Pill shortage still an issue

The 59-year-old Spring Hill woman lay cramped on her couch, in pain, and sick — not with the flu.

“My bones hurt so bad it’s like I’m coming out of my skin,” the woman said, who wished to remain anonymous and keep her medical and physical condition private. “My legs have goose bumps, and I’m cold, and I’m sweating. I’ve had diarrhea and my neck is killing me; it’s just burning.”

“I mean honest to God, a person would put their dog to sleep if it was suffering the way I’m suffering.”

She’s gone to every pharmacy in Hernando County to try and obtain the oxycodone she’s taken every day for the last eight years to treat the pain of herniated discs three through seven and the pinched nerves that put what she describes as a burning electricity feeling down her right arm into her hand.

This month is the first time she’s gone without the opiate. It’s a pain that both patients and pain management physicians understand, said Jean Sidhom, office manager of Hernando Pain Management Center.

“It’s not fair to patients who are legitimately in pain, or for the doctors who are practicing good medicine, because it really does cut into your patient care,” Sidhom said. “There is a shortage on a lot of narcotics medication these days. It’s been ongoing, and not just Oxycontin but morphine, Dilaudid, methadone; it just depends on what the choice is this week.”

And it’s a cost burden, Sidhom said: patients prescribed medication no longer in stock have to revisit their physician to be cleared to take available, substitute medications.

“You’re not doing the patient justice with the shortage, to be honest,” Sidhom said. “It’s not benefiting them, and physicians are trying to do their practice, and you have to see the patient again because you have to see if they have allergies to this new type of medication.”

Gautam Thakkar, pharmacist at Pine Brook Pharmacy, said shortages are very common and not just in states like Florida notorious for prescription drug abuse.

“Yeah, it is very common, not just Florida. Florida was a notorious state, No. 1 nationwide for this crime,” Thakkar said.

“It was very bad; guys died everyday because of overdose,” he added. “They had to take drastic changes to fix it.”

A pharmacy has to report to the state a filled controlled substance prescription within seven days, Thakkar said, and unlike before when a person could go “doctor shopping” for several prescriptions between physicians or pharmacists, such measures keep better tabs on prescriptions written and filled.

“I like it in a way,” Thakkar said. “I used to get (many) phone calls a day from people looking for oxycodone, and sometimes you’d see those numbers on the caller ID: That’s out-of-state numbers.

“In Florida, people used to come from another state, stop in one city, and everybody would go to one doctor and get all this medication then sell it up north.”

Although the ailing Spring Hill woman cannot find a pharmacy to fill her oxycodone prescription, supplies of several narcotics-based medications have been shortened over the last six months.

She said she’s seen $1,250 receipts for 150 pills of the same medication she seeks but is told by pharmacists they do not have.

“All the small pharmacies are either saying, ‘We don’t have it,’ or are saving, ‘What we do have is for our regular customers,’” the woman said. “They say they don’t have it, but if you come in with a thousand dollars, they’ll sell it to you.”

The misuse and abuse of prescription drugs became an increasing concern in 2011 for Hernando County, according to a Hernando County Community Anti-Drug Coalition report.

Data from the Florida Department of Law Enforcement shows Hernando County had 24 deaths caused by prescription drugs in the first half of 2010, which is double the statewide average per capita.

Hernando County Sheriff’s Office reported then that 90 percent of the narcotics cases handled in Hernando were for prescription drugs, and every category of crime, including home invasions and robberies, were affected by prescription drug abuse, according to the report.

Law enforcement efforts such as those of the Drug Enforcement Administration, enforcing what pharmacies can and cannot carry and limiting quantities, are playing a large part in the shortage, Sidhom said.

“People were prescribing Oxycontin out the ying-yang, and now they’re saying, ‘We’re not going to allow that many pills to be released, for them to be monitored,’” Sidhom said. “It’s definitely a DEA monitoring … it’s definitely coming from the higher-ups.”

Since law enforcement crackdowns on “pill mills,” all pain clinics have to be registered with the state of Florida as well as the county they operate out of, Sidhom said, and Hernando County Sheriff’s Office Vice and Narcotics Unit monitors those clinics.

“They’ve closed down quite a bit,” Sidhom said. “A lot of them were just cash-only patients and accepting patients without insurance and many of the doctors working there were not licensed or anything of that nature.”

Nurse and Director of Development for Crescent Community Clinic, Maureen Solimon, said patients and doctors are now screened more intensively for who can dispense and who can receive pain medications since the days of “pill mills.”

“The substance abuse is out of control, and we need more resources,” Solimon said, adding that men and women struggling with addiction often become funneled into the justice system, where the underlying causes of addiction can remain untreated.

“What we’re trying to do is educate professionals to see that addiction is an illness,” she said.

There are other ways to treat pain, Solimon said, but it entails acupuncture or other treatments that a recent study by IMS Health, an analytics company, suggests has very little cross-over with contemporary American treatment.

The U.S. consumes 80 percent of the world’s prescription narcotics.

“They don’t dispense pain medication in other countries like we do,” Solimon said.

Unfortunately, said Thakkar, in the drastic changes to clean up the whole commercial prescription drug market, it is often the case that those in legitimate need of pain medications get caught in the crossfire.

“It happens every time,” Thakkar said. “In getting the bad people, some good people are going to suffer, as well.”

Thakkar’s recommendation is that, once a person heals and recovers from whichever injury warranted the taking of prescription pain pills, that they switch to a different category of pain reliever or seek treatment to help wean themselves off opiates.

“People are on this medication because they’re in a car accident or something, but when they get better they need to stop taking it,” Thakkar said. “It’s addictive.”

Addictive enough that in the nightmare of fighting withdrawals from an opioid her body has spent eight years growing accustomed to, the Spring Hill woman has fathomed new ways to end its pain.

“It’s just getting to where I just need to get myself to bed, get a heating pad and take Ibuprofen, which I’m not supposed to take, and turn the TV on and lay on the couch, shaking and crying,” she said. “And I’ve thought about suicide, but I have kids. And I don’t want to die; I just want to be able to live.”

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