Over the last several years, pharmacy after pharmacy was busted for excessive sales of addictive pain pills. Thursday, U.S. Attorney Mike Stuart announced the latest bust — an Oak Hill pharmacy filling too many prescriptions for a medication to treat addiction.
The medication's brand name is Subutex; its generic name is buprenorphine.
Research shows that buprenorphine, called a partial opioid, prevents opioid overdoses and symptoms of opioid withdrawal. When taken as directed, the Substance Abuse and Mental Health Services Administration (SAMHSA) says it's only likely to cause a high among inexperienced users. However, some users crush and snort the drug to create euphoric effects similar to heroin and sell the drug on the street.
Stuart said, in a news release, that the Drug Administration Administration (DEA) had suspended Oak Hill Hometown's Pharmacy's registration, blocking it from filling further prescriptions, at least for now.
"Prescribing controlled drugs is a privilege and not a right," Stuart said in a statement. "Every pharmacy that fills prescriptions of scheduled narcotics has a corresponding responsibility to assure that those prescriptions do not include unresolvable red flags and are for a legitimate medical purpose."
Stuart said from at least December 2016 to March 2019, the pharmacy filled about 2,000 prescriptions for Subutex "in the face of obvious red flags of drug abuse and diversion." Over half the prescriptions came from an out-of-state clinic located almost 200 miles away from Oak Hill, according to the news release. In some cases, patients drove more than 600 miles.
Stuart said about 96 percent of the prescriptions were paid for in cash.
No criminal charges were filed.
Stuart said the DEA executed an inspection warrant on Nov. 28, 2018, and the pharmacy began filling fewer out-of-state prescriptions.
"However, since that time the pharmacy’s pharmacists have resumed filling prescriptions with the same unresolvable red flags," he said.
Attempts to reach Martin Njoku, owner and pharmacist at Oak Hill Hometown Pharmacy, were unsuccessful. No one answered the phone at the pharmacy Thursday, and the answering machine did not provide an opportunity to leave a message. But the pharmacy will have a chance to make its case before the DEA on Oct. 15, at a location undetermined, according to the news release.
Locals said the pharmacy was closed Thursday, so other local pharmacies couldn't call Oak Hill Hometown Pharmacy to transfer prescriptions for patients. But Shawna Dennler, pharmacist at the Walgreens pharmacy in the Oak Hill Rite Aid, said that they'd be happy to work with patients who need help getting their prescriptions transferred.
Patients may also be able to call their doctors and ask for their prescriptions to be sent to other pharmacies.
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Dr. James Berry, director of addiction services at West Virginia University School of Medicine, said that providers in West Virginia who prescribe medication for opioid addiction typically prescribe Suboxone, not Subutex.
Unlike Subutex, Suboxone contains naloxone. Most people know naloxone, brand name Narcan, as the drug that can reverse opioid overdoses. But when combined with buprenorphine to make Suboxone, it makes the medication less susceptible to abuse because it brings on effects of withdrawal when the medication is injected or snorted.
SAMHSA recommends that Suboxone be used, verses Subutex, unless the person is allergic, or pregnant, as research hasn't shown whether naloxone is safe during pregnancy.
Berry, who is also interim chair of the Department of Behavioral Medicine and Psychiatry, said it was likely that West Virginians who traveled out of state for the Subutex prescriptions could have used Medicaid in West Virginia to obtain Suboxone, but wanted the Subutex instead. Subutex is more likely to be sold on the street, and at higher prices, Berry said.
Berry also said that unlike opioid drugs heroin and fentanyl, buprenorphine has a ceiling effect, meaning the effects don't become stronger after higher doses.
"Certainly it would be safer than shooting up heroin, no doubt about it," he said. "However, you still run the risk of somebody contracting an infectious disease and maintaining their addiction without getting the help they need, where if they're being prescribed the combination product, that's less likely.
"Now that being said though, a lot of the diverted buprenorphine... we know is being diverted because there isn't enough treatment out there and people are forced to go to the streets to try to find this stuff to keep from using heroin for instance, or fentanyl."
Diversion of Subutex has been a problem for at least 10 years, he estimated.
Berry said the state needs "access on demand to legitimate treatment in people's communities so that they can do this the right way," in contrast to "continuing to chase our tails."
"If you had to have some opioid out on the street, the safest thing would be to have buprenorphine since it's a partial opioid, right?" he said. "And so that would be safer than heroin or fentanyl or carfentanyl or anything else you don't know exactly what's in it. But we don't want to have any non-prescribed opiates out on the streets."
Kim Miller, a master's level addictions counselor and spokeswoman at the substance abuse and mental health treatment provider Prestera, said that in West Virginia, the providers she knows choose to prescribe Suboxone, and only prescribe Subutex to pregnant women.
"This kind of discovery tells me that there are still many individuals in West Virginia living with substance use disorders who are not accessing treatment for whatever reason," she said. "It just shows we have a long way to go, and that is is a very complex problem.
"The problem of substance use disorders in our community is a complicated problem and the solution is not going to be any one approach. It's going to be everybody doing everything that they can to solve the problem, including the U.S. Attorney doing his part."
For those looking for treatment, SAMHSA's national hotline is 1-800-662-HELP, while the state's is 1-844-HELP4WV.
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