Wednesday, May 24, 2006

So The Drugnazi Says To The Addict.....

....."this was a 30 days supply filled 15 days ago. You're gonna have to wait a couple weeks for your next refill unless you can get your doctor to OK an early one."

Then the addict says to the drugnazi:

NO YOU'RE WRONG!!!!!! IT WAS A SIXTY DAYS SUPPLY!!!!!! may want to change your line of argument there Perry Mason


The Apathetic Pharmacy Guy said...

I like it when they hobble to the counter for their Vicodin with a fake grimace, then 10 minutes later someone sees them at the park playing basketball.

kirby2 said...

Unbelievable that people are so stupid, but I'm sure you are not kidding!

It's so sad that some yoyos mess it up for others that actually can benefit from proper use of a particular medicine.

The FDA and DEA get involved and want to make hydrocodone/APAP schedule 2 because of a few addicts. It hurts us all.

It hurts the dental patient who needs a few pills to alleviate root canal or extraction pain for a few days, the person who gets chest wall inflammation and the many other people who develop another short-term acute painful condition who need help with pain so they can heal quickly physically and not focus on the 'pain'. The 'pain' goes away (real pain) in acute conditions thanks to meds such as hydrocodone.

And how about a chronic cough not attributed to anything serious. Hydrocodone combos are a great cough suppressant. It helps those that develop a cough for weeks - no known cause.

We make this med a schedule 2 and so many people will continue to suffer with no relief.

When this happens, what's left for effective relief of short-term pain or cough that doctors are willing to prescribe? Nothing! All because of a few addicts.

In the long term, the addicts are detrimental to all of us.

It's their (the addicts) problem, but unfortunately they make it our problem.

philskaren said...

I don't think there are just a "few" addicts. I'm from Las Vegas and every other Rx is for damn Lortab. I don't know what we should do about it, but I think that Lortab is way overprescribed here. I can't even count the number of people on my two hands that get over 100 Lortab each Rx-there are just that many.

Anonymous said...

I am a Registered Nurse. Unfortunately, some doctors UNDERTREAT pain. I've seen patients (decent people) go from doc to doc trying to get pain relief for very real physical ailments. So, these poor people (now physically addicted to a low dose of a narcotic that doesn't really take care of the pain) have several prescriptions from several different docs and, of course, have problems filling them because insurance keeps tabs on the dates or the pharmacy has records of the last fill date. It's awful.

You know, physical conditions can change from day to day. Someone may take an extra two percocets one day. OH NO!!!! God forbid. Then the poor guy is a day short on his prescription at the end.

As pharmacists, please try not to label everyone. You probably don't know the whole story. Anyone w/pain issues is probably an "addict" and IS desperate to get the narcotics. But it isn't always to get's to take care of the pain that is not being addressed properly by the docs.

Believe me, I know you have a hard job (so do I -try hospital nursing for a day. I get my share of PIA "addicts" ). I just get tired of seeing people treated badly by pharmacists when it really isn't their fault. The whole system is a mess.


drugnazi said...

You're not telling me anything I don't know my good nurse. You wouldn't know it from the tone of this blog, but I am well aware of the difference between being dependent on a medication and being addicted to it. There are people who are dependent on chronic meds to control their pain the same way I am dependent on chronic meds to keep my blood pressure under control.

I am also well aware of the controlled substance paranoia some of my colleagues have. I once worked with a pharmacist that refused to ever dispense a CII. Any CII, didn't matter if it was Adderall or Oxycontin, they were all agents of evil to her. Why on earth she still has a license is beyond me. Just the other day a regular customer came to me and said the floater we had in the other day refused to fill his Oxycontin prescription. Why? Because it was for 240 tablets. No other reason. Had the floater fired up his brain and/or listened to the customer he would have seen that the prescription was written for 10mg, with instructions of 4 tablets 2 times a day, precisely because it gave the patient the option of taking LESS narcotic than if the doc had written for the 40 mg tablets. I may have a few words for the floater next time I see him.

Having said all that though, there are times when an addict needs to be shown the door with my foot making contact with their ass. It's a judgment call, and I'm not saying I get it right 100% of the time, but I will say that a person with a legitimate medical need has little to fear from the drugnazi. I'll also say that letting loose on an addict looking for his Friday night buzz can be kinda fun....thanks for the comment.

Anonymous said...

Thanks for your well-reasoned and kind response to my rant.

Perhaps you can shed some light on the deal w/insurance.

Poor Meemaw (1000 year old patient) couldn't get a second narc prescription filled because insurance wouldn't cover it. I think she had one prescription filled a week previously (written by another doc). Pharmacist wouldn't even let her pay out of pocket for it. Just wouldn't fill it. It's a legitimate prescription.

What sort of legitimate power (for lack of a better word) do insurance companies and pharmacists have to approve or deny access to a medication that was ordered by a doc?

I get WAY too involved in these issues because patient and show up at the hospital when they can't get their prescriptions filled. Of course, they get dilaudid IVP and sent away w/ANOTHER PRESCRIPTION THAT THEY CAN'T GET FILLED. Argh.

drugnazi said...

There are 2 answers to your question, one applicable to the insurance company and one applicable to the pharmacist in this situation.

The insurance company can basically do whatever it wants. If they decide they won't pay for any green pills dispensed within a week of a full moon, then there's not a lot a person can do about it. With very few exceptions, when you let someone else pay your bills, you're obligated to play by their rules.

Of course the fact that the insurance company doesn't cover a prescription doesn't make it void. There is still the option of paying the entire cost yourself. This is where the pharmacist comes in. The basic rule that applies to pharmacists ability to refuse to fill a prescription is "if you can be held liable for something you can't be forced to do it" Meaning that if a customer is coming to me for a zillion Vicodin every other day from 20 different doctors I would be held accountable when that customer is busted for dealing in front of the high school. I would be expected to refuse to fill Vicodin for him, and may lose my license for doing so. I am well aware though that many of my colleagues take this way too far. In Meemaw's case, if the pharmacist honestly thought there was reason to be suspicious of her prescription the proper thing to do would have been to call doc #2 to make sure he was aware of Meemaw's previous prescriptions, then document the conversation on the Rx, and whaala...the pharmacist's ass is covered. Why would a pharmacist not do this? Sometimes they have 5 phone calls and 3 customers demanding their immediate attention all day long and they don't have time. Sometimes they are convinced that the DEA is waiting outside the store just waiting for a reason to swoop in. Sometimes they're just pricks who get off on playing the power trip game. There are bad docs out there as well, whose orders for 10,000 Vicodin for Rush Limbaugh every week should not be filled, but all in all, yes, the number of pharmacist refusals is way out of whack with the number of prescriptions that should not be filled.

galia said...

The ashcroft/dea'a war on drugs leaves pharmacist no other choice. There are only 2 ways i can guarantee that a patient wont sell their meds 1. not giving it 2. going home with them and making sure they take each pill accordingly-
Why would i risk my license and livelyhood for a couple of dollars? the DEA already started to focus on pharmacists, they are so much more fun to arrest then real drug dealers. I have had 2 collegues already 'raided' by the dea (along with most of the pharmacy in my area. Its much easier to just say you dont have it in stock rather then worry if an overzealous agent would think I should have known that so and so was going to sell their prescriptions-
screw the're not protected by the law

Anonymous said...

My wife is a pharmD- she is now in medical school. She ALSO is a cancer patient who has had cancer on and off again for 15 years. Now she has cancer again, and because her doctor knows she is a responsible and knowledgeable pharmacist (and also because she has had 7 surgeries and a prosthetic device and a LOT of pain) and med student she is given a LOT of various pain meds that she is able to pick and chose from. The quantities are high, but she REALLY needs them..

However the looks, the embarrassment and the sometimes refusal to fill from some of the pharmacists she has encountered is way out of bounds, especially if they can look up her profile and see what type of patient she is. The power trip some of her colleagues have is WAY out of line. Whenever I hear a pharmacist so quick to label patients it makes me infuriated...

love our blog..take care..

Anonymous said...

After reading some of these comments, I just kind of had to add my two cents- some of these problems have resulted in "drug sharing" and other illicit practices, which I am mildly embarrassed to admit that I do. I have a high tolerance for pain killers, so I'm typically prescribed something along the lines of Demerol/Tramadol when I need a prescription strength medication. At the time it's prescribed and for a couple of days after, I genuinely need something that powerful to manage my pain. But after the first 2-3 days, I'm left at a place in between where my pain is too much for OTC/off-the-shelf pain meds but not enough to warrant need (and risk building an even higher tolerance) for the prescription that I still have about a week or so left of. In those cases, I'll seek out someone I know who was under-treated for their pain to swap meds. Most recently, I did this with Tramadol after an extraction, giving the remainder in exchange for a handful of Vicodin to a friend who had a C-section since we both find Tram to be more effective than Vic for us. Even though the practice is illegal, we both found it to be the preferable alternative to being over/under treated and allowed us the ability to meet our genuine needs.
It saddens me how a bunch of addicts cause trouble for those of us who are just trying to do what we feel is right with our medications. I would never just hand the remainder of one of my prescriptions to someone who doesn't have obvious need for them. When I share, swap, or get some from someone else, it's something that's done responsibly (ie, we're not swapping things we need to fully complete, like antibiotics; warn each other about side effects; make sure the original scripts are in the right names) and at no profit from each other to economically meet real needs. Even though our hearts are in the right places and we do it for the right reasons, we're forced to keep quiet about it and act like shady drug dealers because addicts have caused a legal and social stigma toward it.

All that aside, in relation to the blog post- what a dumbass.