This is a comment on my blog from today https://www.pharmaciststeve.com/?p=7339#comment-4434
In short, all pharmacists are governed by state boards of pharmacy. This pharmacist is doing what is best for her and her career- not the patient.
So when you go to a chain pharmacy to get a prescription filled.. and you are told by the Rx dept staff that “we are not comfortable filling this ” this is apparently “corporate speak” for I don’t give a crap about you.. I am scared shitless of my corporate employer, DEA and Board of Pharmacy and I am not going to go out of my way to take the time to try and ascertain any facts about you and your disease state.. so that I can use my education and the facts to make the appropriate decision using my professional discretion as to your prescription.
If you are thrown into withdrawal… have to deal with elevated pain.. become bed/chair/house bound… suffer a stroke or die because of the withdrawal … over even become so desperate and depressed that you are driven to commit suicide.. I have my ASS/LICENSED covered…
You see… their corporate employer tells the public that these Pharmacist are free to use their “professional discretion”…but.. in reality.. corporate policies have basically dictated what their professional discretion is to be… turning these Pharmacists into self-centered narcissists .. that couldn’t find their backbone or balls if they had to..
Their corporate employers have a “virtual guillotine ” hanging over their heads… first wrong move… and it will come crashing down.
You would think that the various Boards of Pharmacy… whose primary mission statement is to protect the public health and safety … would come to the assistance to people who are being denied their medical necessary medication… but.. don’t count on it… most of these boards are stacked with corporate pharmacy employees.. mostly non-practicing Pharmacists.. so they are not about to take action against a corporate pharmacy over their discriminatory practices.. They know where their paychecks come from… and they don’t want to go back to being a practicing Pharmacist in the “fast food” work environment they have help to create.
Filed under: General Problems
This Is such crap! People go to certain drs cuz they know they can get whatever they want…oh dr my neck hurts my back hurts can I have something for the pain?? Really?? And we’re just supposed to fill up 180 pill for pain? You’re kidding right? It’s as if you think no one out there is a abusing these medications. Get real. I know people who go to a dr because that dr will give them whatever the ask for..an these drs who are supposed to be doing you good are getting you addicted…but you don’t have a problem with them at all??? Get a grip!
I can tell from your post that you have been one of the fortunate ones that have never been in prolonged, intractable, pain to the point that you really do wonder if you can take it getting any worse. Some of us actually fear that a simple fall off of a curb would cause paralysis or even more pain. Many of us used to be productive members of society, but our enemy, chronic pain, has taken that from us an now we can only hope that the medical profession can address this issue properly. I believe that there should be a medical review process for all legitimate, documented chronic pain sufferers that would start with their regular medical pain specialist and then be sent to a group of review medical professionals. Once the record is reviewed if pain treatment is needed then those patients would be certified and given identification so that they could get their medications. As long as insurance would cover the process (ie Medicare), I don’t know any legitimate pain patient that would not go through this process to be able to get their medications in the titrated amount they may be needing. I think that only a few pharmacies in each county should be allowed to fill controlled prescriptions so that it would be easier to moniter refill dates, etc. So any patient with a controlled prescription and identification that their program is acceptable by review then they could take any prescription to one of the “fill centers” and always get there medications and be able to use their insurance. This should take care of this problem if everyone really cared about the chronic pain issue. I will not be holding my breath that this will happen, I think the pain will continue.,
To Nona,,,do u have some sorta psychic ability?For it is fact,,that no-one can physically feel the physical pain of another..thats fact,,Sooo please tell me why u think u have the right o decide,,who is to suffer to death in physical pain,,or who will be able to get MEDICINE for physical pain from a medical condition??Why do u think u have that right to decide,,,who suffers??
Also everyone forgets 2 simple words,,”Informed Consent,” as so-called responsible adults,,,no-one puts that pill in their mouth but the person who owns that mouth,,,maryw
It seems like according to Steve the clown who dropped off a script at my pharmacy for Oxycontin 80 # 480 had legitimate reasons for this quantity. After all, her doctor(who by the way lost his license a year later after DEA investigation) wrote that prescription.
According to the Federal Controlled Substances Act both the pharmacy and practitioner must have a separate DEA permit to treat a patient for opioid addiction that is not the same as the permit they have to sell them for the treatment for pain. I do not know of a single corporate pharmacy with said DEA permit (this is excepted in the case of buprenorphine, ie suboxone). Therefore if a pharmacist has any doubt that an Rx for a pain medication may be for pain then it is 100% illegal for them to fill that prescription. This sounds rough but it is much safer for a patient to receive drugs for addiction from a facility set up to handle those patients. This particular case is a perfect example, your friendly community pharmacist is not set up to work with your suicidal ideation and unless your doctor works with you as part of a licensed narcotic treatment program then I doubt he has the training to work with you either. Opioid addicts require much higher intensity therapy than provided by the community pharmacy, this is why the law requires them not to fill it.
Go somewhere else if u don’t like it.it never says what the medication is or what it’s used for.it could be suboxone used to get off of heroin and 6 a day is way too many.she is protecting her license that she probably worked very hard for.there are so many drug abusers out there.u never can be too careful.
Years ago, pre-data base, I had a customer with BOTH a chronic pain problem and a drug abuse problem. He had been using and abusing oxycodone/apap and hydrocodone/apap products for years. One day he shows up at the pharmacy with a prescription for #240 10mg methadone. I called him to the side of the counter and questioned him about the prescription, and he blithely assured me his doctor was changing him over to methadone to control his chronic pain because the doctor was concerned about the acetaminophen hurting his liver.
I called the doctor and told him I was concerned about dispensing that much methadone to a patient with a history of abuse. The doctor loftily assured me he knew the patient’s history and was working closely with him to control his pain safely. In spite of my unease, I documented the conversation and filled the prescription.
I was blunt with the patient, and told him that this was enough methadone to kill him, and that because I knew he had abused his other narcotics in the past, I wanted him to understand that he couldn’t use the methadone as a recreational drug. I specifically told him it could stop his breathing. He was all nods and smiles, and told me over and over that he was through with “all that” and that from now on he was just trying to control his pain. He left with the 240 methadone tablets at noon on a Tuesday. On Wednesday morning his mother found him dead in his living room floor.
His death has changed the way I approach filling narcotics. When I see that video I see myself, trying to politely refuse the prescription without creating a scene in the pharmacy. I, too, have used the phrase “I am not comfortable filling this prescription” That is code for ” I don’t want your mother to find you dead in the floor tomorrow morning” or “I think you are selling these to teenagers, maybe even some of my children’s classmates”. If a patient wants to videotape me denying him his narcotics, I hope my hair is looking good.
It hurts when you lose a pt.. again pre-PMP.. had a regular that got a PCS card and when I ran it.. it sent back that he had filled the Darvocet N 100 at another store a couple of days before.. He got cut off by everyone.. a few days later… I got to attend his funeral after he took a 38 to his head and face his wife and two young kids.. And they claim that pain never kills anyone… In 2012 there was 1500 more Heroin deaths than 2011 and overall opiate deaths were up 650. People who abuse the drug ALCOHOL have a disease,, those that abuse some other substance are CRIMINALS.
Your regular would have eventually found his way to that death even if you had filled the Darvocet. I’ve seen it happen many times, if it isn’t an overdose it is liver failure, or a 38 to the head, or, even worse, a car wreck that takes innocents with the abuser. It’s a disease, but at some point I have to decide if I am treating them or enabling them. Opiate dependence and opiate abuse are two separate issues, but unfortunately there are crossovers between the two, and after 35 years in the business I have learned to pay attention to the clues. I suspect the pharmacist in the video was doing the same.
I work in a pharmacy and we see people come in with all kinds of forged perscriptions with weird things on them and when we tell the customer we won’t fill it they always respond the same way… That we don’t care… The opposite is true! We care enough about them and the community to stop their overuse and deadly addiction or even selling of these medications. The druggies need help… Not the pharmacist
Kdk
Steve if I remember correctly, that the pharmacists MUST use their professional judgement before filling any prescriptions.
I had this situation before, when we had people coming over with Rxs for Oxycontin 80 # 480, or I had a few customer from the same PA clinic with a typical junkie cocktail. And when I tried to verify the Rx they just yelled at me, telling me the same crap like in this video(You are not a doctor to make decisions). Guess what? If I can’t verify the prescription or I know the doctor is a clown, I will refuse to fill it. BTW the clown who used to prescribe 480 Oxycontin and other stuff lost his license.
I think the point everyone misses is the first thing the pharmacist says in the video… WE JUST FILLED THIS YESTERDAY… Of course she didn’t feel comfortable.
I think she says “we went thru this yesterday” apparently she told him the day before that she wouldn’t fill the for the quantity written.. so the patient got a Rx for a lesser quantity.
The pharmacist is in no way the problem here. Assuming this is for short acting narcotic pain medication, no patient should be taking IR pain meds six times a day and no doctor should ever write for it. No pain management guidelines would EVER recommend that, and clearly, the pharmacist is a professional and making the right decision derived from evidence based medicine and professional organization guidelines.
Hey doc, you wrote- ” no patient should be taking IR pain meds six times a day and no doctor should ever write for it.” EVER? Really?
Well here’s one. THE PRICE. The issue of the cost of medication is one rarely addressed in these discussions. While I don’t take oxycodone, from what I have seen online the IR tablets cost but a fraction of an Oxycontin Rx, the only ER formulation available. Despite Purdue touting its abuse deterrent technology, it is still rather easily abused. Dont believe me? Google it.
In particular video it took an addict 5 minutes and a microwave oven to prepare his OP for injection. 5 MINUTES.
The elderly and disabled are on fixed incomes. Every little bit saved is very important when you consider that these two groups usually have quite a few prescriptions to fill each month, both ‘scheduled’ and non-scheduled. For those doctors, nurses, pharmacists, even the avenging angel opioid zealots in case you didn’t recognize it, the price of medication has soared in recent years.
Still it seems like it is never an issue discussed when a doctor writes the Rx.
IF a discussion occurs at all it is only after the patient returns and tells them that it would have cost them $200 to get it filled and they couldn’t afford it. . This is not just for pain medication or other scheduled meds but for everything. Just 2-3 yrs ago I could get amitriptyline filled for $15-$20. Now the same dose, at the same frequency, and same # per month cost $38-$40 WITH MEDICARE PART D! Tier III for a drug that has been around for decades doubles in such a short time span? I need name brand Plaquenil. The cost 5 yrs ago when I started was approx $170-$180. The cash price listed now is $330!!! Even with approval for a formulary exception it is $90 per month for #60, over $115 when I hit the ‘donut hole’. This is INSANE. In response, many pharmacies have increased stock by ordering more Indian pharmaceuticals. Problems arose when inspectors saw gross violations that resulted in the closing of 19, yes 19 facilities in India (out of a total of appox 200) this is almost 10%!!. Currently Indian imports make up 40% of US imported Rx medications @ $4.23 billion dollars per year. Dr Reddy’s, Ranbaxy, Wockhardt, Ranbaxy are common generics used by Americans.
When many patients bring up this topic about one generic not being up to par with their pharmacist or doctor they are told all generics are the same.
http://www.aei.org/publication/cheap-indian-generic-drugs-not-such-good-value-after-all/
http://www.business-standard.com/article/companies/indian-pharma-grapples-with-quality-problem-113092700014_1.html
*The price of pharmaceutical drug increases are so outrageous that it has even prompted Congressional investigation.
http://www.nytimes.com/2014/10/08/business/officials-question-the-rising-costs-of-generic-drugs.html?_r=0
http://blogs.wsj.com/pharmalot/2014/10/02/lawmakers-probe-staggering-price-hikes-for-generic-drugs/ (article source: The Wall Street Journal)
Most pharmacists replying to this thread mention pill mills and addicts. What of a patient of a major medical center for over 5 years being turned away because their Rx was written in a building not connected to the main hospital (physically) but 2 blocks away and housed one floor below their Reumatology Dept. The PM ciinic is affiliated with the hospital, their doctors are listed on their website.Early you may ask? No, actually day 32 after last fill. Doctor unknown? Again listed on their website. Ibscene quantity? #120 (4 per day) same Rx amount for 3+ years.
I believe if the DEA had been doing its job or cared at all about the reasons for the recent clamp down, to reduce addiction, ODs, and protect society and patients, why did they let the pill mills get so out of hand. You can’t tell me they didn’t notice this crap, its their job, get a clue, you pharmacists are just puppets. The only question that remains is will you dance the jig? The answer when reading your BS is painfully obvious. The DEA sued Walgreens and CVS for not picking up on ‘trends’ like the ‘holy trinity’ well what about it G-men, where the hell were you? And why don’t these grieving parents of OD’d stiffs sue the DEA through the ACLU? NOW THAT SOUNDS MORE REASONABLE IMO.
Even better, why is someone always to blame for everything? In the case of the man who OD’d after receiving 240 methadone? Why is this the pharmacist or doctor’s fault? This country needs to leave consenting adults to make up their own minds (w/ advice from pharmacists and doctors) on the meds they take, What the hell ever happened to personal responsibility? I’m guessing that there were more that 8 pills missing out of the 240 or they were followed by an whiskey chaser. Your govt cant solve everyone’s problems. If anything they only make problems worse regardless of good (or bad) intentions.
You can say that again!
Amen,,”informed consent,” I not being honored anywhere is this country,,if I could,,id grow my own medicine and NEVER EVER STEP FOOT IN A DOCTORS OFFICE AGAIN!!maryw
We had a clinic that opened here where it was obvious the place was bogus. Every pt was from out of town and the qtys were out of the range of sensibility. Yes we turned them down and contacted the drug and narcotics. They finally shut them down. The dr flew in from NC to Ga and ran the clinic during the week. When it got too hot for comfort he hired a ga dr to run it. If it’s from a legit pain clinic you know it’s ok since they have strict guidelines. My corporate is actually scared we might turn someone down and get in trouble over it. We have to document all turn downs which puts the push on us to fill it. It’s a hard spot to be in when you want to do the right thing. The fact he recorded the conversation with the rph and kept pushing is pretty tell-tell.
It’s funny that now we are blaming the corporations for pharmacists refusing fills. A couple of years ago, we were blaming them for forcing (or pressuring) us into filling questionable scripts to increase sales. Is it implausible to think that this pharmacist did in fact use her professional judgement and decide that this script was not within normal dosing limits?
Our patients who visit a legitimate pain magement clinic are not the issue. They tend to fill their scripts on time. But our pharmacists know which clinics are legitimate and those which are pill mills. These pill mill clinics only accept cash for visits and give the patients what they request which is typically the holy trinity of medications such as a controlled pain medication, a benzodiazepine and a muscle relaxer. These patients who go to the pill mills always argue about early fill dates whereas those who see a legitimate pain management doctor understand. Most pharmacists I work with adhere to the correct fill dates. They will not jeopardize their hard earned degrees by filling these questionable scripts and I agree with their decisions.
The company I work for makes us fill out a refusal to fill form everytime we deny filling a prescription. we are required to call the MDs office to verify a patient/prescriber relationship, required to E-force for certain medications, and document it on the prescription. We now have over 10,000 tablets of hydrocodone in our CII safe due to this fantastic law change. Some local pharmacies have been ‘cut off’ by the DEA because they deemed them to be ‘overfilling’ hydrocodone now that it is a CII, even though they havent been filling more than usual.
We know our local pain management doctors and have never denied filling a prescription from them. If it comes from out of state I will call a local pharmacy to them and ask about the doctor.
We know the out of area doctors that seem to write for the same thing for different patients. Amazing how so many people from my area of Florida have found the same doctor in South Florida to prescribe the exact same cocktail of oxy, xanax, soma and adderall. So when we call to verify the receptionist quickly tells us what the patient had filled…reciting it quickly because ITS ALWAYS THE SAME DRUGS!
I made up a patients name one time when verifying and they recited the drugs back to me. I told them I had made up the name and would no longer consider filling for them anymore, they told me they dont care and hung up.
My partner had been filling one patients medication cocktail from a south florida ‘doctor’ because the grandfather always dropped it off saying she had cancer. One day the patient came in stung out as hell, wanting her cocktail and also sudafed and needles…. so I called the ‘doctor’ to verify her condition. Turns out the ‘doctors’ office had no record of her ‘Cancer’ and was treating ‘lower back pain’. So yeah we had to turn her away. ‘Oh..the doctor must have made a mistake’ she told me. Yeah..cancer..back pain..easy to confuse
So I tell the patients straight up we only fill for doctors in our area where a relationship can be verified, and that they need to get them filled at a pharmacy local to that doctor. Those patient circles have learned and do not come to our pharmacy anymore.
We have every right to be cautious and professional when we handle these prescriptions. It is our responsibility in the end..and if a patient is abusing and ODs because we filled their prescriptions without question do you think anyone will come to our defense? HELL NO! We are evil if we try to verify everything..and we are evil if we fill everything.
with the ISTOP program, national database, maybe she did a search that came up with results that showed that the rx shouldn’t be filled. maybe “not being comfortable” is her company’s predetermined line to tell patients when refusing to fill their rxs. maybe there was writing all over the rx that showed that he’d been turned away by other pharmacies already and this was another attempt. the fact that he started recording a video from the very beginning kind of proves that he knew there was going to be a problem- and I’m sure he knows why! We don’t see the patient or the exact rx in the video so I also don’t see how he can claim discrimination
According to this https://www.health.ny.gov/professionals/narcotic/prescription_monitoring/ ISTOP “Patient reports will include all controlled substances that were dispensed in New York State ” and this Pharmacy was in FLORIDA.. And running that report would help how in this situation ?
Florida has a similar system to ISTOP called EFORSCE. Semantics. You don’t know what happened here other than what the patient wanted you to know because they were the director and editor. We don’t know what occured before or after and we don’t know what the script actually was nor the physician that wrote it (or that physician’s reputation.) The pharmacist was in the right.
I also saw that the pharmacist was denying him as he started walking towards her, with a comment like “I already told you”. Also, part of their conversation revolved around him having gotten the rx changed. To me this implies an ongoing issue, either with this pt or this pcist.
I am a Canadian pharmacist practicing in the North and we very seldom have these issues but they do come up. I’m not likely to tell someone that I won’t fill the rx at all, unless I have it in my hand and I tell the pt that I’m going to have to talk to the Dr about it (whatever the concern is). Especially if the Md is not known to me and if it’s for more than a couple days supply at a typical dose, I will keep the rx myself rather than giving it back to the pt, since an rx is a legal document and if it’s being passed fraudulently it’s my responsibility to keep it and pass it on to the police.
I guess I just can’t imagine having all the problems that US p’cists face around N+C drugs. But if I have a chronic pain pt, well known to me and being appropriately managed, I will not deny them a small supply until whatever issue comes up has been resolved.
This is garbage. Most chains will side with the customer and force the pharmacist to fill the script because it’s money in the bank. I don’t know the circumstance of this situation, but if the patient looked off and was trying to fill mass quantities of narcs, then yeah, I could very well tell him to fuck off. There are plenty of pharmacies out there with pharmacists who will fill anything without a second glance.
You have no idea what we deal with every day. People who lie, steal, abuse , sell drugs…we are not in the business to refuse to fill rxs however there had to be. A very good reason professionally and ethically for her refusal .
Members of the clergy-hell, the entire world deal with the same every day. We know who you have to deal with, we deal with them too.
There ARE problems, but turning your backs on legitimate patients because you “mis-profiled” them is wrong. Take it up with the doctor.
Pharmacists have the right to refuse to fill any Rx they are not comfortable with and they do NOT need a reason. Stop trying to strong arm pharmacists into filling narcs THAT is against the law.
I suggest that you read this http://www.wlns.com/story/24635348/rite-aid-settles-after-refusing-flu-shot-to-hiv-positive-man Rite Aid got fined 15K for a Pharmacist refused to give a HIV + pt a flu shot. Pts covered under the Americans with Disability Act are under a different set of rules.. Refusing to fill a legit/on time/medically necessary Rx can be considered a civil rights/discrimination under the ADA. And the pt doesn’t need an attorney to file a complaint, there is a on line form..http://www.ada.gov/filing_complaint.htm
Steve why are comparing apples and oranges? Flu shot in general does not kill the patient, opioids can.
I am comparing apples and oranges because both the HIV + pt and the chronic pain pt are covered under the ADA.. Would you turn someone away because you didn’t like the color of their skin, nationality, religion or sexual orientation ? Depending on which number you believe.. every time a Pharmacist turns down a legally written Rx.. there is greater than a 70% chance they are throwing someone into withdrawal.. which can be deadly.. Pts being non compliant can be deadly… pts taking too much can be deadly.. pts taking OTC with their RX meds can be deadly. Other than the diverter.. someone who is in the business of selling drugs on the street – you are dealing with people who have a recognized disease … pain or addiction. I had a call last night from a chronic pain pt and her neighbor – a chronic pain pt – couldn’t get her opiates filled at any store for 30 days.. they found her hanging from a large tree in her front yard and before the toxicology results came back the medical examiner labeled as “accidental overdose ” But Pain has never killed anyone.
I would like to read whatever information you are quoting from that a pharmacist has the right to refuse to fill any RX they are not comfortable with. I suggest you read the Pharmacist Manual, title 9 of the DEA diversion and control office. It never indicates a pharmacist has a right to deny any prescription. In fact it stipulates the conditions a prescription has to meet in order to be filled. The real requirements for a pharmacist is that he/she must verify that the prescription is written for a legitimate medical purpose and is correctly written. There is no place in the law which I can find that gives a pharmacist a right to deny an RX because he/she does not feel comfortable filling it. Once the prescription has been verified it is the responsibility of a pharmacist to fill it.
I haven’t worked with a pharmacist yet who has denied a legitimate pain management prescription. The issues come to light when we deal with patients who see a doctor at a “pill mill”. For a cash paid.office visit the doctor will write a prescription for a controlled substance pain medication, a benzodiazepine and a muscle relaxer, ” the holy trinity” of drug seekers. These people are typically requesting early refills because the are going out of town. Those in legitimately run pain clinics typically will not ask to refill their medications early. Most pharmacists are sticklers for on time fill dates but will not deny a script based on their personal feelings, rather they make an educated decision based on well know legitimate pain management clinics and your every day run of the mill pill mills.
99% of all Hydrocodone is consumed in America….while we only make up 3% of the world population. Overdose and overuse are killing more people then auto accidents….and you sit here , like every other person , who is the exception , and not the problem…..
Fact is America is an addicted country and everyone looks the other way……the pharmacist has become the only person in this mess who has the ability to stop it…
America a it finest….
The stat of 99% that you quote is correct… the stat that is always ignored is that the rest of the world uses Dihydrocodeine as the primary opiate for pain management. Don’t believe all the “information” that the DEA and CDC puts out..they are like you.. protecting their job perpetuating the opiate hysteria .. There is 16K -18K that die from hospital acquired MRSA every year.. because staff don’t wash their hands.. that is the same number they claim die of a drug overdoses… but that is NOT A EPIDEMIC …
Don’t forget to mention the “pill mills”. People intentionally choose doctors who will write for the pain meds, benzos and muscle relaxers they request for a cash paid office visit. These doctors are very well known for their unethical business practices. A pharmacist should have the right to deny these prescriptions. If you’re in pain then go see a LEGITIMATE pain management doctor.
There are NOT any general practioners in FL that can write for these kinds of controls anymore. Only MD DO’s and pain docs are allowed. With such tough regulations on all pain providers in FL? You can bet they are ALL totally legit or our AG would have taken them OUT ! So any pharmacist making excuses for other pharms to refuse for a decent reason is just BS! Stop looking for anything to find to pick on these patients and refuse them. YES! Everytime one of these videos are done? It’s about pain medications. I am sick and tired hearing the ridiculous excuses. This is a HUGE crisis in FL, so no one would be doing these if it weren’t opioids..Good grief!!
yes I agree, Fla did have a huge problem at one time. I don’t see a rash of Florida prescriptions anymore, but some have just gone to different states unfortunately.
Hate to break it to you, but MOST doctors (even “General Practitioners”) are either MDs or DOs and ANY doctor can write for these meds. I was given a Rx for Percocet from a surgeon, then one for Oxycodone from a hospitalist….IN FLORIDA!!!!
Yes you are right the pharmacist does come across as uncaring for this particular person with this particular prescription. But you and I both know there may be more going on that does not appear in the video.
In the area where I work there are organized gangs which sign up elderly people for Medicare Part D and drive them all over town to get prescriptions for Oxycocodone, Soma, and Alprazolam. The gangs then ship the drugs to other parts of the country for a sizable profit. I am unwilling to act as their wholesaler. This is different from being uncaring.
Also in our area we have doctors which prescribe Hydrocodone, Fentanyl patches, alprazolam, and Adderall for every member of a family, as well as their in-laws and live-in partners. (That is to say, each member of several families.) Each of them for all of them! Am I uncaring for being a bit skeptical?
What am I to think when an expensively attired young lady in the drive though reaches into her designer handbag, driving a BMW, and hands me prescriptions for Oxy 30, Carisoprodol, and Xanax 2mg? Along with her Medicaid card? (I am not making this up).
I am not looking for excuses to deny people medications that they truly need. I would rather be bamboozled from time to time, than deny people who are in need. But there are so many druggies out there, and so many are getting drugs for resale rather than addicts themselves. It’s a business for them, and one I would rather not participate in. I don’t think that’s being uncaring.
I couldn’t agree with you more.. in fact I had a article publish in DRUG TOPICS in April 2014 on establishing protocol at the store level on decisions to accept/decline to fill controls. http://drugtopics.modernmedicine.com/drug-topics/content/tags/ada/filling-prescriptions-controlled-substances-establish-protocol
The disconnect for all of this, Steve, is that every time you post a video like this, you don’t know the story behind it, but you never err to the side of the pharmacist. Would you prefer the pharmacist say “I don’t fill prescriptions for this doctor?” or “I don’t fill prescriptions in this quantity?”
I try to teach my staff to be sympathetic to C2 patients, because they do get dicked around a lot. I special order a lot, and I have a regular patient on *gasp* Zohydro, because I’ll order it for him and everyone else gives him a grumpy “I can’t get it” – but I still turn down more prescriptions than I take in. And I’ll tell you what – if anybody ever tried to videotape me telling them I wouldn’t fill their prescription, the absolute first thing I would do is turn their drivers license outward towards the camera and recite exactly what the prescription says and that I don’t feel comfortable filling it. I’m not violating HIPAA, because I’m talking to exclusively the patient, and if they happen to be recording the information and feel the need to share their healthcare with everyone, that’s not on me.
Being TRUTHFUL with the pt.. that’s a concept you don’t see much any more…
What did the pharmacist say that was a lie? She didn’t say “I don’t have it,” didn’t say “it’s on backorder” – she actually specifically said “I’m not comfortable with it being prescribed in this frequency” – what is it you want for her to say?
IF you listen to it.. she says “to be very honest.. I am not comfortable filling this medication…” What ever opiate it was.. it would appear from her statement.. she does not like to dispense this medication PERIOD !
But that’s not what you said. You said be honest with the patient. And this pharmacist, in fact was.
In fact, it seems like this pharmacist had been doing exactly what you would want – you get the impression that the patient had been filling it before, and she didn’t suddenly become uncomfortable filling the medication yesterday. It just appears that the dosing got too high for the pharmacist to feel comfortable dispensing.
I never feel comfortable filling any C2 narcotic. Do you know why that is? Because they are dangerous drugs. I’m a little nervous every time I dispense one, because I’ve seen them kill people. That’s not congruous at all with “I won’t fill it ever,” but I’m looking at every single one carefully. To do otherwise is incredibly irresponsible, and every single school (and board) of pharmacy will back me up on that.
I am sure that they would stand behind you because – most likely – their clinical experience with dosing opiates you could fit on the head of a pin.. they only know what they read in books or someone with little/no clinical experience taught them.
and you are certain that the doctor that prescribed the particular medication in this video have more clinical experience by what evidence exactly?
If you ask any reputable pain doctor what the biggest problem with pain medicine is today, I’d wager that at least 3 out of 4 will tell you that it’s general practitioners writing extreme amounts of benzos and opiates in combinations without proper training. Dr Steven Lobel, who is a local physician that I have the utmost respect for and will fill anything he writes without hesitation, has made the assertation that the only practitioners who should be able to write for C2 narcotics in greater than a 10 day course are pain specialists. While it’s an extremist view, it’s has a solid basis of reason behind it.
That would be great but there are not enough pain specialists to accommodate all the chronic pain pts. I don’t know about the doc for this pt. but the pharmacist stated that she was not comfortable dispensing this medication – PERIOD which would suggest that her clinical experience with this medication is ZERO !
I think he has really annoyed her, both when this was recorded and the day before when he came in with a larger quantity. I can easily interpret that as “I have reason to believe you are BOGUS and I don’t want to fill this at all, period, in any quantity.”
I see both sides of the issue, but I think Steve you are doing a disservice to the pharmacy professional as a whole… All careers will have a few bad apples or people going rogue (I don’t think this pharmacist was in fact going rogue BTW) She wasn’t comfortable… maybe its a training issue, maybe the patient had just filled another rx.. My state has a huge drug problem, I always give the benefit of the doubt even if it means I get had, but I also have procedures I follow to not allow the drug problem in my area to get worse.. I dont fill c2s more than a couple days early… If there is an outlining circumstance like a death in the family and someone leaving town and its not a week or weeks early, Ill call the doctor, okay it with them, note it on the hard copy and advise the patient that this is the exception and will not be a regular affair. I have had legit reasons to turn down rx’s… like a doctor writing for an opiod naive patient fentanyl 75mcg patches who had just been on a few hydrocodones daily and hadnt been on any in a few days. I also had patients that were flying to florida at the height of the pill mill epidemic and dropping off prescriptions… I like practice close to an airport… I had patients come in that were not even residents of the state, literally off the plane or patients that used a linked pharmacy who had a different doctor in state for all their regular medications but an out of state doctor for their c2;s… I agree, people that are chronic pain patients should be able to get their meds… I know you dont expect every pharmacist to fill every c2 presented to them, but give some credit to the ethical pharmacist that is only trying to do the right thing, not trying to cause harm to the patient (like that patient overdosing on fentanyl) or contributing to the huge drug problem in my state…and I am not even getting into the issue that their were 50 some pharmacy robberies last year in my state… that alone shows the vast extent of the problem here.
I beg to differ that the pharmacist’s “clinical experience with the medication is ZERO.” Perhaps she has personal reasons for being uncomfortable dispensing the medication, maybe she has had other patients who have abused it, maybe she knows the doctor overprescribes it. Without knowing or speaking to the pharmacist, you shouldn’t ASSUME to know what her “clinical experience” is or isn’t.
IMHO, the patient sounds to be under the influence of something….his words are slurred, and he has little affect in his voice. If I were the pharmacist, I’d feel uncomfortable filling ANY controlled medication for the patient also. Unfortunately, I have way too much experience with substance abuse (of both legal and illegal sources) in my family so I’m a pretty good judge of when someone is intoxicated.
Points to consider for sure, but what if that woman in the BMW, with the designer handbag and the medicaid card is in a situation much like I’m about to find myself in?
The car was paid for by my long time state board career I just recently had to leave, and the handbag was a gift. I just had a job interview for hopeful new employment.
I ran out of FMLA & paid accrued leave and as a last resort (from canceled insurance and zero income) had to go on medicaid-
Then what?
There are many different variants to those situations. I don’t blame you for being “cautious” but bringing up a considerable circumstance.
You are the definition of the problem, Pharmd. A customer with a script for a medication prescribed for their condition which is FDA approved to treat that disease is called a PATIENT, not a druggie. When WAG got fined millions it was because they were in the wrong for not following correct procedures. It had absolutely nothing to do with legitimate pain patients who continue to need medication to treat their ailments. Stop confusing the issues and punishing the wrong people, sadist!
Real patients also go to the same pharmacy and they also have insurance . They don’t drive 200 miles to get a precription for pain. I am sure a doctor local could make the same diagnosis of the patient had a true condition.
I can’t begin to start with which statement is most ignorant in your comment. Stop generalizing. I’m not saying you’re a 100% wrong, but please spare the audacity of lumping every patient into your slander.
If the patient is going to go into withdrawal before they can get to another pharmacy they need rehab not a new pharmacist.
That’s right. Pharmacists have every right to put themselves #1 – their license and career are not worth helping out druggies. So if the pharmacist gets fired who is going to line up to help them? When WAG gets fined millions, who lines up to pay the fines? Exactly. No one does. So why would we sacrifice our livelihood?
Steve, after reading all the comments here, and reading your posts for a while, it appears that your advice is to shut up and fill the Rx. You seem to always err on the side of the unhappy patient without knowing all of the details. We do have a right (at least in my state) to not fill anything we are not comfortable with…….and a lot of factors go into making me uncomfortable. I tend to think I am very balanced, and sometimes you HAVE to say NO.
I agree but no one can argue that you simply are not doing your job. Does a cop stop doing his/her job because they might get hurt? Mostly, NO. I have had severe chronic pain for 25 years and the people and professionals who have denied me care is sickening. I know people have to look out for their selves but letting someone suffer in severe, unrelenting pain is criminal in itself. I was a patient of the wonderful, kind and generous Dr. Harvey Rose of Carmichael, Ca., in the 1990’s until 2003 when I returned to Minnesota after having to get a total hip replacement at age 30. These people who simply say just suck it up, I could, are full of shit. There are some people with extreme tolerances for pain but make it chronic and it is often a whole other story. Chronic pain has ruined my life, took my career, made me rather undesirable in marriage because I look like a hunchback and I have lost out in girlfriends and marriage not to mention just about every other great things in life. Chronic pain sucks, it ruins lives, it ruins relationships, it ruins everything that makes life great so everyone that decides not to take a stand that is directly involved, Doctors, Nurses, Pharmacists, family, all destroying the one chance at life chronic pain patients have. I would have committed suicide and I don’t like to admit that but the pain is just too bad to deal with “RAW” so if you don’t like what I am saying, have a friend beat your hand with a baseball bat and see how long you can stand it- it is just a hand- not your whole body.