The War on Drugs Becomes the War on Patients in Pain

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We are a nation at war with multiple enemies that threaten the health and well-being of our people. Some of these enemies include worsening epidemics of obesity, diabetes and drug abuse. While we typically do not think of being at “war” with obesity and diabetes, we have been waging the war on drugs for several decades.

I will leave it to others to decide if the war on drugs has been successful, but I do know that this “war” has had some unintended victims: patients in pain. We treat many patients with pain in the long-term care/post-acute (LTC/PA) facilities we serve. Some of these patients suffer from acute pain either from trauma due to accidents or from recent surgeries including orthopedic procedures. Others come to us with a long history of chronic pain. Our primary goal is to help these patients improve or maintain the highest, practicable level of physical and mental function.

Recently, the Drug Enforcement Administration has proposed moving hydrocodone/acetaminophen products (i.e. Lortab, Vicodin) from Schedule III to Schedule II which would significantly impact the way these products are ordered, dispensed, and administered to LTC/PA patients. The DEA does not recognize chart orders as valid prescriptions in the LTC/PA setting nor does it recognize LTC/PA nurses as agents of the prescriber unless they are employees of the prescriber’s practice. This means that prescribers must mail or fax new or renewal orders for Schedule II drugs to the pharmacy at least every 60 days. By comparison, Schedule III drugs may be called to the pharmacy and each prescription can provide medication to a patient for up to six months.

Hydrocodone/acetaminophen is a very effective and relatively safe opioid pain medication that is widely used in the LTC/PA setting. Restricting these products to Schedule II has the potential to delay effective pain management, especially for patients discharged from acute care hospitals.

However, this concern must be balanced against the potential reduction in deaths and suffering caused by the abuse of these products in the community. The DEA believes that the potential reduction in availability of these products for diversion and abuse more than justifies this action.

Only time will tell who is right, but in the meantime, I urge the DEA to recognize that patients in LTC/PA facilities need the same access to effective pain management as those treated in acute care hospitals where chart orders are recognized as valid prescriptions and nurses can act as agents of the prescriber regardless of employment status.