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    The Opioid Epidemic: Well, It Ain’t My fault … Maybe?

    The opioid crisis? There is enough blame to go around.


    My son-in-law, Mark Garofoli, PharmD, MBA, BCGP, has the ominous task of attempting to make progressive changes at ground zero in the opioid epidemic, his home state of West Virginia. He coordinates an interprofessional panel of pain management experts including doctors, interventionists, pharmacists, and nurses with the goal of saving and improving lives by facilitating the shift of best practices in pain management to a new standard of care. Health insurance representatives on the panel are working to accomplish the same, which is contrary to typical situations in other states where insurance companies have reacted quickly and with the least amount of thought. Limiting a patient to 160 mg morphine equivalents (MME), who was using more than 600 MME/day just last month is simply ludicrous. That isn’t patient care. It is patient neglect.

    Related article: How Independent Pharmacies Are Combatting the Opioid Crisis

    Where do we pharmacists fit into the picture? We need to go no further than the Title-1 Code of Federal Regulations. Section 1306.04A states: a “prescription for a controlled substance to be effective must be issued for a legitimate medical purpose by an individual practitioner acting in the usual course of his professional practice. The responsibility for the proper prescribing and dispensing of controlled substances is upon the prescribing practitioner, but a corresponding responsibility rests with the pharmacist who fills the prescription.”

    My son-in-law put it more accurately: “Dad, it’s only a sheet of paper, until you act on it.”

    Count me in to be part of the solution! 

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    • [email protected]
      As a pharmacist, I am willing to ascribe to the assertion that "there is enough blame to go around". But, in 2001, I caught a lot of flak when I maintained that the Joint Commission's concept of pain as "fifth vital sign" was the most harebrained idea I'd ever heard and that it would certainly lead down the road to the destination at which we have now arrived. And, the worst part was, that Joint Commission leadership added pain-related questions to HCAHPS, where patient pain satisfaction scores were used to determine hospital reimbursement rates. That decision rivals the cigarette companies addition of more nicotine to "improve" their products! So please, we all need to work together to get out of this disaster and, in the future, please vociferously question whether the next asinine standard the Joint Comission proposes is actually based on evidence and not a some "brilliant" marketing idea.