Walgreens and CVS Rated ‘Most Difficult’ for Opioid Prescriptions

By Pat Anson, PNN Editor

When Walgreens and CVS signed the National Opioid Settlements in late 2022, they agreed to pay over $10 billion to states, cities and counties that sued them for their alleged roles in causing the opioid epidemic.

The nation’s two biggest pharmacy chains also agreed to watch for suspicious orders, report any “problematic” prescribers, and to strictly limit the amount opioid pain medication they can dispense in any given month. Opioids, in effect, were going to be rationed to their customers.

Pain patients are now paying a price for that agreement.

In a large survey of nearly 3,000 pain patients by PNN, over 90% of those with an opioid prescription said they experienced delays or problems last year getting their medication. Most patients went to another pharmacy, but nearly 20% still couldn’t to get their prescriptions filled – largely because opioids such as hydrocodone and oxycodone are in short supply.

The average patient had problems at a pharmacy at least three times in 2023. Some had trouble each time they went in for a monthly refill.

“I spent eight days trying to get my last prescription pills and finally got it filled two days ago, but I had to settle for only one third of my prescription,” said a patient who went through withdrawal for 8 days waiting for her medication.

“It's an unreal concept that I can have the piece of paper, I can have the doctor, I can have the pharmacy, I can have the money, and I can have the insurance, but I can't go and have the little medicine that I need to try to make it through this situation.” 

HOW MANY TIMES DID YOU HAVE A PROBLEM OR DELAY FILLING AN OPIOID PRESCRIPTION IN LAST 12 MONTHS?

‘There Is Always an Issue’

Asked which pharmacy chain was the most difficult to get an opioid prescription filled, over half the patients in our survey selected either Walgreens (30%) or CVS (26%).

“I've used Walgreens for all of my medications for the past 15 years and within the past year or so I have started having issues almost every month with them filling my pain medication,” a patient told us. 

“My local CVS says that they cannot get hydrocodone-acetaminophen at all. Yet, my local Giant Food supermarket can. Very strange,” said another. 

“I used Walgreens for many years. Recently they have had several new pharmacists. One pharmacist would not fill ANY controlled substances. The current pharmacist will only order about 3 to 4 times per month. She doesn’t care if patients don’t get their medications,” another patient wrote. 

“CVS continually gives me a hard time to fill my Rx even though I have been on it for over 7 years. It is either out of stock, or they argue with me about filling it,” said another. 

“Every month when I have to get my medication renewed there is always an issue,” explained another patient. “Walgreens always give people a hard time. I've seen many people standing in line and just walk out.” 

Patients also had trouble getting their prescriptions filled at Walmart, Kroger, Rite-Aid, Publix and small independent pharmacies, but they had far fewer complaints. CVS and Walgreens have about four times as many pharmacy stores as Rite-Aid, which may explain why they were singled out more often than the other chains.  

AT WHAT PHARMACY DID YOU EXPERIENCE THE MOST DIFFICULTY GETTING AN OPIOID PRESCRIPTION FILLED?

When told about the findings from PNN’s survey, CVS declined to comment and Walgreens provided a brief statement saying it “follows all applicable federal and state laws and regulations related to the dispensing of controlled substances.” 

More Cautious Dispensing

Even before signing the opioid settlements, Walgreens and CVS were among the first pharmacy chains to look at ways to minimize their dispensing of opioid medication.  

In 2017, CVS said it would limit the dose and supply of opioids to patients enrolled in commercial, employer or Medicaid health plans. The policy was adopted after CVS was fined hundreds of millions of dollars for violations of the Controlled Substances Act, many of those violations involving opioids. 

In 2013, Walgreens adopted a “secret checklist” that required its pharmacists to look for red flags, such as patients paying for opioids in cash, seeking an early refill, or taking a high number of pills. If anything was suspicious, pharmacists were told to “inform the patient that it may take additional time to process the prescription.”  Like CVS, the policy was implemented after Walgreens was fined millions of dollars by the DEA for violating rules for dispensing controlled substances. 

Walmart and Kroger also signed the National Opioid Settlements, while Rite-Aid filed for bankruptcy, in part due to the expense of defending itself in court. Thousands of pharmacies around the country are being closed due to over-expansion, poor business decisions, and the rising cost of lawsuits. 

Patients have noticed that the fines and lawsuits have made pharmacists more cautious. In our survey, dozens of patients said a pharmacist told them they would not fill their opioid prescription because they might get in trouble or lose their job. Many patients don’t know it, but pharmacists have a “corresponding responsibility” to exercise their professional judgement by not filling a prescription they think is inappropriate.

“Pharmacies and pharmacists have become an arm of law enforcement,” one patient wrote. “Pain medication prescriptions are treated as suspicious, with the pharmacist often questioning the appropriateness of my current MME (morphine milligram equivalent) levels while I’m undergoing a rapidly forced taper,” one patient wrote. 

“I have been hung up on just for calling (CVS) and asking if they would put my prescription in the queue for filling the next day. Call disconnected by pharmacist,” another patient said. “I emailed a written complaint to CVS and never heard back.” 

“The new manager in pharmacy at Walgreens, which is where I have gotten my pain medicine for 20 years, feels that I receive too much even though he has no idea of my diagnosis. He makes me feel like I am a low-class drug addict,” a patient told us. “I get much less than so many people I know, so I finally had to switch to mail order with OptumRx.” 

‘Independent Pharmacies Are Better’ 

Many patients have found that it’s easier to get a prescription filled at smaller pharmacy chains or at independent pharmacies that were not caught up in opioid litigation.  

“Independent pharmacies are better. I used to fill my opioid scripts at Walgreens. The pharmacist there always gave me a difficult time. He would refuse to fill unless he received a confirmation note from my pain specialist that I was taking the appropriate dose. I finally left him for an independent pharmacy,” one patient told us. 

“I'm fortunate to have a compassionate, independent pharmacy that bends over backwards to ensure I have the meds my doctor prescribes. If I was stuck with a chain pharmacy like Walgreens or CVS, my experience would be completely different. Those pharmacies treat pain patients like criminals,” wrote another. 

“I have used a small mom and pop pharmacy for over five years with no problems. Their only requirement is I get all my prescriptions filled at their pharmacy, not just the opioid or muscle relaxant,” said another patient. “Prior to changing, I had used CVS and Walgreens pharmacies, with both offering nothing but problems and harassment when taking my scripts in.” 

“Thankfully, I live in a very small town and have had a great experience with my pharmacy so far. Small mom and pop set up. So far, only handful of times had them short me pills when they were unable to obtain the meds. Only had to wait a day or two for them to fill the rest,” wrote another patient.

‘My Pharmacist Is Awesome’

While often frustrated by the ordeal of getting their prescriptions filled, many patients appreciate how they are treated by pharmacists. Asked what their overall experience has been with pharmacists, respondents were evenly divided. Nearly a third said their experience with pharmacists was “very positive” or “positive” – about the same number who said their experience was “negative” or “very negative.”      

“My pharmacist is pretty awesome and always has the opioid medications in stock,” one patient said. 

“Generally, my treatment at pharmacies has been first rate. Not so much the doctors,” said another. 

“My pharmacist is excellent and knowledgeable,” another patient wrote. 

“I made friends with my pharmacist because he knows I have several chronic pain syndromes,” another patient told us. “When I first met him, he didn't want to fill me, but now he helps me get my meds filled.” 

“In my experience, it’s pharmacist specific. Some are compassionate, others think everyone is an addict,” another patient said.

OVERALL, WHAT HAS BEEN YOUR EXPERIENCE WITH PHARMACISTS AS A PAIN PATIENT?

PNN’s online survey was conducted from November 13 to December 31, 2023. A total of 2,961 U.S. pain patients or caregivers participated.

FDA and DEA Silent as Rx Opioid Shortages Worsen

By Pat Anson, PNN Editor

Shortages of opioid pain medication in the U.S. appear to be worsening, with no apparent action from the FDA or DEA to ease the suffering of patients left in uncontrolled pain or going into withdrawal.

Last week the American Society of Health-System Pharmacists (ASHP) added another widely used painkiller to its drug shortage list: oxycodone/acetaminophen tablets, which are more widely known under the brand names Percocet and Endocet. The medication is typically prescribed for moderate to severe pain.   

The ASHP reports that five drug makers are either running low or have exhausted their supply of oxycodone/acetaminophen in 2.5, 5, 7.5 and 10mg tablets.  Amneal, Major and Rhodes did not provide ASHP with a reason for the shortage, while Camber and KVK-Tech said they were “awaiting DEA quota approval for active ingredient.”

Amneal, Camber and KVK-Tech said the tablets were on back order with no estimated resupply date. Major and Rhodes said additional supplies were expected in mid-September or early August, respectively. Limited supplies and doses of oxycodone/acetaminophen tablets are still available from other drug manufacturers.

There are already shortages of two other widely used painkillers. The AHSP put immediate release oxycodone on its list of drug shortages in March and added hydrocodone/acetaminophen tablets to the list in May.  

But those shortages have yet to be acknowledged by the FDA. Asked why oxycodone and hydrocodone were missing from the FDA’s drug shortage list, a spokesperson referred PNN to an FDA website for “Frequently Asked Questions about Drug Shortages.”

One possible explanation, according to the website, is that the FDA “focuses on shortages that have the greatest impact on public health.” Shortages are also not reported if they are expected to be resolved quickly, if other substitutes are available, or if there are only local supply issues.

Manufacturers are required to report shortages and supply interruptions to the FDA, while providers, hospitals, pharmacies and consumers can report them by email to drugshortages@fda.hhs.gov.  

‘No One Seemed to Care’

At PNN, we hear from readers almost daily about opioid shortages.

“I am now past my usual fill date,” said Rick Martin, a retired pharmacist in Las Vegas who lives with chronic back pain. “My CVS pharmacist manager told me that she was told by their wholesaler that hydrocodone won't be available until the middle of August.” 

Martin said pharmacists at Walgreens, Smith’s and Sav-on have also told him they were out of oxycodone and hydrocodone tablets.  

“It's been spotty for 6 months but now seems entrenched. I got switched to tramadol. Not as effective, but I can just barely get by. I've heard that's what doctors are doing. Tramadol or Tylenol with codeine,” he told PNN.

Steve Keating, another Las Vegas resident, has been taking oxycodone for chronic neck pain after his vehicle was rear-ended by another driver. He had no problems getting his prescription refilled at either Walgreens or CVS, until last month. Now he is out of pain medication. 

“I began having withdrawal symptoms. No one seemed to care,” said Keating, who turns 73 this month. “The pharmacy recommendations were to obtain tramadol, which I've tried in the past and found ineffective.  I cannot take opiates with acetaminophen as it upsets my stomach.   

“It seems that there is a huge gap between prescribers, pharmacies and whatever governmental agencies are involved.  Do these governmental idiots not realize how important the medication we've been prescribed for months or years is to give us some degree of a better quality of life?” 

There are several reasons behind the opioid shortages. It started with misleading information that demonized prescription opioids and the false portrayal of patients and doctors as the primary cause of the “opioid epidemic.” That was followed by medical guidelines that discourage opioid prescribing and a tsunami of opioid litigation that cost drug makers, wholesalers and pharmacies tens of billions of dollars. 

Egged on by politicians, the Drug Enforcement Administration also aggressively cut production quotas for opioids and other controlled substances, reducing the supply of oxycodone by 65% and hydrocodone by 73% since 2013.  

DEA PRODUCTION QUOTAS FOR OXYCODONE (KILOGRAMS)

SOURCE: DEA

The DEA quotas are rigidly enforced, making it difficult for a drug maker to boost production of opioids when another manufacturer has shortages or discontinues production, like Teva Pharmaceutical recently announced.

It’s not just opioids in short supply. Drugs used to treat cancer and attention deficit disorder (ADHD) are also hard to get. These problems have been building in plain sight for years, yet the FDA’s commissioner says there is little his agency can do to correct them.

“We wish that we could fix all these things, but we don't make the medicines and we can't tell someone that they must make medicines. There are some things that are out of our control,” FDA Commissioner Robert Califf, MD, said in a May interview. 

That’s not exactly true. The DEA sets annual production quotas for drug makers only after consulting with the FDA. The 2023 DEA quotas for hydrocodone, oxycodone and several other opioids were cut — for the 7th year in a row — based on the advice of the FDA.

“FDA predicts that levels of medical need for schedule II opioids in the United States in calendar year 2023 will decline on average 5.3 percent from calendar year 2022 levels,” the DEA said in a notice published last year in the Federal Register.   

DEA administrator Anne Milgram, meanwhile, has not made any public comments about shortages of opioid medication. In a recent appearance on Meet the Press, she said illicit fentanyl was being used to make counterfeit versions of prescription opioids — the same legal drugs that are now in short supply due to DEA actions.

“They're pressing it into these fake pills made to look exactly like oxycodone or Percocet or or Adderall, when it's just fentanyl and filler. So tens of thousands of Americans are dying without having any idea that they're taking fentanyl,” Milgram said.

(Update: On August 1, Milgram and Califf released a joint letter saying the FDA and DEA were working “as quickly as possible” to resolve the drug shortages, but took no responsibility for causing them. The letter only addressed shortages of prescription stimulants used to treat ADHD, binge eating and narcolepsy. It makes no mention of opioid shortages.)

Home Delivery of Rx Opioids Would Help Chronic Pain Patients

By Pat Anson, PNN Editor

We hear almost every day from people in pain who say they can’t get an opioid prescription filled because their pharmacy is out of stock. Often, the pharmacist has no idea when the next shipment of pain medication is coming.

“Walgreens cannot fill my prescription. They say the drug is on back order with no ship date available,” a patient recently told us.

“20 years on the same Rx for Vicodin and now CVS says they are out of stock and no idea when it will be available,” another patient wrote.

“Just talked to a pharmacist today that said they are out of Percocet, Vicodin and morphine. They said that their supplier, Cardinal Health, wasn't sure when they would get more,” said another patient.

Now imagine, if you will, what it would be like to have a pharmacy that delivers opioid medication directly to your home. No more standing in line at the pharmacy. No more dirty looks from the pharmacist. No more excuses about being out of stock.

For about 1,000 patients in the Philadelphia area, most of them chronic pain sufferers, that fantasy is a reality. They are customers of a boutique pharmacy in the Delaware Valley that specializes in home deliveries of controlled substances – including high dose opioids.  Prescriptions and refills are delivered on a carefully managed schedule before a patient runs out, becomes disabled by uncontrolled pain, and goes into withdrawal.

“We hand deliver directly to the patient. I have a whole delivery team. They're our own drivers, our own vehicles,” says Brian Dunleavy, CEO of PMC Pharmacy. “Our customers get notified when their delivery is anticipated to arrive at their home. And then every patient has to sign for it. They have to be present or we can't leave it there. Or it has to be an adult that's been authorized to receive the medication.”

I first heard of PMC Pharmacy when it sent out a news release last month to address difficulties that some patients have getting opioids and other controlled medications from other pharmacies in the Delaware Valley. PMC said it could help those patients avoid gaps in drug therapy and was committed to keeping them “on schedule, at home, and independent.”

“We should really have every chronic pain management patient in the Delaware Valley under our care because of the way our program works,” Dunleavy told PNN.

While big chain pharmacies and their wholesale drug suppliers are under increased scrutiny from law enforcement and regulators, PMC flies under the radar because its customers’ medical conditions, prescriptions and insurance claims are carefully documented – reducing the risk of diversion or misuse.     

“We won't take patients from a typical primary care practice, we're only working with chronic pain specialists who give us (patient) chart notes and supporting documentation to satisfy our wholesalers’ desires that we're doing due diligence on all these doctors and all these patients, and making sure that there's a legitimate need for the medication,” Dunleavy explained. “The diversion isn't coming from the people that are legitimate chronic pain patients. Those people hold onto that medication as if it's their lifeline.”

Trifecta of Problems

The supply of opioids and other controlled substances is tight because of a trifecta of problems that have hamstrung the pharmaceutical industry.

First, the Drug Enforcement Administration has been aggressively cutting opioid production quotas for nearly a decade, reducing the supply of oxycodone by 65% and hydrocodone by 73% since 2013.

Second is the fallout from opioid litigation. The nation’s three largest drug wholesalers reached a $21 billion settlement with 46 states, requiring them to impose strict limits on opioid shipments to pharmacies. CVS, Walgreens and other pharmacy chains have also paid tens of billions of dollars to settle lawsuits that alleged they helped fuel the overdose crisis by dispensing too many opioids.  

The third reason for tight supplies is a retooling of the generic drug industry. There’s little money to be made in selling most opioids and there’s a risk of further liability, so drug makers are cutting back production of many generic opioids.  One of the world’s largest manufacturers of generics, Teva Pharmaceutical, recently notified the FDA that it was discontinuing production of oxycodone.

It all adds up to an increasing number of drug shortages, involving not just opioids, but medications used to treat cancer, anxiety and attention deficit disorder. Dunleavy thinks the shortages are a direct result of regulatory overreach.

“You have all these things going on and everybody's like, ‘Oh well, there's a shortage of oxycodone out there.’ And in actuality, there isn't. It's a regulatory created shortage, which is why there's a discrepancy between what we're hearing from patients versus what we see at the on the wholesalers’ shelves,” he explained. “The pharmacies can't get those drugs because they're quantity restricted by the wholesalers, based on the programs that the wholesalers have implemented to police the pharmacies.”

Dunleavy says PMC would like to add more patients to its customer base, provided they live in its delivery area in southeastern Pennsylvania and parts of New Jersey and Delaware that border Philadelphia. He’s confident he’ll be able to get the additional medication from suppliers.

“You're not going to have a better adherence and compliance program from a pharmacy than ours,” he said. “Because our program is pain management specific, once we start working with a practice, we start getting quite a few referrals. So it's very easy for us to start growing.”

Could PMC’s business model be adopted by other pharmacies? With pain management under so much scrutiny, Dunleavy says home deliveries to selected patients make sense.

“There's a legitimate need for a pharmacy that puts in a little bit more effort, that's a little bit more specialized. Because the regulatory environment requires it, the patients require it, and the physicians require it,” he said.

“This is a very interesting concept. It almost sounds too good to be true, but if it really works it would be tremendously helpful to many chronically ill people,” says Kristen Ogden, a patient advocate in Virginia. “I think this concept may be really helpful to house-bound patients and persons with limited access to transportation, especially those who don't have an engaged family member helping them.”  

For many years, Kristen and her husband Louis have traveled to California to get the high dose opioids he needs to treat severe pain from arachnoiditis and Ehlers-Danlos Syndrome. Not having to make that monthly cross-country trip for refills would be a welcome relief to the Ogdens.  

“It would be great to think this sort of service would be available to us as we get older, especially since we have no children and no other family members who live in our area to assist us. This could certainly be a big factor in enabling older adults to continue living in their own homes if that's what they prefer to do,” Kristen said. 

The American Society of Health-System Pharmacists put immediate release oxycodone on its list of drug shortages in March and added hydrocodone/acetaminophen tablets to the list in May.  Neither shortage has yet to be recognized by the FDA, although many patients are already well aware that both medications are in short supply. 

“I've been waiting for over a week for oxycodone to come in. Over the last weekend, I went to over 25 different pharmacies searching, until I couldn't drive anymore. It's not fair to any of us!” a pain patient recently told PNN

Lawyers: ‘We Have Nothing To Do’ With Fundraiser for Kolodny Lawsuit

By Pat Anson, PNN Editor

The attorneys who filed lawsuits against three pharmacy chains for allegedly discriminating against pain patients are disavowing any connection with efforts to raise money for a proposed lawsuit against Dr. Andrew Kolodny, a prominent anti-opioid activist.

Dr. Arnold Feldman, a retired anesthesiologist, has a GoFundMe campaign underway to raise $100,000 for a class action lawsuit targeting Kolodny, the founder and Executive Director of Physicians for Responsible Prescribing (PROP). Feldman calls Kolodny an “anti-opioid zealot” who has harmed pain patients through his advocacy against opioid prescribing.

“To be clear, we have no involvement in or with any fundraising efforts by Dr. Feldman or others who may be associated with him or a possible lawsuit against Dr. Kolodny,” attorney Robert Redfearn, Jr. said in a statement to PNN. “Our focus and involvement is on and in the two national class action lawsuits that we filed in Rhode Island and California, through which we hope to bring some relief to pain patients.  Further, we have not received or accepted any funds from Dr. Feldman or others who may be associated with him.”

Feldman and his associate, Claudia Merandi, have claimed they were instrumental in filing the lawsuits against CVS, Walgreens and Costco on behalf of two pain patients. Merandi is one of the founders of the Don’t Punish Pain rally organization.

“BIG NEWS FOR PAIN COMMUNITY: We have filed class action lawsuit against CVS/WALGREENS for DENYING to fill opioid scripts. This will set a precedent as to why you DON'T PUNISH PAIN,” Merandi posted on Twitter when the lawsuits were filed in August.

“Dr. Feldman was successful in bringing a class action lawsuit against Walgreens and CVS to fruition and he will do the same for the Kolodny lawsuit,” Merandi posted to her followers on Facebook, sharing a link to the GoFundMe campaign.

“Fact: There's only a lawsuit filed against CVS and Walgreens because of Dr Feldman,” Merandi wrote in yet another tweet.

‘We Are Litigating This on Our Own’

But the lawyers who actually filed the lawsuits say Feldman and Merandi had nothing to do with their litigation, other than providing encouragement.

“In terms of their involvement, there is none. We are litigating this on our own,” said attorney Scott Hirsch. “We obviously don’t agree with Claudia’s stance that this is her lawsuit. It’s not. We’re representing the plaintiffs and the chronic pain community.”

Hirsch began working with Edith Fuog on her lawsuit against CVS in 2018, long before Merandi and Feldman were even aware of the case. He has been working without pay, which is usually the case in class action lawsuits. Attorneys are typically not paid until damages are awarded.

“We have nothing to do with any sort of fundraising that Claudia Merandi and Dr. Feldman are doing in terms of this lawsuit. There’s no fundraising that we’re doing or they’re doing for us or this Kolodny lawsuit. We have nothing to do with that. We’re not even interested in it, to be quite frank,” Hirsch said.

Hirsch, Redfearn and four other law firms are involved in the pharmacy lawsuits, which they hope will get class action status. If successful, the suits could potentially result in millions of dollars in damages being awarded to pain patients who were unable to get their opioid prescriptions filled.

“All these people came together and brought this lawsuit. It wasn’t just Dr. Feldman, he wasn’t the savior for us all. And that’s my issue. It’s not 100 percent truthful in her (Merandi’s) statement. There’s a lot missing,” Fuog told PNN. “I don’t know anything about what they’re doing with Dr. Kolodny. I don’t know who they are hiring. I don’t know where the funds are sitting until they hire a law firm. I don’t know the basis for the lawsuit that they want to file.”

So many misleading claims have been made that the six law firms representing Fuog and Susan Smith, who filed suit against Walgreens and Costco, have posted a disclaimer on their website disavowing any association with the GoFundMe campaign and Don’t Punish Pain.

“These groups on the internet, such as Don’t Punish Pain, have posted information about our lawsuits on their websites, Facebook, Instagram and other social media. This content is not affiliated with the lawsuits or our effort on behalf of chronic pain patients.

Please understand no organization except the affiliated lawyers and law firms handling these National Class Action Lawsuits are authorized to speak for us or make any financial or informational request on our behalf. In other words, please be advised that all other individuals or groups are NOT authorized to speak on behalf of us or the named plaintiffs in the lawsuits, NOT involved in the handling or prosecuting of the lawsuits, and NOT authorized to raise money to cover expenses associated with the lawsuits.”

Asked to clarify what role he played in the lawsuits, Feldman told PNN he “sounded the alarm” and alerted lawyers to what was happening to pain patients. He said his wife is among those who’ve had trouble getting their opioid prescriptions filled.

“I knew some lawyers and I said, ‘Guys, this is a problem. What do you think?’ And I harangued them and harassed them and called them and screamed at them,” Feldman explained.  “But I had nothing to do with it. I didn’t write the complaint. I didn’t file the complaint.

“I had nothing to do with this litigation. Nothing. Neither does Claudia. Other than the fact that we said we’re happy this has happened. That’s the extent of it.”

Merandi says she exchanged emails and participated in Zoom calls with the lawyers. And she continues to insist that Don’t Punish Pain was the driving force behind getting the CVS lawsuit filed in her home state of Rhode Island.

“This lawsuit was born out of the Don’t Punish Pain organization,” she claimed in a Facebook video feed, not mentioning that the lawsuit was filed in Rhode Island because CVS corporate headquarters is located there.

To date, nearly $12,000 has been donated to the GoFundMe campaign, with most of the money coming from hundreds of small donors, many of them pain patients.

Feldman says he and Merandi have had discussions with several lawyers, but so far no one has been willing to take the case against Kolodny.

“I had nothing to do with this litigation. Nothing. Neither does Claudia. Other than the fact that we said we’re happy this has happened. That’s the extent of it.”

— Dr. Arnold Feldman

“No, we haven’t found a lawyer yet,” he said. “But we’re going to find somebody. We’re talking about billions of dollars in litigation.”

“We want to raise a lot of money to pay these lawyers. Lawyers need to get paid and that’s why this GoFundMe is important,” Merandi said while promoting the fundraiser in a recent radio interview. “We need an investigation done and that costs money.”

Until a law firm is found, Feldman says the donated funds will remain untouched in a bank account. “I haven’t taken a dime. Nor will I ever. When we have enough money and find a law firm, that’s where the money will go,” he said.

Asked what would happen if no lawyer take the case, Feldman said the donated funds would be returned to donors. 

“It’ll be a pain in the ass, but of course. I’m not going to buy a BMW with it, I’ll tell you that much. I’m honest as the day is long. I would starve before I took that money,” Feldman said.

Lawyers May Not Expand Lawsuits Against Pharmacy Chains

By Pat Anson, Editor, PNN Editor

Lawyers involved in class action lawsuits that allege pain patients were discriminated against by three major pharmacy chains are being tight-lipped about whether the lawsuits may be expanded to include additional plaintiffs and pharmacies.

The lawsuits were filed earlier this month in California and Rhode Island against CVS, Walgreens and Costco on behalf of two women who say the pharmacies refused to fill their prescriptions for opioid pain medication.

At least six different law firms around the country are handling the cases. They’ve set up a website called Seeking Justice for Pain Patients, which invites other patients to participate in the lawsuits by sharing their personal information and experiences at pharmacies. It’s not yet clear how the information will be used or if the cases will be expanded.

“Pain patients have been contacting us in response to the lawsuits. The overall response has been very positive and happy that some action is being taken,” Robert Redfearn, a Louisiana attorney, said in an email to PNN. “Though there are no plans to do so at this time, additional individual named plaintiffs could possibly be added, but if a national class is certified, it should not be necessary.” 

Other lawyers involved in the lawsuits did not respond to requests for comment.

Redfearn represents Susan Smith, a 43-year old mother from Castro Valley, California who lives with severe chronic migraines. The only medications that give her relief from head pain are opioids. Smith says pharmacists at Walgreens and Costco refused to fill her opioid prescriptions and publicly shamed her.

“After being harassed by pharmacists [and] pharmacy staff for a number of years — being laughed at, being called names in front of my child — I really couldn’t take it anymore,” Smith told the San Francisco Examiner. “It has been really stressful, demoralizing, not to mention discriminating. On top of that, they were making it really hard for me to live a pain-free life.”

‘Find a New Pharmacy’

“There has to be a change,” says Edith Fuog, a 48-year old Tampa, Florida mother who filed the lawsuit against CVS. Fuog has lived for many years with trigeminal neuralgia, lupus, arthritis and other chronic pain conditions.

“People need to understand what is happening. Everybody in their life is going to be a pain patient at one point or another, whether it’s an accident, becoming elderly, a disease or cancer. If this is happening to people who have chronic pain, the people who are just coming in with acute pain are never going to be treated.”

Fuog told PNN she had no trouble getting her opioid prescriptions filled at a CVS pharmacy until the CDC’s controversial opioid prescribing guideline was released in 2016.

“As soon as those guidelines came out, my life changed. The manager pulled me aside and said, ‘Look, I’m not going to be able to fill these anymore. I suggest you find a new pharmacy.’” said Fuog, who then went to other CVS pharmacies in the Tampa area and was repeatedly turned down.

“They all said, ‘We’ll be happy to fill all your other meds, but we will not fill the opioids.’ And I said, ‘I take 13 other medications. Why would I come here then?’”

EDITH FUOG

Fuog eventually found a small neighborhood pharmacy that was willing to fill all of her prescriptions. She also found a lawyer to file the class action lawsuit against CVS. If her case is successful, Fuog anticipates making only a few thousand dollars in damages.

“It’s not like I’m going to make a bunch of money. The decision could come down for a hundred million dollars, but that’s for the class and the attorneys. I’ll get a ‘rep fee” being the class rep. That’s it. I don’t get anything for my damages or the stress I go through, and the fact I have severe anxiety because of this,” she said.

Fuog says she will only settle out-of-court if CVS adopts a written public policy that makes clear to its pharmacists that they should fill all legitimate prescriptions for opioids.

“My goal in this is to make change that affects the most amount of people with chronic pain. If I can get them a lot of money, I’m going to do it. Why wouldn’t I? To me, these companies deserve to pay all these people money for what they’ve been through,” she said.

Costco, CVS and Walgreens did not respond to requests for comment.  CVS, Walgreens and other large pharmacy chains have been named in lawsuits alleging they helped fuel the opioid epidemic by selling millions of pills in small communities. They’ve also been fined hundreds of millions of dollars for violating federal rules for dispensing controlled substances.

Pharmacies Sued for Discrimination Against Pain Patients

By Pat Anson, PNN Editor

National class action lawsuits have been filed against three of the nation’s largest pharmacy chains for discriminating against pain patients trying to fill legitimate prescriptions for opioid medication. 

Class action complaints against Walgreens, Costco and CVS Pharmacy were filed in California and Rhode Island on behalf of two women seeking legal relief that will allow them to get their opioid prescriptions filled without delays or restrictions, and without the fear that their prescriptions will be denied. 

Edith Fuog, a 48-year old Florida woman and breast cancer survivor, lives with trigeminal neuralgia, lupus, arthritis and other chronic pain conditions. Fuog’s lawsuit alleges that since 2017, CVS pharmacies have refused to fill her prescriptions for opioid medication in violation of the American with Disabilities Act (ADA), the Rehabilitation Act of 1973 and the anti-discrimination provisions of the Affordable Care Act.  Her complaint was filed in Rhode Island, where CVS has its corporate headquarters.

43-year old Susan Smith of Castro Valley, California, filed a similar class action against Walgreens and Costco in the Northern District of California. Smith suffers from Mesial Temporal Lobe Sclerosis, which resulted in scar tissue in her brain that causes severe chronic migraines. The only medication that gives Smith relief from headache pain are opioids.  She alleges that Walgreens and Costco pharmacies refused to fill her opioid prescriptions in violation of federal law.

"Many Americans are unaware of the difficulties chronic pain patients have getting pharmacies to fill their lawfully-obtained opioid prescriptions. It is not only a crisis for Edith and Susan, but for millions of Americans due to the backlash caused in part by the national publicity concerning opioid abuse,” said Scott Hirsch, a Florida lawyer who is one of several lead attorneys handling the cases.

“These lawsuits seek to allow the millions of chronic pain patients to obtain their legitimate opioid prescriptions without being discriminated against, harassed, denied, or embarrassed.  It will hopefully improve their quality of life and save many lives in the process."

Pain patients in the U.S. have complained for years about pharmacists refusing to fill their opioid prescriptions or reducing them to lower doses. It’s also not uncommon for patients to encounter delays and excuses, such as a pharmacy claiming it was out of stock of a particular medication. The California and Rhode Island cases are believed to be the first class action lawsuits to address the problem.

“I have always thought that this is one of the better potential legal avenues for an ADA action regarding prescription opioids.  It is a violation for any person with a disability to be denied service by a place of public accommodation, and pharmacies are clearly covered as places of public accommodation under the ADA,” said Kate Nicholson, a patient advocate and civil rights lawyer who handled discrimination cases at the Department of Justice for over 20 years.

“Whether this will succeed will depend on a lot of intangibles such as the quality of the complaints, what is learned during discovery about any nationwide policies the pharmacy chains had in place, or, alternatively, repeated instances of fills for legitimate prescriptions being denied. Also, whether the court which hears it considers the refusal to fill prescriptions tantamount to a denial of service. I think it’s promising.”

Corporate Policies Profile Patients

While pharmacies have a legal right to refuse to fill prescriptions they consider suspicious or inappropriate, the lawsuits allege that CVS, Walgreens and Costco adopted corporate policies that encourage their pharmacists to profile patients as drug abusers and impose limits on opioid medication. The companies did not respond to a request for comment.

Walgreens adopted a “secret checklist” in 2013 that required its pharmacies to watch for red flags such as patients paying for opioid prescriptions in cash, seeking an early refill or taking an “excessive” number of pills. If anything was suspicious, pharmacists were instructed to “inform the patient that it may take additional time to process the prescription.”  The policy was implemented after Walgreens was fined $80 million by the DEA for violating rules for dispensing controlled substances.

CVS adopted a policy in 2017 to limit the dose and supply of opioids for short-term, acute pain to seven days. For both acute and chronic pain, opioid prescriptions were not filled if they exceeded a 90mg MME daily dose. Customers enrolled in CVS’ pharmacy benefit plan were also required to try immediate release formulations, before using extended release opioids. The policy was adopted after CVS was fined hundreds of millions of dollars for violations of the Controlled Substances Act.

In a recent letter to the CDC, the American Medical Association called the CVS and Walgreens policies "inappropriate" because they misapplied the CDC opioid guideline in ways that were harmful to patients. The AMA said it has received numerous complaints about Walgreens pharmacists refusing to fill prescriptions because of corporate policy.

Other big pharmacy chains have similar policies. Walmart has been accused of “blacklisting” doctors for writing high dose prescriptions. And a tearful video posted online by a California woman with stage 4 breast cancer went viral after a Rite Aid pharmacist refused to fill her prescription for Norco.

The law firms that filed the cases against Walgreens, Costco and CVS are seeking additional information from patients interested in joining the legal action at this website.

Feds Warn CBD Marketers About False Medical Claims

By Pat Anson, PNN Editor.

The Food and Drug Administration and the Federal Trade Commission are tapping the brakes on the fast growing market for cannabidiol (CBD), warning companies not to make false claims that CBD products can be used to treat fibromyalgia, migraine, arthritis and other chronic illnesses.

The agencies sent warning letters to three companies — Nutra Pure, PotNetwork Holdings, and Advanced Spine and Pain — for making false and unsubstantiated health claims about a variety of CBD oils, extracts and edibles.

The FDA and FTC sent the warning letters on March 28 and gave the companies 15 days to respond.

Nutra Pure’s website, according to regulators, claimed that “CBD has demonstrated the ability to block spinal, peripheral and gastrointestinal mechanisms responsible for the pain associated with migraines, fibromyalgia, IBS and other related disorders.”

Claims were also made that CBD is “an effective and safe treatment alternative” for inflammatory conditions such as lupus, Celiac disease and rheumatoid arthritis.

Nutra Pure, which makes a line of hemp oil, has a small disclaimer on its website stating that “these products are not intended to diagnose, prevent, treat, or cure any disease.”

NUTRA PURE IMAGE

PotNetwork has a similar disclaimer on its website, where it sells everything from CBD infused gummy bears and energy drinks to moisturizers and pet care products. According to the FDA, the company falsely claimed that CBD “blocked the progression of arthritis” and “has also shown the ability to kill cancer cells directly.”  

In addition to marketing CBD products, Advanced Spine and Pain also offers stem cell therapy, steroid injections, trigger point injections and ketamine infusions at its “Relievus” clinics in New Jersey and Pennsylvania.

‘Open Questions’ About CBD Safety

The federal crackdown on CBD marketing comes at a time when CBD products are starting to appear in mainstream stores. CVS Pharmacy and Walgreens started selling cannabis-based lotions, tinctures, edibles and lozenges in stores last month. The CBD products are being sold over-the-counter and without a prescription.  

The FDA and FTC announced no actions against CVS, Walgreens or other retailers selling CBD products, but they sent a clear message that the marketing of CBD will be closely watched.

“We treat products containing cannabis or cannabis-derived compounds as we do any other FDA-regulated products. Among other things, the FDA requires a cannabis product (hemp-derived or otherwise) that’s marketed with a claim of therapeutic benefit to be approved by the FDA for its intended use before it may be introduced into interstate commerce,” FDA commissioner Scott Gottlieb, MD, said in a statement. “Additionally, it is unlawful to introduce food containing added CBD, or the psychoactive compound THC, into interstate commerce, or to market CBD or THC products as dietary supplements.”

The 2018 Farm Bill removed hemp – a less potent strain of marijuana – from the Controlled Substances Act. That made hemp products legal to sell, but left the FDA in charge of regulating dietary supplements containing CBD. The agency is still trying to figure out how to regulate a product for which there is growing consumer demand, but little scientific evidence to support its use.

“While the availability of CBD products in particular has increased dramatically in recent years, open questions remain regarding the safety considerations raised by their widespread use,” Gottlieb said. “There are also unresolved questions regarding the cumulative exposure to CBD if people access it across a broad range of consumer products, as well as questions regarding the intended functionality of CBD in such products.”

Gottlieb has announced plans to hold a public hearing on May 31 to review the safety and effectiveness of CBD products. The FDA is also forming an internal working group within the agency to explore what regulatory changes would be needed for CBD products to be marketed legally.  

Would You Support a Boycott of CVS?

By Pat Anson, Editor

One of the most talked about issues in the pain community over the last two weeks has been CVS Health’s announcement that its pharmacists would soon start restricting doses of opioid pain medication and limit the supply of opioids for acute pain to 7 days.

The policy only applies to customers enrolled in CVS Caremark’s pharmacy benefit management program, but it quickly triggered an online backlash from pain patients – including many who called for a boycott of CVS.

“I refuse to patronize companies that practice medicine without a license,” wrote Jeannette on PNN’s Facebook page.

“Don’t go there anymore. Hit them in their pocketbook,” wrote Lauren.

“I very rarely use a CVS and will never go there for prescriptions or anything else,” said Jackie.

“I left CVS years ago for Walgreens and I’m guessing many more will be doing so,” wrote Amanda.

"CVS has some nerve. The use of opioids, or any other drug, really, is up to the doctor and his or her patients, not a pharmacist. This is a terrible precedent, which will drive an even bigger wedge between physicians and patients,” cardiologist Arthur Kennish, MD, told the American Council on Science and Health.

The CVS boycott soon had its own hashtag on Twitter.

“Wrong way to handle, CVS! I will join the #BoycottCVS. You make it more difficult for the sick w/ no impact on the crisis,” Stephanie tweeted.

The online outrage even spilled over onto CVS’ Facebook page, where many negative posts were apparently deleted by the company.

“CVS Pharmacy, why did you take down all your Posts and comments regarding your big announcement over overriding doctor's orders and limiting patients' rights to their pain medication?” asked Lauri. “Where did they all go?”

People are so passionate about this issue that we started an online poll asking if they would support a boycott of CVS. Click here if you’d like to participate.

Would a Boycott Work?

But while there’s plenty of online enthusiasm for a boycott, it’s unlikely to be effective without the support of patient advocacy groups.  An informal survey of pain organizations by PNN found most were critical of CVS’ decision, but opposed to a boycott.

“I think boycotting CVS is not a good idea. I think a better idea is working with them for better care and finding the good in what they are doing and amplifying the bad.  They want better education, they want better disposal, and many other things we all fight for,” said Paul Gileno, President of the U.S. Pain Foundation.  “I don't think a boycott would work or be effective and can come across in a negative way. We need a loud conversation with CVS.”

“I don’t typically like boycotts” said Barby Ingle, President of the International Pain Foundation and a PNN columnist. “But if enough people have a bad experience or don’t like the CVS policies, they will see a drop in the market and will have to reevaluate what their policies will be.

“I wouldn’t call it a boycott, I would call it a shift in patients understanding that we have power and that we can choose to go to the healthcare places that fulfill our needs. Unless CVS changes their practices, I can see them continuing to lose business.”

Penney Cowan of the American Chronic Pain Association did not respond to a request for comment.

One patient advocate who gave full support for a boycott was Cynthia Toussaint, the founder of For Grace, a non-profit that supports women in pain.

“The lack of patient advocacy support for the boycott is totally surprising,” Toussaint wrote in an email. “We’ve all been beating the ‘don’t get between a doctor and a patient’ drum for years, and now that we can put our names behind that, we’re being sheepish.

“For Grace is ON BOARD with the boycott! This is chilling news for the pain world - and I hope our support helps many people. We understand CVS’s very real concern about the opioid crisis, but this new policy is too heavy handed and will greatly harm the chronic pain community!”

CVS is not the first pharmacy to restrict access to opioid medication. In 2013, Walgreens gave its pharmacists a “secret checklist” to help them screen patients with opioid prescriptions. Any red flags, such as a prescription written by a new doctor or a patient paying in cash, could result in a prescription not being filled. The policy was implemented after Walgreens was fined $80 million by the Drug Enforcement Agency for violating the rules for dispensing controlled substances.

CVS has also been fined hundreds of millions of dollars for violations of the Controlled Substances Act and other transgressions, many of them involving opioid medication.

A Florida pharmacist who was fired this year by Sam’s Club for not following the company's opioid policy says pharmacies are driven by profit, not patient care, and a boycott is unlikely to change their bottom line. 

“Patients won't need to boycott. CVS doesn't want the business anyway,” says Karl Deigert, who was fired after complaining that patient rights were being violated at Sam’s Club, which is owned by Walmart.  “Corporations are only acting in their own best interest and have no concern for the patient. Patients can save their breath and energy as any complaints filed will fall on deaf ears. 

“Overzealous corporate policy makers have no desire or interest to protect the patients' well-being. Their policy making is self-serving to protect their assets from DEA scrutiny and monetary penalties. The corporations and the majority of retail pharmacists simply do not care to help the chronic pain patient population.”

The new opioid policy at CVS doesn’t go into effect until February 1, 2018. But CVS Caremark is already tightening the rules for some opioid prescriptions. 

A Caremark client who has been getting fentanyl pain patches at CVS for years was recently notified by letter that new limits are being placed on the patches “to help ensure that your use of opioid medication for pain management is safe and appropriate.” 

But is it really about safe and appropriate use?

The letter goes on to say the patient will still be able to get the fentanyl patches, but without prior authorization they “will have to pay 100 percent of the cost.”