One aspect of the opioid epidemic that’s always baffled me: widespread involvement by major pharmacy chains in the vast over-prescribing that helped jump start the whole thing.

Now that we’re learning more about the extent of their participation, it’s clear to me that it could happen again, perhaps with a different class of high-risk medications, but with comparable results. Might be smart to conduct a post-mortem evaluation of the system, akin to those done in the wake of the Wall Street Crash of 2008 — another entirely preventable disaster that nobody bothered to prevent.

I can understand a corporate exec of a company in need of revenue succumbing to the lure of fast profits. It’s a human failing. But what about the thousands of pharmacists and benefits managers throughout the system? They manage the process. Surely they noticed something, right? How come nobody howled in warning?

I’m not interested in the conscious criminal. It’s the regular folks I wonder about. Three possible explanations for their silence, that I can see:

  • They may have genuinely believed that opioids were the medication of choice for chronic pain. This was a common fallacy in healthcare circles in the late 90’s, based on, well, bad information. Plenty of physicians swallowed that notion as well. At least some pharmacists may have thought they were doing the right thing by filling (and refilling, and perhaps re-refilling) all those oxy- and hydrocodone prescriptions, for years on end, without any substantive review.

OR

  • Maybe they suspected something was badly wrong, but kept their mouths shut. Feeling it was not their place to make a fuss, or perhaps they did broach the subject but got shut down from above.  That certainly happens. Could be they feared losing their jobs — not unrealistic.

OR

  • It’s possible they slipped into denial — rationalizing, minimizing, discounting the possible consequences. Possibly their employers encouraged or incentivized opioid prescribing. Could be that some employees just went about their business, robot-like, never giving the outcome much thought.

 

I had to laugh at the response of the person who answered the phone at a chain drugstore, when a reporter asked about the DEA’s finding that their pharmacy had filled by far the most opioid prescriptions of any in the state. Her confused reply: “We did?”

Across a broad section of the professions, we might encounter all three, along with a few I haven’t thought of. Chains have quality control mechanisms to alert headquarters to abnormal patterns in prescription use, don’t they? Of course they do. Somehow, it failed. Or maybe somebody higher up decided not to listen.

Whatever the cause, the ultimate outcome was certainly destructive. I doubt the big chains are eager to accept the blame, however. Here’s an example:

Around the height of the opioid epidemic in 2009, drug giant Walgreens handled nearly 1 in 5 oxycodone and hydrocodone pills

I don’t have a solution other than to suggest that America take the necessary steps to ensure that corporations and government cooperate to monitor and control the flow of prescription painkillers throughout the healthcare system.

In other words, do what we thought they were doing, but weren’t.

By the way, the Ohio judge handling a vast number of opioid-related lawsuits just set an October trial date for a case involving some familiar names in the world of pharmacy: Walmart, CVS, Rite Aid, Walgreens and Giant Eagle.


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