SHAMARD CHARLES, M.D.
CVS Pharmacy will limit opioid prescriptions to a seven-day supply for certain conditions, becoming the first national retail chain to restrict how many pain pills doctors can give patients.
When filling prescription for opioid pills, pharmacists will also be required to talk to patients about the risks of addiction, secure storage of medications in the home and proper disposal, the retail pharmacy chain said Thursday.
The move by CVS to limit prescription opioids like OxyContin or Vicodin to a seven-day supply is a significant restriction for patients — the average pill supply given by doctors in the U.S. increased from 13 days in 2006 to 18 days 2015, according to a recent report from the Centers for Disease Control and Prevention.
‘We are further strengthening our commitment to help providers and patients balance the need for these powerful medications with the risk of abuse and misuse,” Larry J. Merlo, President and CEO, CVS Health said in a statement.
CVS, which manages medications for nearly 90 million customers at 9,700 retail locations, plans to roll out the initiatives to control opioid abuse as of February 1, 2018.
Daily dosage limits will be based on the strength of the opioid and CVS pharmacists will require the use of immediate-release formulations of opioids before extended-release opioids are dispensed, lowering the risk of tolerance to the highly addictive drugs.
I’m uncomfortable with this. I agree with the idea of limiting opiate prescriptions, using caution, etc. My problem is that the pharmacist has not examined the patient, does not have the clinical experience as the prescriber, there are many potential flaws.
When I first got my DEA number (prescribing license) I was a junior resident in a family medicine training program. While on a surgery rotation a patient had just transferred to the surgery clinics with a huge and severe spinal tumor that was eroding bone–very painful, huge, left the patient in constant pain and paraplegic. Physical exam was remarkable for a HUGE palpable tumor mass from his lower ribs past his pelvis–hard sclerotic tumor mass. He was a new patient to the system, had prior films, CT scans etc. My chief surgical resident/superior was overseeing me. I saw the patient, wrote for a large supply (appropriately, even looking back 30 years later) supply of the medication that he had been using and was working for him and went to present the “case” to my superior prior to discharging the patient. Other senior residents did not have their DEA license yet but the chief did. The Chief was upset with me because of what I’d done, immediately came with me to examine the patient and after literally, a “one-second optical scan” agreed totally with my decision and was no longer upset with me.
I don’t see how a pharmacist behind the counter can or should do what a physician does.