The Opiod Crisis and Lawsuits

[TwolfHerdfan]

Obviously most of Appalachia and big cities have a drug crisis going on. Now states and cities are suing the drug suppliers like McKesson, Cardinal and others for distributing the pills. My question is, since these meds usually need a script, why are we not going after the docs that write the scripts for the pain medications? You can't go to Walgreens and pick up a bottle of pain meds without a script?

McKesson and the other companies are just filling the orders for the docs, practices and healthcare facilities. What's everyone's thoughts on this?

 

[Raoul Duke MU]

They should have noticed something was up. Small pharmacy in a tiny town wanting a million pills? That isn't normal. Same as if I walk in a bank with a million dollars in small deposits.

 

[i am herdman]

They should have noticed something was up. Small pharmacy in a tiny town wanting a million pills? That isn't normal. Same as if I walk in a bank with a million dollars in small deposits.

How is that the manufacturer's fault? Aren't pharmacies under an obligation to fill a doctor's prescription? They are not the health provider. The are just filling an order.

 

[Raoul Duke MU]

How is that the manufacturer's fault? Aren't pharmacies under an obligation to fill a doctor's prescription? They are not the health provider. The are just filling an order.

How is it the bank's fault if you launder drug money? Same concept. And yes I know there are reporting requirements for banks, but when something is obvious it is obvious. And a million painers shipped to fuvking Kermit WV is obvious as daylight.

 

[Dreh_Nagi_HC_IM]

There's big money to be had in the so called legal drug business. Kermit is a great example of this. How many people probably call Kermit home? A few hundred at best?

I think the larger drug outlets, like a Rite Aid, Walgreens, etc., likely have mechanisms in place to at least bring this to someone's attention. More than likely, it's the small mom and pop type pharmacies that are making a killing in Appalachia. I have no proof of that, but I bet that's how it's happening.

 

[Dreh_Nagi_HC_IM]

I actually just googled it to see what's up in Kermit. 392 freaking people, and over 9,000,000 pills. A locally owned pharmacy sold 600 times the amount of pain killers as a Rite Aid pharmacy right down the street. Big money maker for Doc and the local pharmacy, as well as the manufacturers. All guilty in my opinion.

 

[i am herdman]

How is it the bank's fault if you launder drug money? Same concept. And yes I know there are reporting requirements for banks, but when something is obvious it is obvious. And a million painers shipped to fuvking Kermit WV is obvious as daylight.

So they are supposed to question a doctor's orders? Then, people would be suing them for that. I could understand if they know what is going and suspect illegal activity but at what point do they draw the line? I do know bigger pharmacies only will fill orders in so many days and require in store pickup and photo ID on certain controlled substances.

 

[TwolfHerdfan]

There's big money to be had in the so called legal drug business. Kermit is a great example of this. How many people probably call Kermit home? A few hundred at best?

I think the larger drug outlets, like a Rite Aid, Walgreens, etc., likely have mechanisms in place to at least bring this to someone's attention. More than likely, it's the small mom and pop type pharmacies that are making a killing in Appalachia. I have no proof of that, but I bet that's how it's happening.

I would say that's a good bet. But again, they aren't going after the docs or the local pharmacies for the most part. They did shut down the pill mill in Williamson last year.

To make matters worse, the cops arrest people but the magistrates put them back out on the streets after paying a reduced bond. Nuts.

 

[TwolfHerdfan]

So they are supposed to question a doctor's orders? Then, people would be suing them for that. I could understand if they know what is going and suspect illegal activity but at what point do they draw the line? I do know bigger pharmacies only will fill orders in so many days and require in store pickup and photo ID on certain controlled substances.

The doc should know something is up after Bubba calls the office after 1 week and asks for a refill. And the doc willingly writes another script. Certainly a lot of layers in this situation.

 

[ThunderCat98]

So they are supposed to question a doctor's orders? Then, people would be suing them for that. I could understand if they know what is going and suspect illegal activity but at what point do they draw the line? I do know bigger pharmacies only will fill orders in so many days and require in store pickup and photo ID on certain controlled substances.

Pharmacists have a corresponding duty under the law to ensure prescriptions are being dispensed for a legit medical purpose and not being diverted. It comes down to common sense. If 10 people from Mingo County all walk in to your pharmacy at the same time, all with scripts for the same or similar amounts of oxycodone from a doctor in South Florida, you should know what the f*ck is going on.

Same logic applies to wholesalers. If a mom and pop pharmacy in Kermit, WV, or Prestonsburg, KY, is ordering 50x more oxys a month than the Walgreens down the street, you know what the hell they are doing.

 

[ThunderCat98]

My question is, since these meds usually need a script, why are we not going after the docs that write the scripts for the pain medications?

We are. Unfortunately there aren't enough resources to compensate for the number or greedy, dirty doctors and pharmacists.

http://www.kentucky.com/news/state/article59205698.html

http://www.kentucky.com/news/state/article59753356.html

https://www.justice.gov/usao-edky/p...awfully-prescribing-pain-medication-thousands

http://www.kentucky.com/news/local/article44459748.html

http://www.kentucky.com/news/local/crime/article44511531.html

https://www.google.com/amp/s/www.bl...-largest-u-dot-s-dot-pill-mills-rise-and-fall

 

[herdfan429]

It doesn't take a doctor to forge scripts. The physician my wife works with has had many dealings with the DEA over people using forged scripts with his DEA number

 

[CockyHerd]

Obviously most of Appalachia and big cities have a drug crisis going on. Now states and cities are suing the drug suppliers like McKesson, Cardinal and others for distributing the pills. My question is, since these meds usually need a script, why are we not going after the docs that write the scripts for the pain medications? You can't go to Walgreens and pick up a bottle of pain meds without a script?

McKesson and the other companies are just filling the orders for the docs, practices and healthcare facilities. What's everyone's thoughts on this?

It's the Deep Pocket Theory........Doctors and Mom & Pop pharmacies, relatively shallow pockets......International Drug Companies, very deep pockets.

Hell it's practically a class in law school.....Find the money!!

 

[Walter Brennaneer]

It's a demand issue which triggers supply.

Physicians are crossing their code of ethic to line their pockets. Downstream is just reacting to script requests.

Take away the demand, then the problem goes away.

 

[GreenDuke]

It's the Deep Pocket Theory........Doctors and Mom & Pop pharmacies, relatively shallow pockets......International Drug Companies, very deep pockets.

Hell it's practically a class in law school.....Find the money!!

Here is your answer, ask any ambulance chaser.

 

[i am herdman]

It doesn't take a doctor to forge scripts. The physician my wife works with has had many dealings with the DEA over people using forged scripts with his DEA number

Most of the prescriptions I have had filled are not hand written anymore. The doctor's offiice sends them in directly to the pharmacy.

 

[Y.A.G Si Ye Nots]

How about some self-responsibility in all of this? A pharmacist or doctor can't get you hooked on pills. Have a little common sense when you're taking medicine. Sure, they can contribute to it by giving questionable advice in order to make a profit, but that happens in a lot of the medical community (check everything from cancer drugs to cosmetic procedures).

 

[i am herdman]

How about some self-responsibility in all of this? A pharmacist or doctor can't get you hooked on pills. Have a little common sense when you're taking medicine. Sure, they can contribute to it by giving questionable advice in order to make a profit, but that happens in a lot of the medical community (check everything from cancer drugs to cosmetic procedures).

damn it, i am going to have to agree with you

 

[Y.A.G Si Ye Nots]

Most of the prescriptions I have had filled are not hand written anymore. The doctor's offiice sends them in directly to the pharmacy.

Yeah, but you don't live in a third-world state. For 5+ years, a pharmacy in west virginia routinely leaves me voicemails with somebody's information: "Hi, Jane, this is Moron over at XYZ Pharmacy. Your Herpes medication is filled and ready to be picked up at your earliest convenience." One of their longtime customers must have a similar number to mine, and they routinely leave me voicemails for her. After the third time calling the pharmacy about it, I gave up trying to help them.

 

[ThunderCat98]

How about some self-responsibility in all of this? A pharmacist or doctor can't get you hooked on pills. Have a little common sense when you're taking medicine. Sure, they can contribute to it by giving questionable advice in order to make a profit, but that happens in a lot of the medical community (check everything from cancer drugs to cosmetic procedures).

No question personal responsibility comes into play, or should.

 

[Raoul Duke MU]

So they are supposed to question a doctor's orders? Then, people would be suing them for that. I could understand if they know what is going and suspect illegal activity but at what point do they draw the line? I do know bigger pharmacies only will fill orders in so many days and require in store pickup and photo ID on certain controlled substances.

My comment is about the wholesalers being sued. Yes, they should have known what was going on, and have a professional responsibility to, as well. As others have pointed out, most of this was small local pharmacies. It's obvious.

Larry's Drive In Pharmacy (the actual fvcking name, lol) in Madison dispensed almost ten million pain pills over ten years. Would that sound legit to you if you worked for a pharma wholesaler? Never mind it is the law that the wholesalers report such large shipments to the state, because they didn't report it.

 

[Raoul Duke MU]

How about some self-responsibility in all of this? A pharmacist or doctor can't get you hooked on pills. Have a little common sense when you're taking medicine. Sure, they can contribute to it by giving questionable advice in order to make a profit, but that happens in a lot of the medical community (check everything from cancer drugs to cosmetic procedures).

It is very easy to become physically addicted to opioids taking only therapeutic dosages for extended periods. For someone with chronic pain it is a real danger.

Of course there are the people who just want to try it and get hooked, and the ones that get a legit script but abuse it. But yeah you can get hooked just by following your prescription.

 

[Y.A.G Si Ye Nots]

Larry's Drive In Pharmacy (the actual fvcking name, lol) in Madison dispensed almost ten million pain pills over ten years. Would that sound legit to you if you worked for a pharma wholesaler? Never mind it is the law that the wholesalers report such large shipments to the state, because they didn't report it.

If they violated the law, I am all for them facing the punishment for it. But I am not in support of holding one legally liable for an ethics violations (assuming there isn't a law regulating it). Should (and probably did) the company know something fishy was going on at Larry's pill-dispensary? Sure. But if they don't have a legal obligation (I am ignorant to the laws and regulations they face regarding it) to do something, I am not in support of holding them liable for it legally.

Should companies that make wrapping paper for cigarettes be liable for those who become dependent on weed since they know a lot of their wrapping papers are being used for this illegal activity? Should a car manufacturer be held liable for producing seatbelts their tests have shown to be not very good, even if they pass the stringent requirements of federal regulation?

 

[Raoul Duke MU]

If they violated the law, I am all for them facing the punishment for it. But I am not in support of holding one legally liable for an ethics violations (assuming there isn't a law regulating it). Should (and probably did) the company know something fishy was going on at Larry's pill-dispensary? Sure. But if they don't have a legal obligation (I am ignorant to the laws and regulations they face regarding it) to do something, I am not in support of holding them liable for it legally.

Should companies that make wrapping paper for cigarettes be liable for those who become dependent on weed since they know a lot of their wrapping papers are being used for this illegal activity? Should a car manufacturer be held liable for producing seatbelts their tests have shown to be not very good, even if they pass the stringent requirements of federal regulation?

Pharmacy wholesalers indeed have a legal obligation in WV to report large opioid shipments to a single pharmacy to state regulators. I think it is an obvious truth that a pharmaceutical wholesaler knows the danger of dumping millions of pain pills into a limited market, and thus they were negligent.

 

[ThunderCat98]

21 USC 841 makes it is a violation of the CSA to dispense a drug (1) without a legitimate medical purpose, and (2) outside of the scope of accepted medical treatment. It is the same statute that prohibits illegal distribution of drugs. This applies to the writing and filling of prescriptions, and, as noted above, imposes a corresponding duty on pharmacists to exercise reasonable discretion in the filling of prescriptions. This duty, presumably, extends to manufacturers, wholesalers, etc. Similarly, it is a violation of 846 to conspire/agree to do the same.

Moreover, a host of of additional federal and state statutes/regs apply to the distribution/dispensation of any controlled substances, including duties to track and monitor sales of these drugs and address any improprieties, as well as report such matters to DEA Diversion.

 

[Y.A.G Si Ye Nots]

As I said, if they don't have a legal responsibility (I stated I was ignorant of the laws regarding it), they shouldn't be held liable. That comment was in response to Raoul's comment about them having a "professional responsibility." I can't hold somebody legally liable based on simply being "professionally responsible" for it.

 

[marshallisqbu]

The government making part of compensation based on patient satisfaction may as well go ahead and give the doctor a sign saying we give out narcotics freely. People want strong pain pills and now doctors are being punished by pay as well as following hcap and other metrics based on patient satisfaction

 

[i am herdman]

My comment is about the wholesalers being sued. Yes, they should have known what was going on, and have a professional responsibility to, as well. As others have pointed out, most of this was small local pharmacies. It's obvious.

Larry's Drive In Pharmacy (the actual fvcking name, lol) in Madison dispensed almost ten million pain pills over ten years. Would that sound legit to you if you worked for a pharma wholesaler? Never mind it is the law that the wholesalers report such large shipments to the state, because they didn't report it.

Well, they(wholesaler) broke the law then

 

[i am herdman]

Can the pharmacy just reject someones legitimate prescription from a doctor? is that even their job to question the doctor?

 

[ThunderCat98]

As I said, if they don't have a legal responsibility (I stated I was ignorant of the laws regarding it), they shouldn't be held liable. That comment was in response to Raoul's comment about them having a "professional responsibility." I can't hold somebody legally liable based on simply being "professionally responsible" for it.

Wasnt being contentious, just clarifying that they do, in fact, have a legal responsibility. Whats more, there is a legal theory called "deliberate ignorance" that precludes a person or entity from intentionally ignoring facts they knew or should have known in order to avoid criminal liability - facts like monthly orders for excessive amounts of oxycodone from a rural pharmacy.

 

[ThunderCat98]

Can the pharmacy just reject someones legitimate prescription from a doctor? is that even their job to question the doctor?

Yes and yes.

 

[CockyHerd]

A lot of blame to go around on this issue.

Google Nicola Tauraso if you want an example of what was/is going on in many doctor offices.

 

[Raoul Duke MU]

The government making part of compensation based on patient satisfaction may as well go ahead and give the doctor a sign saying we give out narcotics freely. People want strong pain pills and now doctors are being punished by pay as well as following hcap and other metrics based on patient satisfaction

Bullshit. Most of these pill mill doctors accept cash only. These are not doctors concerned with any sort of performance metric except for being a "legal" drug dealer.

I remember one in WV being busted, and the undercover State Trooper that posed as a "patient" testified their cash register had so much money in the drawer it could not be closed. When is the last time you visited a doctor's office that had a cash register?

 

[ThunderCat98]

Pill mills are cash only. Too easy to get busted if you are trying to bill insurance or Medicare/caid. It also makes money laundering and tax fraud easier and more difficult to detect.

 

[Raoul Duke MU]

It also makes money laundering and tax fraud easier and more difficult to detect.

Here is one that had one million dollars in cash on hand when he was raided. People who do not follow this issue have no idea. Doctors worried about satisfaction scores LOL. This is drug kingpin money. You would have to buy, move, and sell about 100 kilos of cocaine from Texas to somewhere north to make a million dollars...which is a good way to end up dead or in prison for life.

http://www.pikecountycourier.com/ap.../Feds-arrest-Milford-doctor-in-pill-mill-bust

 

[ThunderCat98]

DEA seized around $7 million cash from Joel Shumrak, the clinic owner in one of the articles I linked above. They seized around $2 million from Terry Tehnet, the pharmacist in one of those cases. Tehnet had duffle bags full of cash in his house because he didn't know what to do with all of it.

 

[sistersville]

I actually just googled it to see what's up in Kermit. 392 freaking people, and over 9,000,000 pills. A locally owned pharmacy sold 600 times the amount of pain killers as a Rite Aid pharmacy right down the street. Big money maker for Doc and the local pharmacy, as well as the manufacturers. All guilty in my opinion.

For years the preece cartel ran kermit until they were busted. Getting drugs through a drive thru is tolerable to those folks. Its been a year since i was replaced as the n/a instructor. I got the boot when one of the drs went beserk cause i told these people suboxen was very addictive and they needed to wing thenselves off that. They claimed the could not get pills hardly anymore and were using heroin. One guy drove to Texas only to not being able to fill his prescription.thats when he ask for help.

 

[marshallisqbu]

Bullshit. Most of these pill mill doctors accept cash only. These are not doctors concerned with any sort of performance metric except for being a "legal" drug dealer.

I remember one in WV being busted, and the undercover State Trooper that posed as a "patient" testified their cash register had so much money in the drawer it could not be closed. When is the last time you visited a doctor's office that had a cash register?

No Bullshit. I am one of the doctors facing this problem every day. Obviously pill mill doctors are out to make money and do not care about anything else but they are a small but obviously very dangerous minority.

How do you think most of these people became addicted? Most of them were started at normal doses and a small prescription and became addicted. Many don't just show up at a pill mill one day asking for huge narcotic rx's.

Our HCAP scores and patient satisfaction are being watched daily, and our employers want those scores high. THere is a pressure to keep the customer happy, and for many that means giving them stronger pain medicines. Until the government realizes this pressure leads to more abuse and more narcotics being given, we will continue to be pressured to give stronger pain pills.

It's not the whole problem, as you eluded there are doctors obviously going above and beyond and abusing the system to their gain. That being said, when you are incentivizing strong narcotics for patient satisfaction you are worsening the problem.

The pills mills are feeding the addicts. We need to focus on preventing them. By limiting narcotic prescriptions in the first place, we can limit addiction to them. It won't fix the problem (neither will shutting down pill mills.) but it will help.

 

[extragreen]

If/when a drug company creates a pain killer that doesn't give a high, there will be some rich people in that company. Sooner the better.

 

[herdfan06]

Yeah, but you don't live in a third-world state. For 5+ years, a pharmacy in west virginia routinely leaves me voicemails with somebody's information: "Hi, Jane, this is Moron over at XYZ Pharmacy. Your Herpes medication is filled and ready to be picked up at your earliest convenience." One of their longtime customers must have a similar number to mine, and they routinely leave me voicemails for her. After the third time calling the pharmacy about it, I gave up trying to help them.

Are you sure they have the wrong number, not the wrong name?