The DEA and Oxy Madness

With the ongoing Oxycontin (a brand name version of oxycodone, a narcotic painkiller) madness continuing in Georgia and nationwide, now seems as good a time as any to write about the DEA's newsmaking efforts this year.  Eariler this year (http://www.reuters.com/article/2012/02/06/us-dea-raids-idUSTRE8151NA20120206) two CVS pharmacies were raided for filling an exorbitant number of oxycodone prescriptions, and the article also mentions briefly the Cardinal distribution center the DEA had shut down earlier that week.  I don't have a problem with the DEA attempting to rein in pharmacies that are ignoring obvious forgeries and otherwise not making any effort to assure prescriptions are legitimate.  However, I do think it is a slippery slope to expect pharmacists to be able to spot whether each and every prescription is somehow justified beyond being a legal prescription drug order.

More than just checking with the physician and documenting these steps to confirm a legitimate prescription, it seems the DEA would like pharmacies to second-guess prescribers and patients as to whether they actually need the medication.  Well, actually, the DEA would like pharmacies to simply voluntarily cut the supply of painkillers, particularly Oxy, because then the DEA wouldn't look as foolish for their inability to control Oxy's widespread abuse.  So far, the DEA has proven incapable of stopping the flow of Oxy at its source, the physicians running the pain clinics and pill mills.  Moving downstream and targeting pharmacies won't have much of an impact if the dam's gates are still open.  The Oxy scripts are still out there, so they will just move to a different pharmacy.  And who gets left out in the cold in this ambush?  Those with actual chronic or acute pain that would be well served by the strong pain control an opiate like oxycodone provides.

A Cardinal distribution center in Florida (Cardinal being one of the major pharmaceutical drug distributors in the US) was raided and, at present, cannot ship controlled substances.  Perhaps the DEA viewed this as moving up the supply chain: going from the corner dealer (retail pharmacy, e.g. the raided CVS's) to their supplier.  However, the pharmacies that this distribution center supplied will now have to be served by another distributor in order to even fill their elderly patients' sleeping pills.  Another distributor will step in to fill the legitimate need for controlled medications, even if they are wary of the DEA with regards to narcotics.

But won't the distributors heed the message and simply drastically cut down deliveries of Oxy to pharmacies?  Possibly. Oxycontin/oxycodone does typically get filled initially at retail pharmacies before entering the black market; so you can theoretically cut off the black market by either shrinking the Oxycontin/oxycodone supply to pharmacies.  Or, you can reduce the amount of prescriptions written for Oxy by quack prescibers in pill mills.  But the first option harms actual patients and drug abusers indiscriminately.  The second option, targeting prescribers with harsh actions such as revoking medical licenses for proven abuses, disproportionately affects those attempting to fill prescriptions to resell illegally.  Which option do you think the DEA should be focusing on?