Policymakers and business leaders across the country are taking bold steps to combat prescription drug abuse. While we are inclined to support these restrictions, the unintended consequences give us pause.
In the latest example, Hy-Vee announced this month its stores are implementing new restrictions on prescription medications. Under the company’s new policy, pharmacists will no longer refill drugs classified by the federal government as Schedule III or IV more than 72 hours early without authorization from the prescriber.
The company’s stated goal is to prevent opioid dependency, but the new rules include not just opioids, but all schedule IV drugs, which the government acknowledges have a low risk of abuse. Such a policy may well be wise, but it also might erect barriers to treatment even for people who are unlikely to misuse drugs. We are sympathetic to the delicate factors businesses like Hy-Vee are admirably trying to balance.
In a similarly well-intentioned move, Gov. Kim Reynolds signed a bill last year that aims to address opioid abuse through prescription monitoring. The law requires health care professionals to log prescriptions in a statewide database, allowing the government to identify people at risk of addiction and potentially impose penalties on providers who overprescribe habit-forming medications.
Contrary to some media depictions, not everyone who consumes a large number of prescription painkillers is a drug abuser. There are many cases where suffering people have no better treatment than to regularly consume opioids.
Barbara McAneny, president of the American Medical Association, illustrated that point at an association meeting last year. She said she treated a patient with painful metastatic prostate cancer, and increased his prescription for opioid painkillers. However, when the patient tried to fill his prescription, it was flagged by the drug monitoring system.
He went home without the medicine he needed, but when it became too much to tolerate, he tried to kill himself. Fortunately, his family found him, he was stabilized and he got access to the prescriptions he needed.
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“I share the nation’s concern that more than 100 people a day die of an overdose. But my patient nearly died of an underdose. This story illustrates the problems we all confront every day in our current dysfunctional health care system,” McAneny said to the assembly of fellow physicians last November.
Any measure meant to restrict access to prescriptions will inevitably sweep up people with a legitimate need for medicine. While not a reason to nix these projects altogether, the circumstances do beg us to turn a critical eye. As businesses and governments lead the opioid crackdown, Iowans should seek to better understand all the consequences.
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