1. As Bev notes - DEA claims pharmacist should have seen a patient’s naloxone Rx as a red flag. Naloxone is the standard of care for most patients who receive and use opioids. In many, many states, it is now mandated to be co-prescribed with opioids.
2. DEA complaint identifies use of “immediate release opioids” as a red flag. Sure. Ok. They’re also explicitly preferred in the only part of the abominable 2016 CDC Opioid Guidelines that reference dosage formulations. Weird!
3. DEA: patients receiving the same dose and same # of medications monthly as a red flag. 🤦♀️ Actually, stabilization of therapy for patients is probably a good thing? IDK. Maybe my Lexapro should be varying wildly month to month to demonstrate that a pro is actively managing it.
It is LUDICROUS that we allow this level of interference in healthcare from people who are. not. clinicians. Honestly, no wonder every pharmacist in America gets nervous about filling scripts for my patients. #burnitalldown
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I work in KY as an SUD provider. Generally I have very few issues with Kratom - anecdotally for a few of my patients, it seemed to generate tolerance really quickly, so it got very expensive very fast, but I haven’t seen data to support. 1/5
The bigger issue some of my patients have had is that they don’t always know that they’re using it - it has a bunch of different names and is even in some workout supplements, etc. I’ve had a couple of people referred to me for naltrexone “allergies” when they 2/5
Tried oral or IM naltrexone for alcohol use. Turns out it was actually precipitated opioid withdrawal, which was a really crummy way for them to learn what’s in their supplements. :/ 3/5
I think a lot about the time that a former colleague said to me about patient care (this was with respect to urine drug screens) - “trust is a two-way street.” Which, like many platitudes, has a nugget of truth. But, to me, it’s a huge part of what is wrong in SUD treatment. 1/
Because here’s the deal: I absolutely have to earn my patients’ trust. They have to trust that I have the training, background, and ongoing interest in updating my knowledge base to help them reach *their* goals. 2/
They need time to build a relationship with me - to learn how to share vulnerabilities with me and overcome the exceedingly rational worry about whether or not I am going to care for them as a whole person who matters. 3/
Pharmacists are highly trained HCPs who are the subject matter experts in medications and treatment. *However* because of really effective MD lobbying, many of us are unable to practice independently, particularly re: decision making on therapeutics 2/
Because of that, when pharmacists practice - especially in the community - they’re doing so under INCREDIBLY strict protocols and standing orders. Literally not allowed to make decisions outside of those - even if those decisions are correct, medically 3/