Just how much the federal government prioritize drug control over patient care? This much:
Federal authorities have expanded their crackdown on painkiller abuse, charging a major health care company and two CVS pharmacies in Florida with violating their licenses to sell powerful pain pills and other drugs.
The Drug Enforcement Administration linked Cardinal Health to unusually high shipments of the controlled drugs to four pharmacies.
On Friday, the DEA suspended Cardinal’s controlled substances license at its Lakeland, Fla., distribution center, which services 2,500 pharmacies in Florida, Georgia and South Carolina . . .
In its suspension order, the DEA alleges that Cardinal knew or should have known that the four retail pharmacies had purchased far more drugs than it needed to fulfill legitimate prescriptions.
The company called the DEA action a “drastic overreaction” that would disrupt delivery of critical medications to hospitals and pharmacies.
A judge has since temporarily stopped the suspension, pending a hearing.
But think about what the DEA is trying to do, here. They’re attempting to interrupt the treatment of thousands of patients served by 2,500 pharmacies because the wholesaler that supplies controlled drugs to those pharmacies is accused of inadequately policing the actions of four of those pharmacies. And the patients that would have been affected here aren’t just pain patients.
But the effect of actions like this going forward may be worse than the actions themselves. The DEA has forcibly deputized every actor in the manufacture and distribution of these drugs to police everyone else. And they risk severe civil, even criminal, repercussions if the agency determines they’ve done so with insufficient vigor. If you want to survive, you always err on the side of control.
So if you’re a wholesaler, and you have the tiniest of suspicions that a pharmacy is dispensing more of a controlled drug than the DEA thinks it should, you cut off supply, or you risk losing your license. If you’re a pharmacy, and you have the faintest hunch that a patient may not be legitimately in pain, or is getting more pain medication than he needs, or that a particular doctor is writing more prescriptions for a controlled drug than the DEA thinks he ought to, you refuse to fill the prescriptions, at risk of both losing your livelihood as a pharmacist, but also possibly your freedom. If you own a pharmacy, and you suspect one of your pharmacists is insufficiently suspicious of pain patients and pain prescriptions, you fire him, or you risk losing your business. And finally, if you’re a doctor, and you suspect any of your patients have a substance abuse problem, or that they aren’t in as much pain as they claim, you turn them down. Actually, it’s worse than that. It doesn’t really matter what you think as a doctor. What matters is what the DEA thinks of the decisions you make. So your job is not to administer the treatment you believe is appropriate, your job is to anticipate what treatment the DEA will think is appropriate, and deviate from that treatment at your peril.
At each step in the process, the incentives are structured to induce fear, suspicion, and mistrust of the other players in this mess. The interests of patients are way, way down in the ordering of priorities.