The Politics of Medicine

My son attended baseball camp this week at the University of South Florida.  Throughout the week, there were parents who stayed and watched from the stands for the day.  My son asked if I could please come and watch too, so I took this morning off of work to do so, especially because they were doing an award ceremony at the end of the camp day.  I am glad I did, because when they awarded the “Bull of the Week” award (school mascot is a bull) to a child who showed good character, behavior, and a “cannon for a left arm,” my child’s name came at the end of the sentence.

It was an awards ceremony I might have missed because I unexpectedly had to run all over town thanks to the adults who don’t show good character and behavior, and the regulations that have been put in place because of them.

In his eagerness, Aiden has been the first child to arrive at camp all week, and today was no exception.  Since he arrived 30 minutes before activities even started, I told him I was going to run up to the pharmacy and get his prescription filled, and I’d be back as things were starting.  Big mistake.

Aiden’s prescription is for an ADHD medication, a medication which not only improves his focus and decreases his frustration and tendency to get overwhelmed, it has some unexpected effects like handwriting which now can actually be read and shoes which, at a week before his 12^th birthday, he can now tie.  He’s been on it for just a few weeks over a year, a year in which he has been a visibly happier, less anxious child.  After already using behavior modification techniques and diet changes which have helped quite a bit, the addition of the medication has made a tremendous difference in the quality of his life.

It is classified by our government as a Schedule II Controlled Substance.  As such, it is subject to certain restrictions.  Prescriptions cannot be called or faxed in, they must be presented in hard copy form, and there can be no refills allowed.  This means I have to drive to the doctor’s office on the other side of the city (pediatric neurologists are certainly not a dime a dozen!) every month to pick one up, and drop it off and wait for it at the pharmacy instead of being able to just request a refill and have it waiting when I arrive.  Before this morning, I thought that was the biggest nuisance I had to endure.

I had actually gone to the pharmacy to fill the prescription earlier this week, and they were out of his medication. The pharmacy tech told me they got orders in on Tuesdays and Thursdays, so could I come back later in the week.  No big deal, he had enough to last until this morning, as long as I could get it filled before he left for his dad’s for the weekend, we were good.  When I went in this morning, they still didn’t have it, and there was whispering going on between the tech and the pharmacist and careful scrutinization of the prescription.  I was again told orders come in on Tuesdays and Thursdays and to check back. 

At this point, I was a bit frustrated.  I needed the medication today.  I asked if they could please call their store a couple of miles away and see if they had it in stock.

“Well…..”

“Yes?”

“We can call, but they won’t tell us.”

“Excuse me, you have done this for me before?  Maybe not this particular medication, but the last time my son was sick you did it for me.”

“It’s a controlled substance, no pharmacy will tell you unless you present the prescription.  And the prescription has to be a good prescription.  It has to have everything on it that it is supposed to.”

“Is there a problem with the prescription?  This is the same prescription from the same doctor that I bring in to this same pharmacy every month at this same time.”

“No, you have a good prescription.”

“Okay….so, can I get 30 of the 10 mg and a 30 of the 5 mg if you don’t have the 15 mg?”

“Only if you have prescriptions particularly for those.”

“So, can you tell me if you have those in stock before I drive across town and ask the doctor to re-write the prescriptions.”

“No, we have to see the actual prescription before we can tell you.”

I left the bottle of sunscreen I was going to purchase on the counter, and completely forgot to pick up my prescription for my hormone pills that was waiting there, and left to drive on to the next pharmacy. 

It was only 9 am, but I did almost detour into the wine aisle for some reinforcements.

An hour later, I had repeated the same scenario at 3 other pharmacies, and still had not filled the prescription.

One last try. 

“Can you tell me if you have this in stock?  And if you don’t, is it worth my time to continue going from pharmacy to pharmacy to ask?  You are the 5^th pharmacy I’ve tried this morning.  I took the time off of work to go watch my son play baseball and I’m missing it because no one can fill his prescription and no one can tell me when they can and no one can tell me who has it.  He took the last one this morning.”

I don’t know if it was my plea, or the tears in my eyes that did it, but I finally found a pharmacist who would give me some real answers. 

Florida seems to attract a lot of the bad element.  I heard a preacher once say that maybe it was because it was “so hot, the demons get it confused with hell.”  Whatever the reason, there are a lot of problems with painkiller abuse….and doctors and pharmacies that unethically and illegally make them easy to get. So, besides the federal regulations, the state also has their own, and the result is that pharmacies get only a certain “allotment” of Schedule II medications, and once they’ve reached that allotment, well, their customers are just out of luck.  They can be red-flagged as dispensing what the DEA considers more than average, and no one has to supply them (based only on numbers, no consideration whatsoever to how many customers may have prescriptions for a certain thing that use that pharmacy.)  A CUSTOMER can be red-flagged for filling too many prescriptions, even if it is a valid medical reason with valid prescriptions, just because the pharmacist feels they should be red-flagged, something visible to all pharmacies who can then legally refuse to fill a prescription.  And, the best information I received, the major pharmaceutical supplier in this area was flagged by the DEA a little over a year ago, and any pharmacy which uses them as their supplier can no longer get Schedule II medications.  At all.  Once they are out of stock, they are out of stock. 

A lot of these regulations sound great when you are thinking about cracking down on the people doing illegal things.  They really suck when a child can’t get the medication that improves his life.

That 5^th pharmacy, they cancelled their contract with that supplier and begin with a new one on Monday.  They have sent in a special order for my child’s medication, it should be here by Wednesday, per a new regulation that allows a pharmacy to fill for a particular customer even if they have exceeded their quota, something none of the other pharmacies offered to do.  I have 5 capsules of his old dose, at least he can take that until that time.  And I have a new pharmacy, one that doesn’t just assume I am (or my child is!) a criminal just because I have a prescription for a controlled substance in my hand, but rather chooses to treat me with integrity and my child with compassion.

My ID had to be scanned and sent to the DEA to do this, and perhaps I am already red-flagged because I’ve filled a controlled substance for the 13^th time, but my child will have his medication, and I didn’t miss him getting his award at camp.

And that’s why they have wine!  Even if I’ve had to wait hours to have a glass.