[slapshot]

After the pharmacies got sued for filling opiate prescriptions (which were written by abusive doctors, but the pharmacies are the ones who got sued)[1], is it any surprise that Xanax and Adderall are being limited? If pharmacies are at risk for filling prescriptions that are more complex than antibiotics, the end result is that they make it harder to fill them.

[1] https://www.fiercehealthcare.com/finance/federal-jury-holds-...

[runnerup]

> is it any surprise that Xanax and Adderall are being limited?

That depends on who is doing the limiting — if the pharmacy corporations are self-limiting then I would understand they are limiting their potential exposure/liability to whatever risk level they are comfortable with. I’ll still be able to find my necessary drugs at another chain which doesn’t limit.

If the government is doing the limiting, then yes, that would be surprising. That seems to be the case here, and I think it’s a very inappropriate response — totally attacks the wrong part of the system.

[zamnos]

The article goes to lengths to describe how the government, specifically the DEA are limiting supply by issuing edicts to pharmaceutical companies. Corporations don't generally defy government edicts, especially ones that lead to raids and jail time, so we really can say it's the government's doing here, rather than particularly self-limiting behavior on the part of the pharmaceutical companies.

That the government is threatening defiance of edicts with fines and jail time and not using direct means to stop additional production is not a distinction worth making - the government is limiting the supply of these medications.

[landemva]

Can you please provide a cite? I tend to think this coercion probably is happening.

Agency rule making should be public and published in federal register. I don't know what the effective recourse would be. The easy track is to go to Mexico and load up on what your Dr. prescribed.

[zamnos]

I agree should be, but unfortunately that's not the case. Not in proper detail. Broadly, the DEA's power comes from the Controlled Substances Act, originally passed in 1970 - https://en.wikipedia.org/wiki/Controlled_Substances_Act, but the modern day limits themselves are secret.

The medications described are Schedule II, which is defined as "The drug or other substance has a currently accepted medical use in treatment in the United States or a currently accepted medical use with severe restrictions."

One citation for the limits being secret are:

Ike Swetlitz, I (2023) "Xanax and Adderall Access Is Being Blocked by Secret Drug Limits". Bloomberg, Online edition. https://www.bloomberg.com/news/articles/2023-04-03/adderall-...

> Xanax and Adderall Access Is Being Blocked by Secret Drug Limits

> The Drug Enforcement Administration regulates the manufacturing, distribution and sale of controlled substances, which can be dangerous when used improperly

> the limits themselves are secret.

> A Cardinal Health document reviewed by Bloomberg News says that limits are calculated on a daily, monthly, and quarterly basis.

[landemva]

Someone willng to pursue a lawsuit might file a FOIA and pursue in court for non-response. A sketchy approach could be suing pharmacy for ... something ... then find the limits for that company via legal discovery. Land of the free or not.

[zamnos]

We might be able to get the ACLU to sign on. They've filed a number of lawsuits for patients being denied gender-affirming care in various states. Without getting into a debate about the politics of gender-affirming care, those lawsuits would seem to spell out that denial of life-affirming care that sufferers of ADHD, a federally recognized disability, have experienced could give them legal standing to sue doctors over.

[jijji]

as per the article, the limits are being imposed by the DEA not the pharmacies and not the distributors.... a better approach would be to do a FOIA on the DEA and get all evidence about their restrictions on distributors for schedule IV narcotics (xanax, adderall, etc) and then sue the DEA maybe for interfering with interstae commerce, i dont know...

[runnerup]

> The easy track is to go to Mexico and load up on what your Dr. prescribed.

I believe you can only do this with unscheduled drugs so it is not a successful strategy for opiates and amphetamine.

[kevviiinn]

The DEA needs to justify their existence somehow

[pyuser583]

My understanding is that pharmacists are highly trained care providers. They aren’t simply some retailer who fills a doctors order.

[crmd]

In my brooklyn neighborhood, our pharmacist is basically the neighborhood “doctor”. He’s so trustworthy and conscientious that neighbors typically check with him before going to urgent care or making a real doctor appointment for anything. Then if he doesn’t see you for a couple of days he calls to make sure you’re feeling better. It’s all very cute and the relationships and position of trust reminds of what I imagine small town family medicine practice is like.

[cvalka]

They should have no business overriding prescriptions.

[zenexer]

They can and should—that’s their area of expertise. I’ve had pharmacists catch dangerous but obscure drug interactions that my doctors failed to catch, typically because the two interacting medications were prescribed by two different types of doctors. Even though both would’ve had access to the same medical records and my full medication list, and even though that data was being checked by a computer, mistakes happen and databases are sometimes incomplete.

[hombre_fatal]

That's the only happy case.

I've had pharmacists deny me because I was paying for amphetamine without insurance. They said it was suspicious and refused to call my doctor to confirm that I wasn't some sort of criminal.

That's the kind of unreasonable power that they shouldn't have. Finding bad drug combos? I don't think anyone has an issue with that.

If you find a customer to be suspicious (I was wearing a black t-shirt, to be fair), you should be required to call the customer's doctor office and confirm the prescription.

[lotsofpulp]

> That's the kind of unreasonable power that they shouldn't have.

Then the government should come out and say they will not go after pharmacists for filling any and all prescriptions.

The government wants it both ways, keep doctors and pharmacists liable and randomly nail, but not clearly publish standards of rules so no one can accuse the government of intervening in people’s right to healthcare.

Government gets plausible deniability and someone to throw under the bus. No reason for the people that can get thrown under the bus to stick their neck out.

[elcritch]

Even if you do everything right they're still often suspicious. I suspect pharmacies keep tabs of "suspicious activity" like asking for an early refill before a work trip.

These secretive DEA limits just underline a weird "moral judgment" of people who have conditions that benefit from stimulant medications. Almost like its our faults for having neurochemistry's that don't uphold the perceptions of a protestant work ethic.

The worse part is that its mostly separated from any particular religion nowadays but agencies like the DEA that essentially self-reinforce this lopsided moral code.

[hammyhavoc]

Oh no, not a black t-shirt.

[jijji]

I concur, pharmacists have no legal basis nor license basis in determining the decision making of a licensed medical doctor. The doctor is the one that provided the care came up with the diagnosis and came up with the plan for the prescription for the medication. The only role the pharmacist has is in dispensing that medication. it's wholly inappropriate for a pharmacist to get into the business of second guessing the work of a licensed MD.

[pyuser583]

No … just no.

For one thing, pharmacists aren’t just retailers. For example, I take a very powerful medication. It’s essential to get the dose just right.

My health care organization employs a pharmacist who sepecializes in the medication, and sets the doses for patients in the program.

This pharmacist doesn’t dispense medication. She instructs the physicians on what dose to prescribe.

I recently had an extremely painful medical event. I was given hydrocodone, but it didn’t have any effect. A pharmacist was called in, and they figured out a drug cocktail that addresses the pain.

Pharmacists really are medical experts and a knowledgeable part of the care team. Doctors should use their expertise more than they do. And it’s completely appropriate for a pharmacist to assertively demand an explanation for what’s going on.

[_8j50]

And that is such b.s. the one and only time I seeked medication for a certain issue, even though I went through a lot of embarassing process to get a perscription I was questioned like I was a drug dealer or something by the pharmacist in front of many people standing there.

Short of life and death situations I don't think I will be seeking any kind of medical care in the US. If it isn't urgent I'll make a vacation out of it and travel to cheaper more humane countries.

[renewiltord]

My experience has been nothing like this. Ideally, they'd be replaced by a vending machine.

[dsfyu404ed]

>which were written by abusive doctors, but the pharmacies are the ones who got sued

Must be nice to have a professional organization that acts like a cartel and makes lesser people pay for the sins of all but the worst of the worst actors.

[brandonmenc]

It’s amusing watching the hn commentariat freak out that they can’t get their amphetamine after years of telling chronic pain sufferers to just tough it out because opiates and the Sacklers are bad.