U.S. DEA rules prevent nursing home patients in severe pain from receiving needed medication

Physicians, Nurses, Pharmacists Call for Immediate Change to Stop Medication Delays

U.S. Drug Enforcement Administration's rules and procedures are seriously delaying and in some cases preventing nursing home patients from getting the pain medication they need.

According to a new survey released today by the Quality Care Coalition for Patients in Pain (QCCPP), nearly two thirds of physicians, nurse practitioners, pharmacists, nurses and other clinicians say that DEA procedures are resulting in delays in getting pain medication to their patients. In Ohio, where DEA has been most active, 86 percent of respondents indicated that treatment has been delayed.

The report "Patients in Pain: How U.S. Drug Enforcement Administration Rules Harm Patients in Nursing Facilities" explains how and to what extent DEA rules affect patients in nursing facilities, and focuses on long-term care, and those receiving hospice services.

"Current DEA rules and procedures frequently prevent or delay nursing home patients in severe pain from receiving the medication they need," stated Ross Brickley, RPh, MBA, CGP, president of CCRx of NC, Inc. and former president of the American Society of Consultant Pharmacists, founder of the QCCPP. "Without action by DEA or, if DEA won't act, by Congress, nursing home patients will continue to suffer," he added.

One survey respondent who provided an example of how DEA is making it difficult for nursing home and other patients to receive the pain medication they need, said:

"The time required to get the order, communicate to the pharmacy, have the physician called, have the pharmacy call back and give the OK for the E-box or stat drop the medication can be upwards of four hours. That does not take into consideration [that] the last time [the patient] received pain control was three hours prior to leaving the hospital. That leaves the patient at risk [of intense pain] for seven plus hours."

In another instance, a hospice worker reported on the tragic final hours of a terminal patient in great pain:

"We had a [patient] dying and we could not fill her prescription in a timely frame. The [patient] died in fear, gasping for air, crying and screaming... [There is] no excuse for anyone to have to die this way!"

According to Brickley, the changes required to get nursing home patients the medication they need can be implemented quickly. "DEA has the ability to change its procedures immediately," he said. "There is no reason that the elderly, sick, and infirm should wait even a minute longer than necessary to get the pain medication their doctors have prescribed."

Additional key findings of the survey are:

• Among respondents who identified a timeframe, 12 percent reported delays of two days or more, 40 percent reported delays of up to two days, and another 40 percent reported delays of up to one day. Only 8 percent reported delays of up to one hour.
• For patients newly admitted to long-term care, 31 percent of respondents and 43 percent of Ohio respondents said DEA rules had led to a harmful change in prescribing patterns including the use of less effective drugs that are often insufficient to control pain and increase the risk of adverse side effects in elderly patients.
• For existing patients, 26 percent of all respondents and 39 percent in Ohio reported a change in prescribing patterns.
• The DEA-caused delays have unnecessarily forced nursing facilities to send some patients back to the hospital for treatment and readmission. This is costly, difficult for the patients, and completely avoidable.
• Patients' ability to participate in post-surgical rehabilitation also has been impeded by DEA rules. This has delayed the patients' recovery and extended their need for skilled care.
• Physicians, nurses, pharmacists and other clinicians working in long-term care reported they cannot comply with DEA rules and meet their professional obligations to patients or practice based upon established treatment guidelines.
• Physicians, nurses, pharmacists and other clinicians also said DEA rules put them squarely in conflict with federal and state requirements establishing quality standards for nursing facility care. Some question whether they can continue to practice in an environment where they are unable to provide appropriate care to their patients.