NURSES' DRUG DISPENSING EXAMINED

A crackdown by U.S. drug agents on the dispensing of prescription
drugs in nursing homes is coming under industry fire and congressional
scrutiny. The Drug Enforcement Administration last year began probing
allegations that nursing staff at some nursing homes were illegally
dispensing powerful medications without doctor authorization. The
issue is the subject of a Senate hearing set for Wednesday.

Nursing-home and hospice-care trade groups say patients have been
left to "languish in pain" while nursing homes and pharmacies try to
find ways to comply with DEA regulations requiring physicians, in most
cases, to write prescriptions. The industry groups are lobbying
Congress to change the law. Because of the DEA's heightened scrutiny,
"vulnerable patients have at times been left to languish in pain as
nursing-home nurses and doctors strive to adhere" to federal
regulations, Sen. Herb Kohl (D., Wisc.) said in a statement. Sen. Kohl
called the Wednesday hearing, to be held before the Senate Special
Committee on Aging.

A DEA spokesman declined to comment on the issue yesterday.

Recently, the DEA has intensified efforts to fight prescription-drug
abuse, which some experts say may surpass the abuse of illegal drugs.

DEA officials say the diversion of legally prescribed pain drugs into
a burgeoning black market is a major problem.

Last July, DEA officials armed with court orders visited several
nursing homes and the offices of PharMerica Corp., a pharmacy supplier
to the facilities. The agents were following an informant tip that
drugs including the pain medications Fentanyl and Oxycontin were
dispensed without proper authorization, according to a DEA affidavit
filed in U.S. District Court in Milwaukee. A PharMerica spokeswoman
didn't respond immediately to a request for comment. In a letter to
lawmakers in December, Assistant Attorney General Ronald Weich said
the DEA, part of the Justice Department, was acting out of concern for
patients.

Allowing nurses to issue prescriptions "trivialize[s] the
doctor-patient relationship and weaken[s] the quality of care for the
frail and infirm," Mr. Welch wrote.

He said DEA investigators found instances where nurses faxed or called
in prescriptions without a doctor's knowledge. In some cases,
pharmacies were "shopping for doctors to sign prescriptions"
regardless of whether the patient was under their care. Industry
groups say the business models of long-term care facilities don't
provide for enough doctors to issue prescriptions every time. "DEA's
reliance on hard copy prescriptions and failure to acknowledge the
role of nursing in long-term care and hospice place additional burdens
on prescribers, pharmacists and nurses and can substantially delay and
in some cases, impede access to appropriate pain medication," says a
brief prepared last year by the Quality Care Coalition for Patients in
Pain, which represents trade groups such as the American Society of
Consultant Pharmacists.