In recent months, the FDA/DEA has enacted new rules and regulations regarding the scheduling of certain pain medications. The main change was bumping up hydrocodone to Schedule II. This change may appear minor on the surface but it is having a ripple effect throughout the healthcare community. Doctors are more leery of prescribing the medication due to fear of being investigated for improper prescribing practices. Pharmacists are scared to fill valid prescriptions due to fear of going against company policies and losing their jobs. Pharmacies are writing company policies that deter their employees from filling prescriptions. And what happens to a patient who relies on these medications every day? They end up in the Emergency Room going through withdrawal which gets them labelled as addicts.
Another medication that was also rescheduled this year and which has not received a lot of press is Tramadol. It went from being unscheduled to now being a Schedule IV. This also appears to be a fairly innocuous decision. However, it was not enacted without its own headaches. Most patients were surprised to have their prescriptions voided as soon as the new rule went into effect. Pharmacies were told it was to their discretion to fill refills on prescriptions written prior to the change. Most pharmacies saw this as an opportunity to void all refills. The scheduling change happened under the radar, overshadowed by the Hydrocodone issue. Therefore, many doctors who regularly prescribe Tramadol missed or forgot about the change and wrote new scripts on the wrong prescription pads (and yes, doctors have different pads for scheduled versus non-scheduled medications). Regardless, even with a new prescription in hand, many patients were turned away by their pharmacies. From my own experience, my pharmacy went out of its way to NOT talk to my doctor. They persisted in calling my doctor’s office after hours day after day. They even had the gall to tell me they were leaving messages for the doctor to call them back, which is not an option if you call my doctor’s office after hours. After a week of playing phone tag with the pharmacy, I finally had to take matters into my own hands. I was truly appalled at the level of either incompetence or desire to not fill my prescription that was expressed by my pharmacy. Needless to say, I am happily switching pharmacies as soon as my health insurance changes on January 1st.
Now I don’t rely on traditional pain medications every day, something I am eternally grateful for. But my heart goes out to those who do. If I am having this much trouble getting Tramadol filled, I can’t imagine the heartache and pain they are. Doctors and pharmacists are taking the oath “first, do no harm” to literally and are erring on the side of doing nothing with the mistaken belief that that is was good healthcare is.