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By Elizabeth Millard
As the cost for prescription drugs continues to rise, some health
care consumers have been going to Canada or Mexico to obtain medications.
Recently, the National Society of Clinical Psychopharmacologists
(NSCP), has developed a plan that could save some mental health
care patients that trip.
Citing concern for their patients, NSCP members announced that
they would begin bypassing U.S. physicians and routing their prescriptions
through Canada instead. The NSCP is mainly comprised of psychologists
with a pharmacology training certification known as RxP, and the
prescriptions will only be for mental health drugs.
In the past, the psychologists have used U.S. doctors to countersign
prescriptions. With the new plan, which is already being implemented,
psychologists with RxP certification can call a Canadian pharmacy,
connect with a physician who will countersign, and have patients
buy the medication through the mail or online.
NSCP President John Caccavale, Ph.D., says that the change in policy
is in response to alarmingly high costs for drugs in the U.S., and
that the ideal change would be lower drug prices domestically. However,
because no plans are in progress to bring about that outcome, he
feels the move toward Canada is the only option.
"The issue here is psychologists responding to the needs of their
patients," he says. "There's no question that the current political
structure is designed to protect the drug companies, not the consumers.
We want to correct that imbalance."
Caccavale adds that he and the NSCP believe that they're working
in the public interest and that if any controversy comes from their
actions, at least the issue will be highlighted. "Canadian law requires
price controls on drugs," he says. "Why don't we have price controls
here? I think it would behoove all psychologists to be working on
this, to be getting more affordable drugs for our patients. If we
don't do it, who will?"
The NSCP is just one organization that is in the center of the
Canadian drug controversy, which is a fairly fierce and lively debate.
"This is a very dangerous plan," says A. Peter Kohl, R.Ph., a member
of the board of directors of the New Hampshire Pharmacists Association.
"They are taking an unsuspecting population and putting them at
risk." Kohl says that it is currently against the law to import
drugs into the U.S., but that the larger issue is the quality of
the drugs that are being dispensed.
"Canada has drugs coming into their country from all over the world,"
he says. "And the places that they're coming in from don't have
any regulations. That means you can't guarantee what you're getting.
And to pass that lack of quality onto patients is irresponsible."
Chris Albanese, R.Ph., president of the Rhode Island Pharmacists
Association, worries that if a problem occurs with NSCP patients,
they won't know where to turn. Also, the NSCP psychologists would
have sole liability in the event of pharmacy or physician error,
he adds. Lost, too, would be the interaction between patient and
pharmacist that can result in information about drug combinations,
side effects, and medical record reviews.
Albanese says, "[We] realize that the prices of medications here
in the U.S. are too expensive, and obviously something needs to
be done to reverse the price disparity of American-made medications
here as compared to prices abroad. However, we feel importation
from abroad is not the answer."
For psychologists that aren't in the NSCP, the issue can be a murky
one. While giving patients the ability to buy medications at a lower
rate is a powerful strategy, some psychologists wonder if using
Canada to do it is really the answer.
"I greatly appreciate the efforts by Dr. Caccavale and others to
find creative solutions to these problems," says Jeff Matranga,
Ph.D., ABPP, who works in the health psychology department at Maine
General Medical Center in Waterville. "At the same time, I believe
we should be very cautious about using a method that could be framed
as doing something underhanded."
Matranga says that even if the intentions of the psychologists
in the NSCP are good, it's possible that in the long run, any controversy
that's generated might harm those psychologists who believe they
should be able to write prescriptions. "Let's keep building trust
with our patients and primary care providers," Matranga says, "and
avoid doing anything that might either inadvertently sabotage that
trust or that might give the guild-oriented psychiatrists ammunition
for attacking our integrity."
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