The Pharmacy Shuffle: Navigating the Opioid Shortage Again
/By Crystal Lindell
The pain medication I take daily was completely out of stock at my pharmacy, as well as every other pharmacy near us in northern Illinois this week.
The first replacement my doctor prescribed would cost me $529 out-of-pocket – even with a GoodRx coupon.
Let me take you through what it’s like to navigate the morphine extended-release (ER) shortage as a pain patient who depends on this medication to function. And yes, this is the second time I’ve had to deal with the shortage in the last few months.
But this time, it was much worse.
The whole saga really started last week, when I sent a MyChart message to my doctor’s office letting them know that I was due for a refill on Monday, March 31. They sent the refill prescription to my pharmacy on Friday, with the fill date set for Monday.
Despite the fact that my pharmacy had this prescription in their system all weekend, they waited until 11 Monday morning to tell me that morphine ER was out of stock at their store and every other pharmacy in the area – and that there was no way to order it.
After the pharmacy tech explained that to me, she said, “Did you want me to transfer the prescription somewhere else?”
Um, you just said it was out of stock everywhere? Where the heck would you transfer it to?
I asked her what alternatives they did have in stock, so that I could let my doctor know the best options. Because morphine ER and all of the alternatives are controlled substances, she immediately started acting like I was an armed gunman asking for details so that I could rob their narcotics safe later.
Finding an Alternative
At that point, I realized that this situation was going to take at least the rest of the day to navigate, so I was growing impatient. I told her, “Sorry, I’m just trying to avoid having to make 17 phone calls about this, playing phone tag with you and my doctor’s office.”
She relented, and finally told me that they did have morphine instant-release (IR) available.
I then got to work calling other local pharmacies hoping for a miracle. Unfortunately, I got the same information from all of them: Morphine ER was out of stock, they had no way to order more, and they had no idea when they might be able to get it.
So then I called my doctor and left a message explaining the situation and that morphine instant-release was probably the best alternative. I called him 2 more times because I didn’t hear back.
Finally, the nurse called me back at 5:13 pm – just 17 minutes before the doctor was slated to leave for the day. And it was not great news. She told me that my doctor did not want to prescribe the instant-release version because he was worried it would be too strong for me.
I suggested that he prescribe oxycodone extended-release, but that I was worried about the cost. I don’t currently have health insurance.
My doctor sent in the oxycodone replacement at 5:28 pm, just minutes before he left for the day.
At this point, I naively assumed that the oxycodone ER would cost around $200, which is significantly more expensive than the $60 I usually pay for morphine ER.
Sadly, my guess of $200 was pathetically low.
My pharmacy gave me two pieces of bad news: One, they didn’t have the oxycodone in stock, but they could get it tomorrow, and two, the cash price with GoodRx would be $529.
For some reason, the pharmacist thought this was a good time to have a conversation with me about my patient profile. He said that I needed to have my doctor prescribe a non-controlled medication for me because I only get prescriptions for controlled substances from them. That’s a red flag for the DEA, which could impact him – as if patients get to decide for their doctor what they’re prescribed.
I don’t have insurance and was on the verge of going into withdrawal without pain medication, and the pharmacist thought that was the best time to tell me that I needed to get an unnecessary medication to protect him?
At this point, I did what any sane person would do: I started crying.
I couldn’t afford the $529 oxycodone and now I also had the added stress of knowing that my pharmacist thinks I’m a “red flag” patient.
I immediately called my doctor again, knowing that I was making the phone call in vain, because he was gone for the day. I was routed to the on-call service. The on-call doctor didn’t feel “comfortable” prescribing a controlled substance after hours to a patient they had never met.
By now, any patience I had was as unavailable as the morphine ER tablets were – so I used it as an opportunity to tell him that perhaps their “policy” should consider how dangerous it is to send patients into morphine withdrawal.
He said I could go to the emergency room if it gets really bad, and I reminded him that I don’t have insurance. At that point, I accepted the fact that I will have to wait until day 2, and just hope it’s resolved then.
That night was awful. It’s not a good idea to go from 3 morphine ER tablets down to zero in one day, and I spent all night in and out of a fitful sleep, before finally deciding to get up for the day at 3 am.
I called my doctor’s office as soon as they opened and left a message with his receptionist explaining the $529 price tag. I also let them know that I had already called additional pharmacies that morning and I was still getting the same excuse about them being out of stock with no way to order more morphine ER.
I called my doctor back again in the afternoon, because I still hadn’t gotten a response. Finally, at 3:24 pm, my doctor’s nurse called back. I had to explain this entire situation again. She gasped when I told her about the $529 price tag, said she would talk to the doctor, and call me back.
Less than an hour later, she calls to tell me that they are sending in the prescription for morphine instant-release – the same medication they could have sent in the day before, which would have saved me from a night of unnecessary suffering.
By that point, I was thankful that I was finally closer to getting this resolved. I call the pharmacy, they tell me they got the new script, and that they’d start working on it. It’s ready when I get there, and the price is just $52.60 – far cheaper than the oxycodone replacement.
I Got Lucky, Other Patients May Not
The whole situation was just an awful chain of events, where I felt like I was failed by every single person in the healthcare system. Why didn’t the pharmacy tell me on Friday that my medication was out of stock? Why did my doctor’s office wait until the end of the day Monday to call me back? Why did the on-call doctor shrug me off?
I say all of this knowing that I’m one of the “lucky” ones who was actually able to get this situation resolved. Thousands of other patients are also dealing with shortages of morphine ER and other opioids. I suspect most of them won’t get an alternative medication at all.
My last prescription for morphine ER was manufactured by Rhodes Pharmaceuticals, which did not provide a reason for the shortage to the American Society of Health-System Pharmacists (ASHP). Neither did Major, Mallinckrodt, Sun Pharma or Teva Pharmaceuticals. The drug makers would only say the medication is on “back order.”
You might still be able to get MS Contin, a branded version of morphine ER, but it costs more and most insurers won’t pay for it, according to the ASHP, so pharmacies don’t usually keep it in stock.
At this point, I’m genuinely wondering if generic morphine ER will ever be available again. Drug makers don’t make a lot of money selling generics and opioids come with the added risk of liability, so some manufacturers have quietly discontinued production.
I think sometimes people believe that opioid pain medications are a want, not a need. But I need morphine ER to deal with my chronic pain. It allows me to work, shower, make dinner, clean my house, and spend time with my loved ones. Most of all, it allows me to get through the day without suicidal levels of physical pain.
If you’re a patient trying to navigate this shortage, just know that my heart goes out to you.
And if you're a physician or a pharmacist trying to deal with this from the other end of things, I hope you’ll treat morphine ER the same way you’d treat any other necessary, daily medication. If you wouldn’t do it to a patient who needs insulin, don’t do it to a patient who needs pain medication.
