Many of us take lots and lots of pills, by necessity or choice. Some are related to chronic conditions that can worsen as we age, like blood pressure and adult diabetes. Others are supplements that social media and TV ads urge us to take for a happier and healthier life. One notable TV ad brags about “an ingredient originally discovered in jellyfish.” I can’t remember what the pill is for; I’m just thinking about the poor jellyfish.
Over at Nature’s Select, owner John Palmer tells me the most popular pills he sells are “red yeast for cholesterol” and “stress-related” potions. Also popular in his store are “immune boosting” herbal products.
All these pills may be useful, or at least benign. What should concern us are pain pills. A constellation of developments should focus our attention. This summer, a Santa Rosa physician was arrested on murder charges for over-prescribing opioids for five patients who died. And a judge in Oklahoma fined Johnson & Johnson more than a half million dollars for pushing the sales of opioids in that state.
Then the Washington Post uncovered a national database of all oxycodone and hydrocodone pills distributed to pharmacies in 2006-12. According to the Post, there were “76 billion oxycodone and hydrocodone pills shipped over the seven years covered.”
The state that had the dubious honor of having the most pills distributed was Tennessee. That state had over 2.5 billion pills sent to drug stores. Along another dimension, West Virginia had the equivalent of 67 pills per year for every resident of the Mountaineer state. One pharmacy in West Virginia received over 13 million pills. It’s hard to get our hands around such numbers.
By orders of magnitude, St. Helena came off with much lower numbers. In the seven years counted, 2.3 million pills were sent to our three pharmacies, Deer Park, Smith’s, and Vasconi’s, with Deer Park and Smith’s up near a million each and Vasconi’s at 400,000. To put these numbers in perspective, we should note that Kaiser in Napa received 4.7 million pills, and what are now the CVS stores in Napa got over 3 million.
I reviewed the use of opioids with Dr. Heather Lewerenz, chair of the psychiatry department at St. Helena Hospital. The good news is that she said, “I’ve not observed a large opioid problem in St. Helena.” But she issued a warning to those of us who are prescribed pain pills after surgery or for a chronic condition. Lewerenz instructs us to watch for “a need for an escalation of doses.” That’s not a good sign. In fact, for short-term use after surgery, after “a few days” the need to take them should go away. Her bottom line is that we should “try to manage without” opioids.
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I sat down with Jeff Hansen, pharmacist owner of Smith’s St. Helena Pharmacy to discuss how he handles opioid prescriptions. He says, “We always verify a narcotics prescription if it’s not from St. Helena or a local doctor.” If he has any concerns, they “call the doctor to confirm dosing.” And he always counsels customers when they receive their first pain pills.
An email from Vasconi’s emphasizes that, “We have detailed procedures and protocols in place to help ensure we fill prescriptions appropriately and legally.”
What Hansen finds particularly useful is the new “CURES 2.0,” a California Justice Department program that collects and analyzes opioid data. From the retail perspective, Hansen says the CURES program “allows us to check pharmacy and doctor shopping.”
Smith’s, Vasconi’s and all other drug stores must report weekly their narcotics prescriptions. Doctors and pharmacists can check for opioid data by individual patients or specific doctors. Moreover, “health care practitioners authorized to prescribe … a controlled substance shall consult the CURES database to review a patient’s controlled substance history” in advance of issuing a prescription and then do so again every four months if the pain pills are being continued.
Individual patients can confirm their prescription data by contacting the “CURES help desk” at the Justice Department. We may not be comfortable that we have government agencies collecting more and more data on us. But in this opioid crisis, that’s unavoidable. Data is an immensely powerful weapon in the war on drug abuse.
The Economist editorialized this summer that “making sure that opioids are a gift to humanity and not a curse is a job for the entire health system.” That task includes government agencies, doctors, pharmacists, and all of us as individual patients.
Mark G. Epstein moved to St. Helena from the East Coast early this century after a career in international business.