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The routine became rote. At roughly 30 minutes before closing time, an average-looking, relatively non-descript customer would approach the prescription counter and addressing either the pharmacist or a technician stated, “I’ve been all over town this evening and nobody has any of these in stock. Can you fill this for me?”

The prescription would be for an opioid analgesic. Schedule II, the most restrictive of the listing of controlled substances (save Schedule I, drugs that had, according to the DEA, no medicinal value). The story was familiar to every pharmacist who worked in Huntington in those days.

If you chose to lie (“Nope. Sorry, we don’t have any either.”), you risked the wrath of your employer for turning down a “legitimate” prescription (which they mostly were, yet we all knew who the “legitimate” prescribers were and those who were not). If you simply refused the prescription outright (“So you are from Portsmouth, Ohio? I can’t fill anything like this if it comes from a prescriber that far away. Did you try the pharmacies in New Boston, Wheelersburg, Ironton or South Point?”), the sarcasm was always lost on the more professional of them; by then they had turned away to exit.

If by some incident of aligning stars you actually did fill the prescription, within 10 minutes four to six more customers with identical prescriptions would descend on the counter. All new clients, all from locations miles away. All from the same doctor. All “legitimate.”

My colleagues (the majority) walked that tightrope daily. Refusing prescriptions because our gut told us they were not for purposes of patient health, because our profession commanded that we act with the patient’s best interests at heart, because we knew what was going on out there.

In fact, more than once individual pharmacists reported suspect physicians to the DEA or state authorities. Investigations were commenced that ultimately saw their removal as prescribers, but that took time, and all the while the wheel continued to spin and grind. At the same time when one “pill mill” closed in a given area, it (or its sister) would reopen in another location and the whole process would begin anew.

As the whole tragic affair unfolded, methadone clinics had lines around the block from those either trying to assume some sort of life or some sort of control. It (methadone) was touted at the Capitol as the “gold standard” for substance abuse treatment in a public relations tour de force that even had the governor on the sharing the limelight.

The red flags and alarms were everywhere, and yet it was left to line pharmacists to deny access, if even for unsubstantiated “illegitimate” reasons. No one else was there until it was far too late.

Herein lies my question.

How is it that the only real chance to slow the process was at the far downstream end — the prescription counter? How is it that drug wholesalers and the industry in its entirety (who spend millions to analyze sales data) did not stem the tide at its source?

Don’t get me wrong; there is a good deal of shared responsibility among all the players, yet who was it that dealt the “game,” and why? I submit, whatever the outcome in court may be, we all know.

Don Perdue is a Wayne County resident and a former member of the West Virginia House of Delegates.

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