The article “70M pain pills dispensed from 2006-12” (Times Standard, July 19, Page A1) requires more in-depth discussion because on its surface, it makes a number of the pharmacies listed in the article appear to be rogue “pill mills.” As one of the owners of the pharmacies listed in this article (Cloney’s), I can tell you that when looking at opioid dispensing data, one must look at it as a percentage of overall prescription volume dispensed by the pharmacy. Green’s Pharmacy, like Cloney’s, was and is one of the busiest pharmacies in Humboldt. On any given day, these pharmacies are dispensing hundreds of prescriptions. If the percentage of opioids dispensed represented, say, 50% of all prescriptions dispensed by the pharmacy, this would be a significant red flag. But this simply isn’t the case. A “pill mill” is something like what I saw in Florida circa 2007-2009, where a pharmacy down the street from where I worked dispensed over 245,000 Oxycodone 30mg tablets to a single patient in a 13-month period. Nothing like this, to my knowledge, was happening in Humboldt County during the 2006-12 time period or since.
We must also examine the culture and attitudes that were prevalent during the time period of the early to mid-2000s. When I first started my career as a pharmacist in 2004 in Florida, it was common for patients to frequently come in with questionable opioid prescriptions and threaten to sue me if I didn’t fill them. “Who are you to question the doctor?” and “It’s your professional responsibility to ensure I live pain-free” were common statements often yelled toward me from patients on the other side of the counter. (I can only imagine what the doctors were going through in their offices. I suspect many prescriptions were written either out of fear of retaliatory litigation, or simply to get persistent, raging patients out of their offices). I may not win popularity points for saying this, but perhaps patients need to do a little self-reflection and accept some personal responsibility for the situation they may be in. I’ve had two knee surgeries in my lifetime: in 1994 I was prescribed 20 tablets of Tylenol with codeine post-op. My parents still have the partial bottle lying around their house. In 2002 I was prescribed 50 tablets of Percocet post-op. I used 10 and discarded the rest. At no time prior to those surgeries did I take opioids for pain relief. Living pain-free is unrealistic, in my opinion. Medication should be only one facet of pain relief. Lifestyle changes can factor heavily into pain management in many cases.
During the early to mid-2000s, drug company reps would frequently visit doctor’s offices and pharmacies and inundate us with faulty data regarding the safety studies they performed on their products. By the time I arrived in Humboldt County in 2010, the opioid crisis, as it were, was in full swing. Four months after I arrived, our store was robbed for OxyContin twice in one month at gunpoint, after which we stopped dispensing it. I’m guessing the “safety studies” didn’t take into account the safety of pharmacy personnel who were literally on the front lines of the opioid battle.
Since then, a number of things have changed: The California Substance Utilization Review and Evaluation System (CURES) was implemented, allowing doctors and pharmacies to see exactly when and where patients are filling controlled substance prescriptions. “Doctor shoppers” are now easy to detect. Suboxone programs have been growing, which treat opioid addiction while also allowing for pain control. At Cloney’s, a number of our pharmacists have come together and implemented a program whereby we document and track patients prescribed controlled substances, and work with doctors’ offices to wean people off of these medications. It will take time, but I think we will be able to help reduce the amount of opioid consumption in our county. But it will also require buy-in from doctors and patients as well. Change will be difficult, but if we all work together we can overcome this particular problem.
John Backus is owner/partner of Cloney’s Pharmacy, Inc.