Imagine being unable to obtain medication from your pharmacy that you desperately need and must take daily. Imagine if there was no insulin available for several days in a row, week after week; or no medication to treat your high blood pressure.
Now imagine being unable to obtain your medication in time to stave off an extremely painful and dangerous withdrawal because you suffer from opioid use disorder. This is the situation facing our patients who rely on daily medication to keep them healthy. Known as MAT, for Medication-Assisted Treatment, the medication is a combination of buprenorphine and naloxone that blocks the effects of opioids and diminishes physical dependency on them.
Our agency, Behavioral Health Leadership Institute, operates a treatment program for people who suffer from opioid use disorder. Patients call us from their pharmacy when they’re denied their lifesaving medication, afraid and anxious, asking what they can do. Our staff is overwhelmed, and the situation is getting worse. Every day, prescriptions have gone unfilled, putting our patients at risk of death. The week we write this, six of our partner pharmacies in Baltimore reported zero available medications — brand name or generic — for our patients.
They are vulnerable. Many are homeless and suffering from ill health. Some are frail and/or elderly. They often lack transportation. To pick up medications to avoid withdrawal, many of our patients need to walk, some may use a cane, to reach a pharmacy that is a mile away or more. And, at the same time, they are beginning to experience the first symptoms of withdrawal, which causes unbearable discomfort, pain and nausea. And they still need to find a place to sleep for the night.
Imagine being sick and having to walk to a pharmacy only to learn that a medication that is extremely safe and allows patients to fully function while healing is unavailable. What are the options then? Risk arrest or death by overdose, by buying heroin, often adulterated with fentanyl, on the street for a few bucks to get through the night.
Why are pharmacies failing to stock sufficient supplies of this evidence-based medication? Because of fear of triggering an investigation and stigma. This medication does not make you high, is not addictive, and it is extremely safe. But it is classified as a narcotic “controlled substance” and is under the jurisdiction of the Drug Enforcement Agency.
There is a focus now on blaming the pharmaceutical industry for addiction and subsequent overdoses, with OxyContin manufacturer Purdue Pharma and others settling lawsuits for millions if not billions of dollars. Pharmacists, too, are taking the blame, with a federal jury in Cleveland finding last month that Walgreens, Walmart and CVS furthered the opioid overdose crisis by dispensing prescriptions pursuant to physician orders.
Because of this, many pharmacists are wary of increasing MAT orders because it puts them on the DEA’s radar. Similarly, they are refusing to stock enough medication to maintain sufficient supply during the ups and downs of demand, because they believe that will cause them to be flagged by the DEA as well. Therefore, we are playing a deadly guessing game about demand that is resulting in low supply and intolerable suffering for our patients, who need the day they need it; withdrawal symptoms start quickly and make them anxious and ill. And they can’t just hop over to another pharmacy or run home and back when the medication is in.
It is an absurd situation we are facing: The treatment for the addiction is being denied in response to lawsuits based on overdoses and addiction that spread to impact wealthy, white people causing a sudden demand for accountability. And our patients disproportionately suffer, as always, because of their vulnerabilities as people who use drugs/heroin, people of color who live in poverty in the streets or the shelters. “
Sadly, the lack of medication is only one example of the barriers to treatment, but it is one we can — and must — fix. Pharmacies must be allowed to order supplies without looking over their shoulders. The Biden Administration must take action with the DEA to work with pharmacies on a policy that promotes the flow of medicines, thus allowing for the appropriate distribution of this lifesaving medication. This must be done immediately to increase treatment and prevent increasing overdose deaths. Each day of delay means more suffering and more deaths. Let’s fix this now so that we can build healthier communities for all.”
Deborah Agus (firstname.lastname@example.org) is executive director of the Behavioral Health Leadership Institute and an adjunct professor at the Johns Hopkins School of Public Health. Contributing to this op-ed are: Lenny Feldman, president of the BHLI Board; Jay Unick vice president of the BHLI Board; Andrew Reinel, BHLI outreach director; Ayanna Fews, BHLI operations director; Courtney Nordeck, BHLI research director and Ashley Truong, BHLI research associate.