CVS, Walgreens, and WALMART found responsible for the opioid crisis

[ornithoptor]

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Ohio jury finds pharmaceutical chains responsible in precedent-setting opioid suit

A jury in Ohio ruled Tuesday that three major pharmaceutical chains bore responsibility for the opioid epidemic in two Ohio counties.

www.cnn.com

Another headwind for the retail pharmacies. I Guess CVS, Walgreens and Walmart will have to come up with some money to pay the fines and find ways to shift responsibilities to practicing pharmacists with policy and operation changes down the road.

I disagree with the verdict myself. I think personal responsibility, accountability and free will are to be emphasized. (Maybe the judge will set the fine to be a dollar only.) At the same time, I think that our profession is to protect the public regardless of the pressure from DM, providers, or even customers themselves.

Few questions for my peers at the forum.

Do you agree with the verdict?
What changes will the big three implement?
Do you expect them to cut positions or reduce salary to maintain pharmacy margin?
Will the plaintiff go after individual pharmacist next?
Do you think this verdict support the narrative that pharmacists need more autonomy and the ability say no customers. In another word, this is actually a victory for pharmacists?

Have a great Thanksgiving!

 

[projektreverb]

I didn’t read the full article but I’m shocked Walmart was lumped into this. I thought they managed their opioid dispensing pretty well based on what I’ve read?

 

[JustFillIt]

Expect swift retribution to be executed upon the pharmacists by the corporate overlords who would take zero responsibility for the conditions which have been created in retail pharmacy.

Don’t expect for a second that the business or senior leaders to take the financial hit - instead the pharmacist will have decreased pay, benefits, and further hour cuts for the total team to make up for this loss. They have a gravy train to keep gassed up and this better not slow things down.

 

[watchfulwaiting1957]

I didn’t read the full article but I’m shocked Walmart was lumped into this. I thought they managed their opioid dispensing pretty well based on what I’ve read?

I think some Walmart pharmacies are now refusing discount cards like GoodRx for opiates but it's too little too late as far as the trial goes. Overall I doubt whatever fee they have to pay will be significant to these corps. They are fortune 500 companies after all. CVS is trying to become more of a "HEALTH HUB" so I think they will be hiring psychiatrics and maybe have the pharmacists doing more billable stuff like PPDs in the future.

Do you agree with the verdict? YES
What changes will the big three implement? Give lip service to being more strict with opiates. probably no real change besides making sure there are ICD10 codes on more opiate scripts.
Do you expect them to cut positions or reduce salary to maintain pharmacy margin? No
Will the plaintiff go after individual pharmacist next? No. I mean they could go after me but I have little assets and like $180,000 debt so it wouldn't matter anyway.
Do you think this verdict support the narrative that pharmacists need more autonomy and the ability say no customers. In another word, this is actually a victory for pharmacists? Interesting view point. im unsure

 

[JustFillIt]

Do you think this verdict support the narrative that pharmacists need more autonomy and the ability say no customers. In another word, this is actually a victory for pharmacists?

Until we stop getting shamed on social media with mindless mob support for enforcing reasonable fill date limits and refusing duplicate therapies. Compound that with the fact that we can expect zero support from our employers when this does happen.

Until this culture ends - this “autonomy” we have to prevent this from happening will not change at all.

 

[VA77]

If they try to push back on pharmacists, then I will stop filling opiates. Walmart already stopped phenergan/codeine so I expect the snowball to grow.

This is my favorite quote from the trial.
"They didn’t hire enough pharmacists and technicians or train them to stop that from happening and failed to implement systems that could flag suspicious orders, Lanier said."

I wonder how many former pharmacists would be HAPPY to testify to this at the appeal

 

[mentos]

What about the prescribers? The ER hands out Percocet like candy. I called an ER doc one night and asked why customers kept coming in one after another with the same Percocet script. His response was "I'm just a cog in the machine".

Dentist order sets for wisdom teeth are 7 day supply of Norco, ibuprofen 800mg and amoxicillin. Half the customers don't know they got an Rx for a narcotic and refuse it. Before I knew anything about pharmacy, I had my wisdom teeth taken out and took one Norco and passed out. No one explained to me what I was taking. I threw the rest out.

 

[JustFillIt]

No

What about the prescribers? The ER hands out Percocet like candy. I called an ER doc one night and asked why customers kept coming in one after another with the same Percocet script. His response was "I'm just a cog in the machine".

Dentist order sets for wisdom teeth are 7 day supply of Norco, ibuprofen 800mg and amoxicillin. Half the customers don't know they got an Rx for a narcotic and refuse it. Before I knew anything about pharmacy, I had my wisdom teeth taken out and took one Norco and passed out. No one explained to me what I was taking. I threw the rest out.

You know what drove me nuts. We had a dentist office in town that would prescribe Norco 10 #10 1-2 q8h for just about EVERYONE that had any sort of dental work.

Inevitably, I would get the patients that just picked up #120 oxy 30 just 5 days ago and would want to fill the Norco rx.

Obviously I would refuse the Rx and the patient would show up and throw a massive fit saying - “but this is for the tooth pain!! My oxy treats my back pain!”

😑😑😑😑😑 🤯

 

[VA Hopeful Dr]

No



You know what drove me nuts. We had a dentist office in town that would prescribe Norco 10 #10 1-2 q8h for just about EVERYONE that had any sort of dental work.

Inevitably, I would get the patients that just picked up #120 oxy 30 just 5 days ago and would want to fill the Norco rx.

Obviously I would refuse the Rx and the patient would show up and throw a massive fit saying - “but this is for the tooth pain!! My oxy treats my back pain!”

😑😑😑😑😑 🤯

Those receptors are so full they won't even notice the hydrocodone

 

[JustFillIt]

Those receptors are so full they won't even notice the hydrocodone

Exactly - I would tell them that they are already blocking the pain. But they would just keep driving the point that one is for their back and the other is for their dental work.

 

[ValeRx]

No



You know what drove me nuts. We had a dentist office in town that would prescribe Norco 10 #10 1-2 q8h for just about EVERYONE that had any sort of dental work.

Inevitably, I would get the patients that just picked up #120 oxy 30 just 5 days ago and would want to fill the Norco rx.

Obviously I would refuse the Rx and the patient would show up and throw a massive fit saying - “but this is for the tooth pain!! My oxy treats my back pain!”

😑😑😑😑😑 🤯

You didn't know about targeted pain meds?? I once called a dentist back because they wrote for norco 7.5 and percocet 7.5. The nurse was completely baffled why I would call about this. I get it - the dentist is trying to save time because if a person has worse pain than what the norco script can treat. However, I told their office I would be cancelling one of their orders and they just couldn't believe it. I told her that this was literally the reason for the opiod crisis.

 

[zelman]

No



You know what drove me nuts. We had a dentist office in town that would prescribe Norco 10 #10 1-2 q8h for just about EVERYONE that had any sort of dental work.

Inevitably, I would get the patients that just picked up #120 oxy 30 just 5 days ago and would want to fill the Norco rx.

Obviously I would refuse the Rx and the patient would show up and throw a massive fit saying - “but this is for the tooth pain!! My oxy treats my back pain!”

😑😑😑😑😑 🤯

But what if the norco gets confused and goes to their back and then the oxy goes to their mouth? Then their back will hurt MORE!!! Best not to chance it.

 

[The_Dude]

Why doesn’t anyone ever actually look at addiction stats. 95% of patients prescribed opioids do not abuse them while taking them nor do they go on to become addicts. It’s LESS than 5% that abuse these drugs in some shape or form.
But it IS NOT prescription medication that’s killing addicts. It’s adulterated illegal drugs coming in from illegal lab facilities in other countries. This is government obfuscating their own culpability and punishing providers for the bad choices people are free to make. I hope they get 0.01 dollars.

 

[frosted2]

Why doesn’t anyone ever actually look at addiction stats. 95% of patients prescribed opioids do not abuse them while taking them nor do they go on to become addicts. It’s LESS than 5% that abuse these drugs in some shape or form.
But it IS NOT prescription medication that’s killing addicts. It’s adulterated illegal drugs coming in from illegal lab facilities in other countries. This is government obfuscating their own capability and punishing providers for the bad choices people are free to make. I hope they get 0.01 dollars.

Source? My prior work involved working with patients who were addicted to heroin on a frequent basis... guess how every single one (hundreds) of them but 1 started... pills after they got hurt doing yadda, yadda, yadda.

 

[JustFillIt]

Why doesn’t anyone ever actually look at addiction stats. 95% of patients prescribed opioids do not abuse them while taking them nor do they go on to become addicts. It’s LESS than 5% that abuse these drugs in some shape or form.
But it IS NOT prescription medication that’s killing addicts. It’s adulterated illegal drugs coming in from illegal lab facilities in other countries. This is government obfuscating their own culpability and punishing providers for the bad choices people are free to make. I hope they get 0.01 dollars.

If we are talking strictly about CII opioids - Not sure I agree with much of this. But I appreciate your opinion.

Never underestimate the powerful addictive qualities of opioids. It’s very unfortunate and it happens to very good people.

 

[The_Dude]

Source? My prior work involved working with patients who were addicted to heroin on a frequent basis... guess how every single one (hundreds) of them but 1 started... pills after they got hurt doing yadda, yadda, yadda.

I don’t think anyone is condoning improper use of opioids, but using anecdotes doesn’t replace actual stats. They’re not hard to find. And I was wrong, it’s about 80% of people prescribed opiates don’t abuse them, ~20% abuse them or divert them when prescribed, and 6-8% of ALL prescribed opiate users go on to develop an addiction. Heroin and fentanyl (illegally obtained account for most overdose-related deaths).
Addiction is multi-factorial and often associated with LONG term use and not acute care, poor pain management and a DEA crackdown on MD’s that are afraid of losing their license for treating legitimate pain experienced by their patients.
We have a duty to our patients to not be judgmental butt-faces and understand the HUGE difference between tolerance and addiction, especially in chronic pain management.

The Opioid Crackdown Is Hurting People in Pain | Washington Monthly

Purdue Pharma and “pill mills” are rightfully getting clobbered with lawsuits and regulations for their role in the opioid crisis. But the crackdown is pummeling patients with chronic pain.

washingtonmonthly.com

https://www.nejm.org/doi/full/10.1056/nejmra1507771

NIDA.NIH.GOV | National Institute on Drug Abuse (NIDA)

NIDA's mission is to advance science on the causes and consequences of drug use and addiction and to apply that knowledge to improve individual and public health. NIDA is one of the National Institutes of Health.

www.drugabuse.gov

 

[WorthlessOxygen]

Heroin and fentanyl (illegally obtained account for most overdose-related deaths).
Addiction is multi-factorial and often associated with LONG term use and not acute care, poor pain management and a DEA crackdown on MD’s that are afraid of losing their license for treating legitimate pain experienced by their patients.

Directly from the article you linked:

"However, two major facts can no longer be questioned. First, opioid analgesics are widely diverted and improperly used, and the widespread use of the drugs has resulted in a national epidemic of opioid overdose deaths and addictions. More than a third (37%) of the 44,000 drug-overdose deaths that were reported in 2013 (the most recent year for which estimates are available) were attributable to pharmaceutical opioids; heroin accounted for an additional 19%. At the same time, there has been a parallel increase in the rate of opioid addiction, affecting approximately 2.5 million adults in 2014.9 Second, the major source of diverted opioids is physician prescriptions."

 

[The_Dude]

Directly from the article you linked:

"However, two major facts can no longer be questioned. First, opioid analgesics are widely diverted and improperly used, and the widespread use of the drugs has resulted in a national epidemic of opioid overdose deaths and addictions. More than a third (37%) of the 44,000 drug-overdose deaths that were reported in 2013 (the most recent year for which estimates are available) were attributable to pharmaceutical opioids; heroin accounted for an additional 19%. At the same time, there has been a parallel increase in the rate of opioid addiction, affecting approximately 2.5 million adults in 2014.9 Second, the major source of diverted opioids is physician prescriptions."

 

[The_Dude]

I’m glad you read it 🙄... That’s why I sent you more than one source. The article was just to relay the point that addiction and legitimate pain Rx don’t correlate well.
“Pharmaceutical” opioids doesn’t imply they were legitimately obtained, it just distinguishes the type. If you had actually read the article and not just cherry picked some paragraph you’d have gotten that point.
That’s why I sent more than one link, because stats have been updated since 2013 and again last time I checked 37% isn’t a majority…

 

[WorthlessOxygen]

I’m glad you read it 🙄... That’s why I sent you more than one source. The article was just to relay the point that addiction and legitimate pain Rx don’t correlate well.
“Pharmaceutical” opioids doesn’t imply they were legitimately obtained, it just distinguishes the type. If you had actually read the article and not just cherry picked some paragraph you’d have gotten that point.
That’s why I sent more than one link, because stats have been updated since 2013 and again last time I checked 37% isn’t a majority…

I largely agree with you and only really commented on what I disagreed with. My points are that
1: 6-8% of opiate patients going on to develop an addiction is not insignificant
2: overdoses from prescription opioids are also significant, if not an outright majority of overdoses.

 

[owlegrad]

What an upside down viewpoint. Is it Opposite Day or something?

What % of “legitimate” opioid use would be acceptable to lead to addiction?

What % of pharmaceutical opioids causing overdose would be acceptable?

I don’t know the answers to those questions but surely what ever the answer is, the current numbers are much, much higher. How is that even debatable?

 

[WorthlessOxygen]

And more I work, more I feel benzos are as bad or perhaps even worse than opioids. Wouldn't be surprised if they become C II somewhere down the line.

They practically are already in New York

 

[RxPreceptor]

You didn't know about targeted pain meds?? I once called a dentist back because they wrote for norco 7.5 and percocet 7.5. The nurse was completely baffled why I would call about this. I get it - the dentist is trying to save time because if a person has worse pain than what the norco script can treat. However, I told their office I would be cancelling one of their orders and they just couldn't believe it. I told her that this was literally the reason for the opiod crisis.

Stupid **** like this & catering/"customer/patient service" BS.

Until we stop getting shamed on social media with mindless mob support for enforcing reasonable fill date limits and refusing duplicate therapies. Compound that with the fact that we can expect zero support from our employers when this does happen.

Until this culture ends - this “autonomy” we have to prevent this from happening will not change at all.

This mob can't seem to understand that taking controls around the clock, non-stop, is not normal (yeah, forget sleep)....oh and basic math. Seems pretty strange that over the course of 30 days, someone using say 120 count of percocet for chronic pain comes perfectly down to the wire, every 30 day interval (that's just ****ed up how dependent the person has become).

This is a generalization...I've have a few suboxone users who actually come 1-2 days later than the earliest allowed fill date (few who've actually gotten clean completely - rare)

 

[sfachine]

Directly from the article you linked:

"However, two major facts can no longer be questioned. First, opioid analgesics are widely diverted and improperly used, and the widespread use of the drugs has resulted in a national epidemic of opioid overdose deaths and addictions. More than a third (37%) of the 44,000 drug-overdose deaths that were reported in 2013 (the most recent year for which estimates are available) were attributable to pharmaceutical opioids; heroin accounted for an additional 19%. At the same time, there has been a parallel increase in the rate of opioid addiction, affecting approximately 2.5 million adults in 2014.9 Second, the major source of diverted opioids is physician prescriptions."

Directly from the article you linked:

"However, two major facts can no longer be questioned. First, opioid analgesics are widely diverted and improperly used, and the widespread use of the drugs has resulted in a national epidemic of opioid overdose deaths and addictions. More than a third (37%) of the 44,000 drug-overdose deaths that were reported in 2013 (the most recent year for which estimates are available) were attributable to pharmaceutical opioids; heroin accounted for an additional 19%. At the same time, there has been a parallel increase in the rate of opioid addiction, affecting approximately 2.5 million adults in 2014.9 Second, the major source of diverted opioids is physician prescriptions."

That was then.This is now. 101,000 opioid overdose deaths despite a dramatic decrease in opioid prescriptions.85 percent from illegal sources.Methamphetamine overdoses climbing despite putting pseudoephedrine in the pharmacy.After limiting purchases the Mexican cartels swooped in with a much cheaper and powerful substitute.

 

[GrandTheftAutumn]

Stupid **** like this & catering/"customer/patient service" BS.


This mob can't seem to understand that taking controls around the clock, non-stop, is not normal (yeah, forget sleep)....oh and basic math. Seems pretty strange that over the course of 30 days, someone using say 120 count of percocet for chronic pain comes perfectly down to the wire, every 30 day interval (that's just ****ed up how dependent the person has become).

This is a generalization...I've have a few suboxone users who actually come 1-2 days later than the earliest allowed fill date (few who've actually gotten clean completely - rare)

Actually, they come back every 28 days per 30 day supply.
Every. F-ing. Month.
I wonder where those 8 tabs of Percocet 10/325mg go for every #120 that gets filled every 28 days.

 

[mentos]

Actually, they come back every 28 days per 30 day supply.
Every. F-ing. Month.
I wonder where those 8 tabs of Percocet 10/325mg go for every #120 that gets filled every 28 days.

They run out exactly at midnight on the 28th day.

 

[folkensan]

I didn’t read the full article but I’m shocked Walmart was lumped into this. I thought they managed their opioid dispensing pretty well based on what I’ve read?

don't be shocked. Not until CVS and Walgreens started getting fined did Walmart stop incentivizing opiate rxs as a part of bonus structure (~2010?)

 

[folkensan]

I think some Walmart pharmacies are now refusing discount cards like GoodRx for opiates but it's too little too late as far as the trial goes. Overall I doubt whatever fee they have to pay will be significant to these corps. They are fortune 500 companies after all. CVS is trying to become more of a "HEALTH HUB" so I think they will be hiring psychiatrics and maybe have the pharmacists doing more billable stuff like PPDs in the future.

Do you agree with the verdict? YES
What changes will the big three implement? Give lip service to being more strict with opiates. probably no real change besides making sure there are ICD10 codes on more opiate scripts.
Do you expect them to cut positions or reduce salary to maintain pharmacy margin? No
Will the plaintiff go after individual pharmacist next? No. I mean they could go after me but I have little assets and like $180,000 debt so it wouldn't matter anyway.
Do you think this verdict support the narrative that pharmacists need more autonomy and the ability say no customers. In another word, this is actually a victory for pharmacists? Interesting view point. im unsure

I think most retailers have it built in their system to not allow discount cards on opiates; it would automatically reject, or take off nothing from the final charge. I don't remember a time when discount cards ever worked for opiate Rxs at least..

 

[folkensan]

I don't understand how is Walmart dragged into this? They are the strictest when it comes to opioids by far..

And more I work, more I feel benzos are as bad or perhaps even worse than opioids. Wouldn't be surprised if they become C II somewhere down the line.

They only got strict with the anti-opiate initiatives ~2015. Previous to that it really depended on the integrity of the pharmacist working. I'm sure a lot of you remember hydrocodone being stored on the shelves in 1000 count bottles, and dispensing entire 100-count bottles on the regular..

And I agree, benzos are just as badly abused/diverted and commonly used as cocktails with the opiates.. lots of fake Rx too fyi. Run that PDMP (and not just for your state if you live near a state line) and don't hesitate to call the prescriber's office (from your state records of course) if you feel something is off.

Oh word of caution to those who work in retail and have Tricare beneficiaries who are filling high amounts of narcotics and/or benzos at your store: if they fill on base or at a federal facility (ie, VA, base) that info will not be available on the state PDMP website. Unfortunately, I've had to scrutinize that a lot in the past and have found plenty of people double dipping.

 

[WorthlessOxygen]

I think most retailers have it built in their system to not allow discount cards on opiates; it would automatically reject, or take off nothing from the final charge. I don't remember a time when discount cards ever worked for opiate Rxs at least..

We still allow discount cards on opioids

 

[BidingMyTime]

Actually, they come back every 28 days per 30 day supply.
Every. F-ing. Month.
I wonder where those 8 tabs of Percocet 10/325mg go for every #120 that gets filled every 28 days.

Saving up for the zombie apocalypse?

 

[WVUPharm2007]

The government needs to publish strict guidelines that everyone needs to follow by law. I'm sick of this **** where everything is based on professional judgement. Tell me how much a patient can get and how often. And if they need more, what steps I need to take so that it's all legal and leaves me with no legal exposure. That's all I ask.