November 7, 2018
Hilton Head Library
Leading with the statement that he faces ethical decisions dozens of times a day in his business, David Burke pointed out that pharmacists who are handed doctors’ prescriptions for opioids get no information on the patient’s condition. “Does this person have bone cancer? Has she been in a car accident? Is he hopelessly addicted to opiates? We have no idea. It is illegal for me to fill a prescription that I know is illegal, but often I have no way of making a judgment.”
Both speakers said the majority of drug addictions start with opiate prescriptions.
A recent improvement to pharmacists’ daily dilemma is a new state law demanding a prescription monitoring program; through this, the pharmacist can go online and get information from South Carolina on what else has been prescribed for the patient and refuse to fill it under certain conditions. The pharmacist is not able to get similar information from all other states, however. A second safeguard is the limit that opiate prescriptions now can be for no more than seven days’ worth of medication.
As for his own ethical decisions, he now requires that every opioid prescription come either from a local physician or be for a local resident. The huge rash of prescriptions that once came to him from south Georgia has subsided.
Nevertheless, as a few legal constraints on abuse of prescriptions have come into play, the black market for street drugs has exploded dramatically, he said. With 200 Americans dying every day from opioids, the blame is “all over the map,” and the problem is so massive that it’s a fix requiring “many forces,” in his judgment. The widely publicized antidote for overdose, Narcan, costs the pharmacists $150 per dose, so another ethical dilemma asks who should pay for that and asks as well how many times an overdose victim should receive the treatment from emergency medical technicians.
Larry McEllyn said that the country is not addressing the huge opiate problem in any meaningful way. There has been no DEA administrator for two years. Many Americans are subject to obesity, depression and economic stress, all of which they interpret as pain requiring drugs or alcohol. “We cannot arrest our way out of this problem,” Larry said.
The lure of mind-altering substances has been an important part of history, he said, identifying opium, morphine, laudanum and alcohol as problems for society in the past. A few fairly recent phenomena contributed to the current epidemic. The medical profession began considering “pain,” which cannot usually be detected through diagnostic procedures, as a vital sign that must be treated when patients complain of it; in addition, pharmaceutical companies insisted that narcotics are “not addictive.”
In the 1990s pharmaceuticals began lobbying doctors with gifts and trips, persuading many to begin operating “pill mills,” essentially throwing Oxycontin and related addictive medications into many segments of society. For example, for a South Carolina population of almost 5 million, the number of opiate prescriptions annually is approximately 4.9 million (or almost 1 per person---nationally 70/100 people).
The addicted population can readily turn to heroin from very accommodating street dealers, and the dealers are now adding fentanyl to the heroin, making it extremely potent and in many cases lethal.
From the audience:
How does the United States compare to other countries?
The speakers said that the problem is widespread globally but our country’s affluence makes it a really attractive target for the drug cartels, which are clever, devious, determined and violent.
Should we legalize these drugs?
The speakers repeated that the vast majority of problems begin with already legal prescriptions. David repeated his earlier assertion that the only solution is to stop the demand.
David and Larry agreed that there are crying needs for:
Thanks also to Neil Funnell for moderating, Marion Conlon for recruiting our two speakers and to Fran Bollin for her note-taking and excellent summary.