Once again the war on drugs forgets LTC

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Here we go again.

On May 23rd U.S. senators unanimously passed an amendment to a Food and Drug Administration reauthorization bill that would reclassify all hydrocodone substances. The amendment, introduced by Sen. Joe Manchin, D-W.Va., would reclassify painkillers like Vicodin and Lortab as Schedule II drugs, which also affects how they are to be stored and prescribed. This is now being called the Manchin amendment. Those of us in long-term care might have other names for it, none of them that flattering!

The biggest problem is that despite the arguments we might make, even in an organized fashion, is that this is a train that has left the station, as usual before we can hop on and have our say. Four other senators have co-signed the amendment that was added (snuck?) onto the FDA user fee legislation (part of the PDUFA consideration on the Senate side).

So before any of the medical associations knew it, it's out there and the senators are applauding themselves for “this legislation on behalf of the countless West Virginians whose lives have been cut short by drug abuse and the families who are picking up the pieces.” OK, I mean drug abuse and drug abuse deaths are some serious “stuff.” I get it. But what about other settings besides the streets? Meaning, the severely, heavily, federally regulated and controlled long-term care setting???? While I strongly support efforts to prevent the abuse of drugs, I am very fearful that this approach will unintentionally limit access to legitimately needed pain treatment for residents in LTC. Why doesn't anyone ever consider us?  (Other than penalize us.) You know, beat us up for not meeting the requirements of F309, beat us up for transferring these patients to the ER so they can get pain medication, sue the heck out of us for both these reasons, but not help us be able to get appropriate pain medication for these frail elders. (I mean, at least buy me dinner first if you catch my drift!)

Let's face it, many patients today experiencing acute pain in nursing care facilities are facing significant delays in getting needed Schedule II medications. The reclassification of hydrocodone-containing combination products will only serve to expand the scope and severity of this problem.  

Look, the DEA doesn't care that grandma is in pain. That's not their job. They're an enforcement agency so don't look for sympathy from them. The senators, well, they have political agendas on their mind. They are not thinking about the millions of frail elders  that are in pain rotating in and out of long term care each year. And good luck for the legislative Nurse as Agent bill (The Pain Relief Act) to make its way to actualization (multiple reasons for that, but let's just say it may snow in Hades before….).  Seriously, do you have any idea how apocalyptic it will be if the schedule III's get moved to schedule II's without some carve out or protection for LTC?  Now is the time to open your mouths (or rather take out your pens) and write your senators and congressmen and say remember your elders and stop letting them suffer.  Tell them to find a way to make their war on drugs but protect their elders.  NOW!

Just keeping it real,

Nurse Jackie

The Real Nurse Jackie is written by Jacqueline Vance, RNC, CDONA/LTC — a real life long-term care nurse who is also the director of clinical affairs for the American Medical Directors Association. A nationally respected nurse educator and past national LTC Nurse Administrator of the Year, she also is an accomplished stand-up comedienne. She has not starred in her own national television series — yet.

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The Real Nurse Jackie

The Real Nurse Jackie is written by Jacqueline Vance, RNC, CDONA/LTC, an APEX Award of Excellence winner for Blog Writing. Vance is a real life long-term care nurse. A nationally respected nurse educator and past national LTC Nurse Administrator of the Year, she also is an accomplished stand-up comedienne. The opinions supplied here are her own and do not necessarily reflect those of her employer or her professional affiliates.