences for people with legitimate needs in the US. Stricter laws have made access to controlled medications more difficult. Patients wonder whether restricting their access is necessary to reduce illicit drug use when the misconduct of physicians running for-profit “pill mills” has been responsible for most misuse.1
In 2011 my doctor was no longer allowed to order my prescription electronically; instead I had to carry it to the pharmacist. Soon after, my regular drive through pharmacy insisted that I come inside the store with identification. These were minor inconveniences, but everyone acted more cautiously.
The next indication that Florida’s climate had changed was more disturbing. At my sixth appointment for spinal radiofrequency ablation, I asked a nurse for a refill of the muscle relaxer that my doctor had prescribed for several years for my neck. She snarled, “How dare you risk the doctor’s licence! She’d never write that prescription if she wants to keep her job. And you shouldn’t ask.”
I was dumbfounded. When rheumatoid disease inflames my neck joints, I can barely raise my head. However, medication, along with anti-inflammatories and ice packs, allows me to function. I need this medicine only a couple days a month. I used it as directed and kept the bottle locked in a medication safe. Although I had not done anything wrong, I felt embarrassed.
In 2014, Florida began a severe crackdown on painkillers. I encountered pharmacist technicians afraid to handle my prescriptions. They insisted I deal with the pharmacist in person and refused to tell me whether my prescription had refills. They refused to transfer a controlled prescription when I moved to another county even though all my others were transferred.
There have been times that people have humiliated me in their attempt to comply with the law. One practice I had never visited before demanded I urinate in a cup on arrival. I knew it was unwarranted because I had no prescriptions there, so I refused. Once I told an intrusive pharmacy technician, “You have no idea why I need that medicine. It’s not your role to approve or disapprove.”
Messages other patients sent to me corresponded with tragic stories on local television news about people living in terrible pain. People could no longer get their prescriptions from their doctors but were forced to visit specific pain clinics, an added expense for people with chronic diseases who already pay high costs. Prescriptions were limited to 30 days, requiring additional visits for refills.
I have also witnessed the destruction of prescription misuse in a friend. People certainly use lies, doctor shopping, and multiple pharmacies to game the system. But a single doctor wrote most of the prescriptions for my friend, even after several involuntary psychiatric hospital admissions and encounters with the authorities. None of the humiliations that I have experienced would have prevented my friend’s prescription misuse.
In most US locations, all prescriptions are held on an electronic list, and doctors can refuse to prescribe anything beyond limits. As someone with many prescriptions, I have been confronted with this list repeatedly. I wonder why my friend was not.
People like me with complex chronic medical conditions have legitimate need for long term prescriptions for controlled medications. Patients need not be harmed by reasonable measures to prevent medication misuse. Patients are not harmed when illegitimate pill mills are shut down, such as in Florida’s crackdown. However, creating an atmosphere of fear among pharmacists and medical professionals can harm patients without having any effect on the conduct of irresponsible prescribers.
Competing interests: I have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.
Provenance and peer review: Commissioned; not externally peer reviewed.