Friday, Apr 25, 2014
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Patients caught amid Walgreens drug suspension

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SPRING HILL - Mike Davidson was injured in 1993 while working as a Florida Department of Corrections officer, and required back surgery two years later.

A 13-year patient of Dr. George Sidhom's at Hernando Pain Management Center, he said he was prescribed a low-dose narcotic that allowed him to work with the department up until 2008. He hasn't had any trouble filling that prescription at Walgreens pharmacies over the last eight years, he said, but that was before recent discussions started about "mysterious criteria."

"I was actually in the drive thru. I waited there 15 minutes, and (the pharmacist) said, 'You need to come around and come inside,'" Davidson said, adding he spent 30 minutes giving the pharmacist requested information. "She came back and said, 'Unfortunately, I can't fill your prescription, because you don't meet the criteria.' "

"What criteria is that?" Davidson asked. "And she said, 'Sorry, I can't tell you that.' "

Confused, Davidson went to another Walgreens, he said, where the law enforcement officer of 17 years learned he is now on a three-month "do not fill" list with the pharmacy chain.

"It floored me," Davidson said. "That pharmacist did call and verify (with my doctor's office) that I have injuries. I mean I'm 100-percent disabled right now. I'm not some crack head."

Dr. George Sidhom's office called the pharmacy at Davidson's request to resolve the issue.

"She wouldn't tell me the criteria. I called back and said, 'I just wanted to know how you determined Mr. Davidson couldn't receive his medication?'" said office manager Jean Sidhom, who is authorized to provide patient information to pharmacists. "I said, 'I'm obligated to know,' and she said, 'No, it's (Health Insurance Portability and Accountability Act Privacy Rule) compliance."

Jean Sidhom asked the pharmacist if she'd like to speak to Davidson's prescribing doctor, but she declined, Sidhom said.

"Then she hung up," Jean Sidhom said. "It was unreasonable for them not to fill it and not give us a reason."

Walgreens spokesman Jim Graham said he also is fairly limited in what he's been able say about new company policies. But he could email some provisions on the company's "good faith policy," which state pharmacists may verify from a patient's prescribing physician's office that a controlled substance prescription was issued for "a legitimate medical purpose," verify the diagnosis, confirm that the patient has had a recent examination, and, as always, check the state's Prescription Drug Monitoring Program database for anything unusual.

According to Jean Sidhom and Davidson, each of these processes were verified ahead of time and cleared with the pharmacist, who still declined to fill the prescription.

"We ran the drug monitoring system here as well, and we're the only physician (Davidson) sees and receives narcotics from," said Jean Sidhom, who received permission from Davidson to provide recent medical history. "He has been receiving the same medication from the same prescribing physician for the same diagnosis, so he's definitely not doctor shopping."

And besides, Jean Sidhom said: under the Board of Medicine guidelines patients like Davidson cannot even receive prescriptions until they've been examined, which is done procedurally with every monthly prescription. Davidson tried to fill his prescription the day of his examination, he said, but the pharmacy told him they did not have the medication in stock. Three days later he gave his business to Walmart.

"The games are being played too much with the patients," Jean Sidhom said. "This is not the only patient. This has been ongoing with Walgreens since the tail end of last year, and the beginning of this year ... "

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It was around that time, in September 2012, when the Drug Enforcement Administration placed an immediate suspension order against Walgreens' Jupiter distribution center, effectively hindering Florida Walgreens' distribution of schedule 2-5 drugs like oxycodone.

The Jupiter center distributes controlled substances exclusively to its own Walgreens pharmacies located along the east coast and since 2009 has been the single largest distributor of oxycodone products in Florida, according to the DEA.

But under the terms of an $80 million civil penalty case leveled against Walgreens this summer by the U.S. Department of Justice, the immediate DEA suspension order against Walgreens' Jupiter distribution center will remain in effect until September 2014. 

According to DEA and Walgreens freight data, that means one of three Walgreens distribution centers in the state cannot disseminate drugs classified under the Controlled Substances Act as having the potential for physical and psychological dependence, which include: Dilaudid, Dolophine, Demerol, OxyContin, Percocet, Sublimaze, Duragesic, morphine, Codeine, Dexedrine, Adderall, Desoxyn, Ritalin, Vicodin, Suboxone, Didrex, anabolic steroids like Depo-Testosterone, ketamine, Xanax, Soma, Klonopin, Valium, Tranxene, Ativan, cough medicines like Robitussin AC, and ezogabine.

v vWalgreens' legal woes began in 2009 when the DEA launched Operation Pill Nation I and II and Operation Oxy Alley.

A 2010 Florida Medical Examiner's Commission Drug Report showed the drug that caused the most deaths in Florida for that year - 1,516 - was oxycodone, which occurred around the same timeframe Florida termed its prescription drug abuse problem an "epidemic."

When the U.S. Department of Justice reached their $80 million settlement agreement with Walgreens two months ago, the department alleged the company's Jupiter distribution center failed to comply with DEA regulations requiring it to report to the Drug Enforcement Administration suspicious prescription drug orders received from Walgreens' retail pharmacies.

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That hits closer to home for Hernando County when considering that two of six Florida pharmacies under investigation by the DEA were located in Port Richey and Hudson.

For example, the Walgreens pharmacy in Hudson increased its oxycodone orders by almost six-fold between 2009 and 2011, or from 388,100 to 2,175,100 dosage units.

The Walgreens pharmacy in Port Richey more than tripled its oxycodone dosage units in the same time period, multiplying from 344,000 to 1,400,200 dosage units.

By comparison, the average pharmacy in the U.S. ordered about 73,000 oxycodone dosage units in 2011.

"I'm an officer of the state of Florida," Davidson said. "I'm not some dope fiend."

According to Walgreens' website, Florida has the largest number of retail pharmacies in the country - 857 - or 157 more than Texas and 224 more than California.

According to 2011 Walgreens freight data, the pharmacy chain's current operational distribution centers in Florida are located in Jacksonville and Orlando.

mreinig@hernandotoday.com

(352) 544-5271

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