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In September, one of the country’s largest prescription providers, CVS Health, announced its plan to combat the epidemic of fatal opioid overdoses. According to the National Institute on Drug Abuse, nearly 65,000 people died in 2016, largely because of prescription painkillers and fentanyl-laced heroin.
To put the opioid-related death toll in perspective, more Americans died in one year from overdoses than the whole of the Vietnam War.
“The opioid epidemic touches all of the communities we serve, and as a pharmacy innovation company, we are in a unique position to make a difference,” reads CVS Health’s statement.
How Will CVS Limit Prescriptions?
With the goal of ensuring prescription painkillers are dispensed according to guidelines set by the Centers for Disease Control and Prevention (CDC), CVS is taking the following actions:
- Keeping certain acute prescriptions to a seven day supply
- Limiting the daily dosage of opioids dispensed based on the strength of the medication
- Mandating the use of immediate-release formations before extended-release opioids are approved and dispensed
Larry Merlo, the CEO of CVS, told USA Today that pharmacists had routinely been asked to provide 30 to 60 day supplies of the powerful, potentially addictive painkillers, for conditions that shouldn’t require that many pills.
“We see that all too often in the marketplace, and we believe it’s appropriate to limit those prescriptions to a much more moderate supply. We think this can help make an impact,” Merlo said.
This is not the first time pharmacies have tried to curb the opioid crisis by participating in diversion plans.
What Other Methods are Used to Control Opioid Prescriptions?
Nearly every state in the U.S. participates in the Prescription Drug Monitoring Program, a database of that’s supposed to notify doctors and pharmacists if a person is “doctor shopping,” which means getting the same prescription from several different doctors.
One of the challenges with that program, however, is getting physicians to use it.
Yet, another pharmacy-targeted approach is electronic prescriptions or E-Rx. In theory, this approach, which allows physicians to digitally generation prescriptions, should curb fraud by creating a digital trail for pharmacists, doctors and investigators.
Though, some worry that lax internet security could allow expert hackers access to patient information and even lead to counterfeit prescriptions.
Problems With Limiting Access to Opioid Prescriptions
The move to limit the amount of opioid painkillers CVS dispenses came under immediate fire from chronic pain patients, who feel the company is overstepping the doctor-patient relationship.
In response, CVS told the Pain News Network that the company understands “there are patients with a legitimate need for pain medication and our approach is carefully designed to ensure that those patients can access their medication in an appropriate manner.”
Ensuring Patient Access and Effective Drug Enforcement Act
Totally ignored in CVS Health’s announcement are the company’s lobbying efforts in Congress to ease opioid regulations. According to an explosive investigative report by the Washington Post, pharmaceutical companies spent in excess of $100 million in their own interest. CVS, for its part, contributed $32.5 million, according to public records.
One outcome of these lobbying efforts allowed the Ensuring Patient Access and Effective Drug Enforcement Act, which make it virtually impossible for the Drug Enforcement Administration to track suspiciously large shipments of opioids to pharmacies.
“The drug industry, the manufacturers, wholesalers, distributors and chain drug stores, have an influence over Congress that has never been seen before,” Joseph T. Rannazzisi, former chief of DEA’s office of diversion control, told Washington Post reporters.
Pros and Cons of Restricting Opioid Prescriptions
The epidemic of addiction to opioids and heroin in the United States is, perhaps, the most insidious and complex public health crisis in the nation’s history. CVS Health’s well-intentioned plan to limit and monitor opioid prescriptions might make a dent in slowing the problem.
Others, however, suggest limiting a patient’s supply of needed painkillers might drive them to the street where they can purchase cheaper drugs that are far more dangerous. Some healthcare advocates also believe there will be little to no change unless the for-profit model of pharmaceuticals is amended.