A crackdown by US drug wholesalers in response to the opioid crisis is preventing some pharmacists from dispensing a combination of stimulants and sedatives routinely prescribed by psychiatrists to help patients manage conditions like anxiety and ADHD.
The three main US pharmaceutical wholesalers – AmerisourceBergen Corp (ABC.N), Cardinal Health Inc (CAH.N) and McKesson Corp (MCK.N) – tightened monitoring of suspicious orders from pharmacies in July as part of a $21 billion nationwide opioid settlement with attorneys general from 46 states, the District of Columbia, and five territories.
Five independent pharmacists in five different U.S. states told Reuters that in recent months they were notified by the wholesalers that they would be cut off from the distribution of all controlled substances after filling prescriptions for psychiatric drugs such as the stimulant Adderall – used to treat attention deficit hyperactivity disorder (ADHD) – and anti-anxiety drug Xanax. The pharmacists spoke on condition of anonymity for fear of harming their businesses.
These psychiatric drugs are regulated by the federal government as controlled substances that have high potential for abuse and addiction but are not opioids.
The wholesalers imposed the bans because the pharmacies had filled prescriptions written by medical practitioners who frequently prescribed controlled substances or had filled prescriptions assigning both a stimulant and a sedative to the same patient, according to interviews with the pharmacists and letters from AmerisourceBergen to one of the pharmacies, seen by Reuters.
The US Drug Enforcement Administration (DEA) identifies combination prescriptions of stimulants and sedatives as a red flag in its guidance to pharmacies on illicit drug use.
Three psychiatrists interviewed by Reuters described such combination prescriptions as medically valid and dispensed routinely for years to manage comorbidities or address stimulant side effects like insomnia. Comorbidity refers to the simultaneous presence of two or more diseases or medical conditions in a patient.
An ADHD patient taking Adderall to focus during the day may need the sedative temazepam to sleep at night, or clonazepam to treat anxiety, the psychiatrists said. ADHD and anxiety disorders are among the most common psychiatric disorders and have a 25% comorbidity rate with each other.
Matthew Goldenberg, president-elect of the Southern California Psychiatric Society, a chapter of the American Psychiatric Association, said some members had complained that pharmacies were no longer comfortable filling combination prescriptions for controlled substances because of concern they could be blacklisted.
“This is detrimental potentially to many patients who have comorbid anxieties along with ADHD, or sleep issues along with ADHD,” he told Reuters. “I think it’s a trickle-down effect from the opiates.”
The impact on independent pharmacies’ prescriptions of psychiatric drugs from the widening crackdown on opioids has not been previously reported. There are just over 19 400 independent pharmacies in the United States, representing just over one-third of all retail pharmacies, according to the National Community Pharmacists Association (NCPA).
The five pharmacists interviewed by Reuters said wholesalers’ bans on supplies of controlled substances threatened the viability of independent pharmacies while letting chains like CVS Health Corp (CVS.N) and Walgreens Boots Alliance Inc off the hook.
CVS, the biggest US pharmacy chain, did not respond to requests for comment for this story. Walgreens, the largest shareholder in AmerisourceBergen, declined to comment.
Reuters was unable to determine to what degree the chains have been impacted by the enhanced monitoring.