ESPAOLA Ronnie Flores feels more comfortable on the street talking to people who use drugs than people in the hospital who are being treated for substance use disorder.
As a Peer Support Specialist at Presbyterian Espaola Hospital, Flores helps individuals suffering from substance use disorders related to opioids, stimulants and alcohol.
Flores, who was born in the Espaola area and is recovering himself, helps patients get started on drug-assisted treatment, schedule their follow-up appointments, and make sure they actually get to those appointments.
But Flores and other addiction treatment workers say that even though someone can get a prescription for drugs that will help them manage their condition, actually filling it in northern New Mexico is often so difficult that people forgo treatment altogether.
We don’t have pharmacies that have enough buprenorphine, Flores told U.S. Senator Martin Heinrich and his staff during a hospital meeting Wednesday.
Buprenorphine is an FDA-approved drug for opioid use disorder that can be prescribed without the patient having to go to a clinic and can be sold in retail pharmacies. Both buprenorphine and methadone have been shown to reduce overdose and related to opioids deceased.
Researchers last year found Tightening federal regulations on how pharmacies can dispense the drug have led to shipments being delayed or suspended. It has also caused buprenorphine prescriptions to be refused and not filled for people in need.
Another study published in May it found that only 57.9 percent of pharmacies in the United States reported stocking buprenorphine or naloxone; only 42 pharmacies in all of New Mexico carry the drugs.
The unmet need was fresh in the mind of Leslie Hayes, a primary care physician at El Centro Family Health, which is associated with the hospital. Four different patients came in on Monday saying they couldn’t get their buprenorphine prescriptions because the pharmacies didn’t have them, she said.
Two of those patients had to visit three different pharmacies before they could finally get the drug, Hayes said.
Kelly Mytinger, who runs the harm reduction program at Santa Fe Mountain Centershe said the nurse easily spends two to three hours a day on the phone on hold with pharmacies trying to fill people’s prescriptions.
It ends up being really disruptive to her workday and to our patients, Mytinger said.
When a patient new to recovery doesn’t get their prescription, they often feel ashamed and think they did something wrong, Hayes said.
Even from my long-term recovering patients, they’re very ashamed of it, but for new patients, it’s often enough of a barrier that they don’t come back, she said.
DEA messages inconsistent
Vanessa Lucero, director of pharmacy at the hospital, said prescription drug distributors were forcing pharmacies into unforeseen, unwritten rules and regulations governing the treatment of people with buprenorphine.
In December, as the hospital was approaching limits for dispensing methadone, Lucero said he could continue treatment only by passing patients tablets instead of liquid and giving others more morphine.
In meetings with the regulatory directors of two different prescription drug distributors, Lucero explained why he needed methadone and how he uses it with patients.
My take on this is that they also don’t want to be sued, so they’re limiting all of us what they can provide, Lucero said.
Lucero has asked the DEA to increase her maximum amount of methadone, but they have never given her an explicit limit.
After dozens of pages of paperwork and a written interview with the agency, Lucero was only able to increase her stock by one bottle, which she says is an insignificant amount for the number of patients at the hospital.
There is no uniform message from the US Drug Enforcement Administration about buprenorphine stock limits in pharmacies, Hayes said.
Our DEA officers have told us very specifically that there is no limit to the amount of buprenorphine pharmacies can have, Hayes said.
However, Hayes said addiction medicine doctors have told her DEA officials have said there are limits on how much pharmacies can carry.
Drug dispensers and pharmacies don’t have clear guidelines, said Eric Ketcham, the hospital’s emergency physician and addictions specialist.
The problem stems from two issues, Ketcham said.
The first is with the Suspicious Order Reporting System, he said, which was created by a 2018 federal law which is up for renovation this summer.
The DEA requires all suppliers of prescription drugs to track drug orders for controlled substances through the centralized database, and suppliers must notify the DEA of unusually large or suspicious opioid drug orders.
The second underlying problem, Ketcham said, is that similar requirements have been written into federal settlements for opioids.
All they know is that it will fall on them, or they’ll get in trouble with the DEA, so everyone is very cautious about setting those limits, but it’s very hazy, he said.
After listening to speeches from addiction workers, Heinrich said the problems they are describing are unintended consequences of the law change and the result of improperly assessing risks against the impact of people not getting treatment and returning to using the fentanyl.
We clearly don’t have that balance right and need to figure out how to lean more on therapy and less on bureaucracy, Heinrich said.
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