DEA Crackdown on Pain Meds Hurting Those in Nursing Homes and Hospices

Sens. Herb Kohl (D-Wis.) and Sheldon Whitehouse (D-R.I.) have written to Attorney General Eric Holder protesting the DEA crackdown on pain medicine prescriptions. Pharmacies, nursing home administrators and geriatric experts agree with them. They are asking Holder to revise DEA policies on prescribing meds like percocet and morphine, and to seek a legislative change.

The DEA has sought to prevent drug theft and abuse by staff members in nursing homes, requiring signatures from doctors and an extra layer of approvals when certain pain drugs are ordered for sick patients.

The law, however, "fails to recognize how prescribing practitioners and the nurses who work for long-term care facilities and hospice programs actually order prescription medications," Kohl and Whitehouse write. They conclude that delays can lead to "adverse health outcomes and unnecessary rehospitalizations, not to mention needless suffering."


The DEA's newly revised guidelines:

The DEA has sought to prevent drug theft and abuse by staff members in nursing homes, requiring signatures from doctors and an extra layer of approvals when certain pain drugs are ordered for sick patients.

The law, however, "fails to recognize how prescribing practitioners and the nurses who work for long-term care facilities and hospice programs actually order prescription medications," Kohl and Whitehouse write. They conclude that delays can lead to "adverse health outcomes and unnecessary rehospitalizations, not to mention needless suffering."

Another problem:

Most nursing homes do not have pharmacies or doctors on site, adding to delays for patients who fall ill late at night or in transition from a hospital.

A central issue, the DEA has not issued guidance on:

... whether a nurse could serve as an agent of a doctor and administer pain medication with a verbal directive rather than a written prescription from a doctor.

Because of the DEA's crackdown, pharmacies are balking at filling prescriptions:

The problem took on new urgency this year after the drug agents heightened their enforcement of the rules at pharmacies in Ohio, Michigan, Wisconsin and Virginia. The pharmacies face tens of thousands of dollars in fines if they deviate from strict controls that require doctors to sign paper prescriptions and fax them to a pharmacy before a nurse can administer them in the nursing home setting.

It's the war on drugs vs. the war on pain and the patients who need the meds are losing.

Doctors in nursing homes say the restrictions do not take into account that many more patients, with higher levels of illness and pain, are moving into long-term-care sites and out of hospitals.

Simply shameful.

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    I do not know (5.00 / 1) (#2)
    by nyjets on Thu Oct 29, 2009 at 07:16:45 AM EST
    While I understand the point of the senators, prescribing medicine should only be done by doctors.And that prescriptions should be written. If you allow nurses to give out prescriptions or allow for verbal rather than written prescription, there is a possibility of abuse and theft. I agree that there is no easy solution but I do not think the regulations are not bad on the surface.
    I would rather see some compromise solution rather than the regulations being completely thrown out.

    Which is worse though.... (5.00 / 1) (#3)
    by kdog on Thu Oct 29, 2009 at 07:56:08 AM EST
    a pill-popping nurse taking home some five-finger discount percs or somebodys grandmother/grandfather suffering in pain all night while they wait for their healthcare providers to jump through hoops to get the drugs their patient needs?

    Allowing the sick and the old to needlessly suffer is the far greater sin, imo.


    I agree (5.00 / 1) (#8)
    by BarnBabe on Thu Oct 29, 2009 at 09:10:32 AM EST
    In the final days of my Mother's life, there came a night when she was in horrific pain and gasping for every breath. Her face showed the panic and fear and I was horrified that I could not do anything to help her. Except, I was able to get the head nurse to administer medication immediately. The morphine shot the nurse gave her settled her down and she was able to slip peacefully away later that night.It would be considered torture to have had her lying in pain for 5 hours awaiting her death. She was a good person and did not deserve the final suffering. I am grateful that there was a policy in place at the nursing home that allowed the morphone for pain in a dying person.  

    It isn't that simple (none / 0) (#7)
    by jimakaPPJ on Thu Oct 29, 2009 at 09:03:56 AM EST
    The premise should be, if someone needs pain killers the docs should be available to approve same. I speak as someone who had security called on him for insisting that a nurse find a doctor to provide my mom some medication when she was being treated for a broken hip. I won the argument by noting that everyone has cell phones and pagers and a doctor should be able to be reached. The nurse later apologized and said she just didn't want to disturb the doctor. Ha. As if I gave a flip.

    If you turn a blind eye to people, addicts or not, stealing drugs then some of them will wind up being sold thus expanding the use.


    Are the senators (none / 0) (#9)
    by gyrfalcon on Thu Oct 29, 2009 at 09:44:58 AM EST
    or anybody here suggesting "turning a blind eye to people stealing drugs"?  Jeralyn didn't post the whole letter, but maybe that suggestion is in there somewhere.

    Nursing homes are not hospitals.  My mother did stints in two highly regarded ones for rehab.  There were no full-time staff physicians, a doc dropped in to the facility once or twice a week for a few hours.


    I see you didn't read Kdog (none / 0) (#18)
    by jimakaPPJ on Thu Oct 29, 2009 at 04:30:58 PM EST
    It is that simple Jim... (none / 0) (#10)
    by kdog on Thu Oct 29, 2009 at 09:45:00 AM EST
    Honestly, who cares who uses what?  People should not have the ease of their suffering delayed in the slightest over concerns that somebody else might be getting high for fun somewhere in the world.

    If theft is the main concern...well, I don't have to get a signed permission slip to take a roll of toilet paper out of the supply closet at my job...there are other ways to try and prevent employee theft.


    No,it isn't that simple. (none / 0) (#19)
    by jimakaPPJ on Thu Oct 29, 2009 at 04:50:55 PM EST
    The use of addictive substances create addicts and in most cases addicts are addicts for life.

    My goal would be to stop the creation of addicts by giving away the drugs of choice to anyone who signs up as an addict. That would largely reduce the profit motive and reduce the number of addicts.

    Having said that you would always have people who are addicted who would not want it known. Pilots, truck drivers, doctors, nurses, etc. immediately come to mind. I don't know what you do about these people outside of getting them into treatment and then imposing some draconian penalties if they fall back.

    As to the DEA, etc and et al..... Look, the FDA did not come into existence because the druggists, doctors and snake oil salesmen were capable of keeping the killers out of the market.. Again having said that I think it is past time to start having some adult conversations about to change the laws.

    I was hopeful that Obama, along with the damage I knew he would do otherwise, would provide some change. He hasn't and the Left is letting him slide on this and other societal problems.

    Maybe it will require a Nixon to go to China.


    No one here... (none / 0) (#20)
    by kdog on Thu Oct 29, 2009 at 05:34:47 PM EST
    is letting him slide...the general left-leaning, probably so.

    I don't share your concern about doctors, pilots, etc...not that I want an alcoholic or drug addict pilot who is under the influence flying my plane of course, but because if every drug were available to adults legally and hassle-free tomorrow we'd have anymore pilots flying under the influence than we do right now.  

    I mean alcoholism is the #1 addictive drug problem in this country right now, highly impairing drug when taken in excess...drunken piots and truck drivers and doctors exist and we deal with them as they cause trouble...and thats the best you can do.  

    How do you feel about functional addicts?  Do they deserve draconian penalties?  


    Actually the largest problem is (none / 0) (#21)
    by jimakaPPJ on Thu Oct 29, 2009 at 06:17:58 PM EST
    tobacco products. Very addictive, only long term damage, usually discovered too late for effective treatment...Alcohol is a close second. Again very addictive to some individuals..health issues also mostly long term. Problem is we allow the pushers to advertise and create more addicts out of our children.. Smoking used to make you rugged and sophisticated (at the same time... depending on brand) while booze makes you funny with lots of jolly friends and/or sophisticated at the same time, depending on brand.

    That's why I would lump them and MJ together and sell only under very rigid controls with very tough penalties for selling to children/teens/certain others.

    And no advertising. And a lot of education paid for by the taxes off the users.

    And no, I wouldn't want drunk pilots or drivers of any stripe.

    Functional addicts? Assuming the addict is either using a product legally sold and/or given away I have no problem with that assuming they are in a job where a careless mistake doesn't wipe out a couple hundred people, or one for that matter. Draconian? Loss of license.

    I don't see this as a law enforcement issue in the large because I think the sellers would be out of business pretty fast and the police could get back to stopping crimes of violence and more extreme crimes against property.... bank robberies, etc.


    As long as there's a high demand (none / 0) (#13)
    by jondee on Thu Oct 29, 2009 at 10:11:24 AM EST
    there'll be availability.

    It's not some power-of-suggestion voodoo like if we legalize gay marriage, suddenly everyone will start turning gay (not that theres anything wrong with that!)


    But did you know (none / 0) (#5)
    by SeeEmDee on Thu Oct 29, 2009 at 08:26:36 AM EST
    that from the beginning of the Republic to 1914, a doctor didn't have to formally prescribe anything, just told the patient to take a 'scrip to the pharmacist and pick up whatever the doctor ordered...and there was no governmental interference at all in the process?

    Patients were advised by their doctors as to what they could expect from taking the medication...which was often an addictive one, such as an opiate. Said patients were warned of the consequences if they overdosed. And that was that. You were expected to be a freakin' adult about following those directions, not a superannuated child as the Gub'mint assumes you to be with its' damnable DrugWar intent upon saving you from yourself.

    This is definitely one case where the Gub'mint needs to butt out, but won't because of the vast bureaucracy that has grown up over that assumption that adults are children in need of perpetual supervision. It will probably take a full-on financial meltdown (we ain't seen nothing yet, folks, just wait until the next round of mortgage defaults takes place) before this country abandons this insane DrugWar, as too many parasitical snouts are permanently attached to the money trough it represents to quit feeding off the taxpayer's life-blood that sustains those parasites.


    In most states (none / 0) (#6)
    by me only on Thu Oct 29, 2009 at 08:29:22 AM EST
    nurse practitioner have script writing privileges.

    Why would nurses be more prone to abuse and theft than doctors?


    In CA PA's can as well, (none / 0) (#16)
    by sarcastic unnamed one on Thu Oct 29, 2009 at 12:27:36 PM EST
    although I don't know about scrips for narcotics.

    it's funny, (none / 0) (#1)
    by cpinva on Thu Oct 29, 2009 at 02:10:16 AM EST
    you'd think the same people so adamantly opposed to "government run healthcare" would be apoplectic about the DEA (a government agency) inserting itself directly in between doctor and patient.

    and yet, nothing.

    Great point. (none / 0) (#15)
    by sarcastic unnamed one on Thu Oct 29, 2009 at 12:22:38 PM EST
    This is nothing new (none / 0) (#4)
    by SeeEmDee on Thu Oct 29, 2009 at 08:09:43 AM EST
    Immediately after the passage of the Harrison Narcotics Act in 1914 a Fed police force to enforce it began chasing after doctors in exactly the same way, even going so far as to use entrapment by having agents pose as withdrawal-suffering addicts to get prescriptions for pain meds from sympathetic doctors, by having those agents claim that their regular doctor is unavailable.

    This is what the War on Drugs has brought us: Fed agents practicing medicine without a license by inserting themselves between doctor and patient and dictating what the doctor may and may not prescribe, under penalty of prison and fines for failing to follow said agent's dictates.

    The War on Drugs is a fraud, has always been a fraud, and always will be...and now, it's a horrendously expensive fraud that is taking money away from where it's most desperately needed (millions face the loss of their unemployment bennies right effin' NOW) and using it to buy Armored Personnel Carriers with .50 cal machine guns on them...for police departments to serve warrants with.

    WTF? Millions of people are staring financial (and thus, personal) Armageddon in the face, and we have money to throw at things like this? Enough, already!

    The Authorities (none / 0) (#11)
    by SOS on Thu Oct 29, 2009 at 09:53:11 AM EST
    Never question authority.

    Just shut up, pay your bills (none / 0) (#12)
    by SOS on Thu Oct 29, 2009 at 10:05:16 AM EST
    and suffer.

    I don't want some Gov. bureaucrat getting between (none / 0) (#17)
    by Yes2Truth on Thu Oct 29, 2009 at 04:06:59 PM EST

    someone in pain and their right to have ready
    access to something that provides pain relief.

    This is another example of what happens whenever
    a bad idea (criminalizing what someone eats, drinks, snorts, injects or smokes) is allowed
    to get a foot in the door.

    Does anyone here think that those who profit from
    the War on Drug Users would ever voluntarily
    cease fire?  They know a good thing and humans
    are wired with the ability to rationalize and
    ignore their conscience.