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Retail Pharmacy Paranoia Is Understandable–But Patients Are The Real Victims



By Jeffrey A. Singer, Cato Institute


There is already ample evidence that the war on opioid prescribing has intimidated many pharmacies and pharmacists into refusing to dispense legally‐​prescribed opioids. This is tragic for patients, but an understandable result of incredulous lawsuits brought by state attorneys general against pharmacy retailers CVS, Walgreens, and others for allegedly contributing to the opioid overdose crisis by filling opioid prescriptions—even as overdose deaths continue to mount while opioid prescribing continues to drop precipitously. (87 percent of those overdose deaths involve illicit fentanyl, more than a quarter involve cocaine, and more than a quarter involve meth.)

A recent study by Oregon State University College of Pharmacy found 1 in 5 pharmacies refuse to fill prescriptions for buprenorphine, the Schedule 3 drug used for medication assisted treatment for addiction to opioids. The Drug Enforcement Administration classifies Schedule 3 drugs as “drugs with a moderate to low potential for physical and psychological dependence.”

It now appears that pharmacy chain paranoia has extended to prescribing psychostimulants. The Wall Street Journal reports that CVS will no longer fill prescriptions for Adderall and other psychostimulants used to treat ADHD that are prescribed by clinicians working for the telehealth providers Cerebral, Inc. and Done Health. These two telehealth firms have been treating patients with ADHD with these drugs, classified by the DEA as Schedule 2: “a high potential for abuse which may lead to severe psychological or physical dependence.”

Prior to March 2020, DEA regulations required an in‐​person evaluation before clinicians could prescribe any Schedule 2 drug. That rule was relaxed in response to the COVID pandemic and the public health emergency. Providers are now permitted to prescribe such drugs after a telehealth appointment.

Cerebral and Done Health attracted many patients through social media ads during the darkest days of the pandemic. Some have criticized their telehealth providers for prescribing the psychostimulants after a 30‐​minute video appointment. But Cerebral claims its clinicians can require an unlimited number of appointments for evaluation and follow‐​up. Done Health claims its software helps its clinicians complete their initial evaluations in 30 minutes. Clinical psychologists will tell you it is not necessary to evaluate a patient for ADHD in person—a detailed history and interview is usually all that is needed, and that can be done with telehealth technology. Some but not all practitioners supplement their interviews with cognitive tests.

The pharmacy chains’ paranoia over filling prescriptions for controlled substances—and their increasing reluctance to do so—is understandable considering that policymakers and prosecutors blame them for somehow causing an overdose crisis that is really the direct result of drug prohibition. The pharmacies have a lot to lose when the government comes down on them. Alas, the biggest losers in all of this are the patients.


Jeffrey A. Singer is a senior fellow at the Cato Institute and works in the Department of Health Policy Studies.