Heightened efforts by the Drug Enforcement Administration to crack down on narcotics abuse are producing a troubling side effect by denying some hospice and elderly patients needed pain medication, according to two Senate Democrats and a coalition of pharmacists and geriatric experts.
Tougher enforcement of the Controlled Substances Act, which tightly restricts the distribution of pain medicines such as morphine and Percocet, is causing pharmacies to balk and is leading to delays in pain relief for those patients and seniors in long-term care facilities, wrote Sens. Herb Kohl (Wis.) and Sheldon Whitehouse (R.I.).
The lawmakers wrote to Attorney General Eric H. Holder Jr. this month urging that the Obama administration issue new directives to the DEA and support a possible legislative fix for the problem, which has bothered nursing home administrators and geriatric experts for years.
The DEA has sought to prevent drug theft and abuse by staff members in nursing homes, requiring written signatures from doctors and an extra layer of approvals when drugs such as morphine and Percocet 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 wrote. They concluded that delays can lead to "adverse health outcomes and unnecessary rehospitalizations, not to mention needless suffering."
Most nursing homes do not have pharmacies and doctors on site, adding to delays for patients who fall ill in the middle of the night and in their transition from hospitals to long-term care facilities.
Justice Department and DEA officials had no immediate comment. The DEA sent out guidance last summer in response to some of the pleas but it did not resolve the central issue of 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.
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.
"The system is broken. It isn't working and patients are suffering," said Claudia Schlosberg, director of policy and advocacy for the American Society of Consultant Pharmacists. "While we need to ensure there are proper controls on the medications, the overall law enforcement concern has to be compatible with meeting patients' needs and right now, it's not."
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.
William Smucker, medical director of the Altenheim Nursing Home in Ohio, said that the "delay is not what I would want for myself or my family, and it's not the way I practice in other settings."
Terence McCormally, a doctor who cares for patients in nursing homes in Northern Virginia, said the tug of war reflects "the tension between the war on drugs and the war on pain."
"Prescribing narcotics in a long-term care facility seems to be more of a nuisance than it needs to be," McCormally said. "For the doctor and the nurse it's a nuisance, but for the patient it is needless suffering."
By Carrie Johnson
October 28, 2009
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