CVS Creates Questionably Unethical Policy to Try and Help Reduce Opioid Epidemic (2017)

Controversy

CVS-filled opioid prescriptions

     CVS has created a policy that will now limit the strength and amount of opioid prescription. They are doing this to help fight the growing opioid epidemic in the United States. “The overdose death rate for illicitly-obtained opioids like fentanyl — the drug involved in the death of musician Prince — is skyrocketing (it jumped 73% from 2014 to 2015)” (Brodwin). People don’t realize how significant this epidemic has become. The shock of this epidemic is the people who are being affected. “Different age groups were also hit far harder by fatal opioid overdose than others. While overdose death rates increased for all age groups, the greatest increase was in adults aged 55-64. Still, the group with the highest overall rates of fatal overdose was slightly younger — adults aged 45-54. The percentage increase of drug overdose deaths among adults aged 55-64 rose from 4.2 per 100,000 in 1999 to 21.8 in 2015. In 2015, adults aged 45-54 had the highest death rate from drug overdose at 30 deaths per 100,000” (Brodwin). The people most effected by the drugs aren’t elderly people who are prescribed these drugs to help them with diseases, cancer, old age, or any type of illness they could develop with old age. It is secondary users who are getting hold of these drugs and using them for recreational purposes. “According to estimates from the CDC, 0.7% to 6% of individuals who take opioid prescriptions are addicted. Therefore, perhaps the biggest consequence of the crisis is the sale, theft, and sharing of the painkillers, notably between young adults. Many people become addicted after taking leftover pills initially prescribed to someone else” (Bhatt). CVS missed out on this statistic when they created this policy to reduce the number and strength of prescriptions given out to the people who need it the most and the people who aren’t the majority abusing the drug.

     This policy is meant to help reduce addiction of this strong and powerful drug. Chronic pain patients were outraged by this new policy. Many of the patients fear that they won’t be getting the correct amount of pain medication they need because of this new policy. They are not abusers of the drug but, yet they feel like they are being punished for this opioid epidemic. A huge ethical issue that has been around for a long time now is "when is it okay for doctors to prescribe opioids?" It is always uncertain whether they have enough pain to need these strong drugs, or if they are suitable to have these drugs and be able to handle the power of them. CVS putting a limit on the prescriptions might limit some addiction, but it also causes patients who are able to handle taking the drug, not able to get the correct strength or number of drugs because it exceeds the guidelines that were created in the new policy. The policy might reduce the number of patients that will become addicted or are addicted but it’s not just the patients that are prescribed the drug that end up abusing the drug, the biggest victims to the drug are secondary users. The sale, theft and sharing of the drugs are what cause the most harm in this growing epidemic. Many people become addicted after taking leftover pills initially prescribed to someone else. So, the problem is not from prescribing the drugs, it’s from distributing it to other people after they are prescribed to patients who really need it. The new policy is just limiting the patients who actually need it and most who can properly use the drug correctly. Now the people who need it the most are restricted to the amount and strength of the prescription even though they don't make up the majority of abusers who become addicted to this drug.

CVS Health Chief Policy and External Affairs Officer and General Counsel Tom Moriarty addressing the epidemic and reiterating CVS Health commitment through the new policy

Stakeholders

    There are many stakeholders in this case. The biggest stakeholders are the patients who are being prescribed opioids and CVS which is the business that made up the policy and is the largest pharmacy chain in the US. The opioid suppliers who supply CVS with the drug are going to be affected since CVS probably won’t need as much of the drug since the policy is restricting the amount and strength of all prescriptions. CVS stockholders will be affected by this policy being put into effect because stocks are always affected when a company is involved in ethical issues or a big business decision like this new policy. Upper-management, which most likely had something to do with the final decision and details to the policy, is also a stakeholder. Other pharmacies who compete with CVS such as Walgreens, and Rite Aid will be affected by this business decision. The last stakeholder will be the community. The community consists of the overall population of the US that has been affected by the epidemic and the people who are being potentially save from becoming addicted to opioids due to this new policy. The overall good of the US should be affected by this decision according to CVS since they plan on really helping the epidemic by reducing addiction.

Individualism 

     According to Milton Friedman, "The only goal of business is to profit, so the only obligation that the business person has is to maximize profit for the owner or the stockholders." The business policy created by CVS would not be considered individualistic. This is because their only goal was not to make a profit. That wasn't a goal at all in this business decision. If anything, they are going to lose money by putting limits on the amount and strength of prescriptions. CVS' obligation was not at all to make a profit for stockholders, it did the opposite, but this was to help fight the epidemic and benefit the overall good of the US. Maximizing profit was not the goal in this business decision by any means. Making any sort of money by making this decision was not on the minds of the decision makers, they were trying to help stop the growing epidemic. The problem is that they choose a method that deprives the wrong people of the drug. The new policy was not meant to be individualistic and increase profits and by possibly losing money by this policy, you could consider this business decision the opposite of an individualistic view.

Utilitarianism

     Utilitarianism is an ethical theory that focuses on the consequences of your decisions. A decision is considered ethical and an overall good decision if the consequences of that decision is positive and benefits the overall good. The utilitarian goal is to make ethical decisions that help the majority. Maximizing the overall happiness of the company and the employees is the most important thing in utilitarianism. "The economy exists to provide this highest standard of living for the greatest number of people, not to create wealth for a privilege few (DesJardins 30). Utilitarians are pragmatic thinkers meaning nothing is ever right or wrong in itself, the consequences are what determines a good or bad ethical decision or action. I think CVS created this policy to benefit the overall good, but I don't think they fully realized the consequences of this policy. Although CVS created this policy to benefit the overall good, I don't think a utilitarian would consider this an ethical right decision due to the consequences causing more bad than good. The policy is going to cause a lot more hurt and pain for chronic pain patients and patients that can handle taking the drug than it will cause good to the overall population of the US. The majority of the addicts that are contributing to this opioid epidemic in the US are not the patients who are receiving the prescriptions which are the people that will be directed affected by this policy. The majority of the addicts are secondary drug users and this policy is not going to affect these people. The consequences of this policy are badly affecting the patients but not directly affecting the main source of the epidemic which is why a utilitarian would label this unethical.

Kantianism

     A Kantian would say that this trial goes against the Kant's principles and the formula of humanity.  The Formula of Humanity is a more intuitive version of the Categorical Imperative and it states to “Act in such a way that you treat humanity, whether in your own person or in the person of another, always at the same time as an end and never simply as a means” (Salazar). "In the Formula of Humanity, it can also be seen quite clearly that people ought never to be unfair or treat people poorly" (Salazar). CVS is directly limiting the amount and strength of the prescription that patients who need it most get. This is unfair to these patients who need the drug to relieve them of pain and aren't using it just for a recreational drug to get them high. "According to the Formula of Humanity, honesty is also good, because deceit involves using people by bypassing their rational consent" (Salazar). The Kant's principles focus on the 'good will'. This means "your motivation is from duty and is not simply self-seeking" (Salazar). CVS is trying to help reduce the opioid epidemic but in doing so, they are taking away the right for patients to have a certain amount or strength of medication to keep them out of pain. "The Kantian principles will allow you to sell ineffective and harmful supplements if you are not deceiving or harming people, or otherwise using them for your own personal gain" (Salazar). CVS is selling a harmful drug to customers but it’s for their own benefit since it will relieve them of pain. Now they are putting limits on this pain relief because certain people can’t handle the power of the drug. Although this case doesn't break every one of the Kant's principles and the formula of humanity, it does qualify as unethical. CVS is going against what the patients want, and they are going to hurt the patients by limiting their pain medication and putting restrictions on it. This might not even decrease any addictions in the US, it might only severely hurt the patients who need a specific amount and strength of prescription that now won't be able to get it because of this policy. This is a big issue according to the Kants that would deem the case unethical. 

Is it an ethical business decision that will actually help?

Virtue Theory

    The characteristic that allows things to function property are called 'good-making features' or 'virtues' (Salazar). The four main virtues of character are courage, honesty, temperance/self-control, and Justice/Fairness. Courage is risk-taking and willingness to take a stand for the right ideas and actions. CVS shows courage for standing up for what they believe in and what they think is right. They definitely took a huge risk in creating this policy. The risk might not be worth it in the end though. They might have showed too much courage and risk in enforcing this policy as it might have a huge effect on their customers and overall well-being of their company. Patients with chronic pain due to disease, illness, or cancer and patients who just underwent a big painful procedure might go to a different pharmacy, so they know they will be able to receive the correct amount and strength of prescription. Honesty is represented in agreements, hiring and treatment of employees, customers and other companies. CVS is honest about the decision and the details of the policy which is good, and they stand by this policy. Temperance is “reasonable expectations and desires” (Salazar). I do not think that CVS policy is reasonable. I think that at the end of the day they will cause more hurt than good. There needs to be more surveillance and monitoring on the distribution of opioids in the US and I believe that is the real problem. I don't believe that it is all the pharmacies fault. Their needs to be more cracking down on drug selling by law enforcement to make sure that these dangerous drugs don't get into the wrong hands of people who don't need the drug but rather just want it for the high. The goal of reducing the prescription giving to patients who are in dire need of the effects of the drugs just to hopefully try to reduce the likelihood of addiction to these drugs by everyone in the US is irrational. The main source of abusers aren't these users who are getting medical permission to take this prescription that is intended to help them, it’s the secondary drug users who are causing this opioid crisis. Justice is hard work, quality products, good ideas, and fair practice. CVS means well by the policy, but they aren't going to help this epidemic by enforcing this policy. They aren't limiting the drug use of the majority of the problem, they are limiting the people who actual need it and the people who are the whole reason why opioids became a medicine prescribed to people in the first place, to relieve them of pain. This policy is unfair to the people that deserve to be able to take this drug without restrictions. 

References

Anson, Pat. “CVS Defends Rx Opioid Policy.” Pain News Network, www.painnewsnetwork.org/stories/2017/9/28/cvs-defends-rx-opioid-policy.

Bhatt, Zayani. “Limiting opioid prescriptions reduces addiction, but will it raise ethical issues?” MIMS News, today.mims.com/limiting-opioid-prescriptions-reduces-addiction-but-will-it-raise-ethical-issues.

Brodwin, Erin. “Deaths from opioid overdoses have jumped - and one age group is being affected at stark rates.” Business Insider, Business Insider, 28 Feb. 2017, www.businessinsider.com/opioid-overdose-death-statistics-2017-2016.

DesJardins, Joseph R. An Introduction to Business Ethics. 5th ed., McGraw Hill, 2014.

Joseph, Andrew. “CVS tightens restrictions on opioid prescriptions in bid to stanch epidemic.” STAT, 21 Sept. 2017, www.statnews.com/2017/09/21/cvs-opioid-prescription-limits/.

Rieder, Travis. “An ethical dilemma for doctors: When is it OK to prescribe opioids?” STAT, 25 Sept. 2017, www.statnews.com/2017/09/26/ethical-dilemma-doctors-ok-prescribe-opioids/.

Salazar, Heather. The Case Manuel. Heather Salazar, 2014-16.