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The Los Angeles Times has a recent piece bringing home the role of corrupt or inattentive pharmacists in fueling the nation’s prescription painkiller abuse epidemic. While chain drug stores have also come under scrutiny for excessive dispensing of prescription painkillers, the Los Angeles Times story zeroes in on several independent pharmacies filling eye-popping numbers of painkiller prescriptions, often for patients living long distances away and paying cash.

The story reports on four people who died of drug overdoses after getting their prescriptions filled at “tiny” Pacifica Pharmacy in Huntington Beach, California. A top-seller for Pacifica was the 80 mg. OxyContin tablet; the pharmacy sold twice as much of that as nearby Walgreens, CVS, and Sav-On pharmacies combined.  Another pharmacy in the story, Burbank Medical Pharmacy, filled 85 painkiller prescriptions in a single day in 2007 – and none of the patients or the prescribing doctors were from the Burbank area. Four people died of drug overdoses in 2008 after having prescriptions filled by Jay Scott Drugs in Burbank. One of the Jay Scott Drugs overdose victims was able to fill 89 painkiller prescriptions there in a 14-month period (including 400 pills in just one four-day period).  Jay Scott Drugs was selling more than 100,000 hydrocodone pills per month.

While prescription painkiller abuse is abetted by doctors who may be conned into writing prescriptions for pain relief (or who may turn a blind eye because of the profitability of writing painkiller prescriptions), the story makes clear that “pharmacists are supposed to be the last line of defense against misuse of prescription medications.” Pharmacists are legally required to scrutinize prescriptions and to refuse to fill them when there are indications of abuse. But some pharmacies are willing to provide painkillers with no questions asked. The story says these rogue pharmacists “are key enablers of drug abuse and an important source of supply for the illegal market.”

The prescription painkiller abuse epidemic costs our country billions of dollars every year. One study has estimated the financial impact to health insurers from nonmedical use of prescription painkillers to be $72.5 billion in direct health care costs annually. A part of that cost includes insurance claims from drug-seeking individuals who visit physicians, emergency rooms, pain clinics, dentists, and other prescribers with spurious pain symptoms.

As the story notes, authorities currently have little ability to address the problem of rogue pharmacies. While California’s 42,000 pharmacists fill 318 million prescriptions each year, there are only 37 California Board of Pharmacy investigators charged with ferreting out “careless or corrupt” pharmacists. Clearly pharmacy regulators need some type of automated early warning system that can identify problem pharmacists. Existing state prescription data monitoring programs fall short now because, according to a recent report, few record the self-pay or cash transactions that are one of the hallmarks of potential abuse. The West Virginia Sheriffs Association recently noted that 93 percent of all pharmaceutical transactions are now entered into a national database – when patients pay with health insurance or third-party payers such as pharmacy benefit managers (PBMs) – but that the other 7 percent of prescription transactions now avoid PBM reporting. But, as the West Virginia Sheriffs note, existing PBM systems could easily be modified to capture cash transactions for controlled substances in a national database that could provide law enforcement officials with real-time trend data on prescription filling and could alert pharmacists not to fill potentially abusive painkiller prescriptions.