# How can a pharmacist decide not to fill a valid prescription? **URL:** \ **Category:** In My Humble Opinion\ **Created:** [April 5, 2016, 10:50pm UTC](https://boards.straightdope.com/t/how-can-a-pharmacist-decide-not-to-fill-a-valid-prescription/751302 "2016-04-05T22:50:37Z")\ **Posts on this page:** 20\ **Page:** 5
**Author:** ![septimus](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/septimus/32/410_2.png) [@septimus](https://boards.straightdope.com/u/septimus)\ **Post date:** [April 9, 2016, 9:16am UTC](https://boards.straightdope.com/t/how-can-a-pharmacist-decide-not-to-fill-a-valid-prescription/751302/81 "2016-04-09T09:16:40Z")
> [@Doctor\_Jackson](#): > > Oh, I don’t know, could it be because accidental drug overdose is now the leading cause of accidental death? I’m afraid I’ll sound like a right-wing bigot but … is it possible U.S. carries “correctness” too far? We want to stop Islamic terrorists, so to be “fair” we search ten grandmothers for everyone who fits an actual profile? Teenagers overdose on street drugs, so respectable citizens are denied pain relief, or have trouble getting their prescriptions filled? When my mother’s purse was stolen on vacation I wanted to get a few “nitroglycerin” pills for her in case of emergency. The pharmacy acted like I was trying to buy heroin. I don’t think anyone consumes nitro recreationally — it gives a horrible headache. (And do you know how many 5mg nitro tabs it takes to make a bomb?) BTW, I see that Tylenol with codeine is schedule III — I thought the purpose of the Tylenol was so that anyone seeking a good codeine high would have to consume a dangerous amount of Tylenol 😛 (Or is the drug-seeker presumed not to know that?) > [@TBG](#): > > … problem … ever since Obamacare … OK; I should have known whom to blame. ---
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [April 9, 2016, 10:39am UTC](https://boards.straightdope.com/t/how-can-a-pharmacist-decide-not-to-fill-a-valid-prescription/751302/82 "2016-04-09T10:39:34Z")
> [@septimus](#): > > I’m afraid I’ll sound like a right-wing bigot but … is it possible U.S. carries “correctness” too far? We want to stop Islamic terrorists, so to be “fair” we search ten grandmothers for everyone who fits an actual profile? Teenagers overdose on street drugs, so respectable citizens are denied pain relief, or have trouble getting their prescriptions filled? What makes you think teenagers in street drugs are the problem here? Most especially, what makes you think teenagers on street drugs are the problem here…when I just provided a cite that patients taking their opiates as prescribed, by a single doctor, are still overdosing on them? This isn’t (only) a War on Drugs thing. This Is a “Holy shit, look at these numbers, we’re killing people! We have to stop killing people!” thing. THIS is the evil Big Pharma, clueless doctor shill, and mismanagement of healthcare scandal that the conspiracy theorists have been slavering for. This Is it. This is where we screwed up, big time, and we’re killing people. …and no one wants to notice, because no one wants to be in pain. Even if our painkillers are giving us pain. ---
**Author:** ![GrumpyBunny](https://avatars.discourse-cdn.com/v4/letter/g/bc8723/32.png) [@GrumpyBunny](https://boards.straightdope.com/u/GrumpyBunny)\ **Post date:** [April 9, 2016, 2:28pm UTC](https://boards.straightdope.com/t/how-can-a-pharmacist-decide-not-to-fill-a-valid-prescription/751302/83 "2016-04-09T14:28:50Z")
Walgreens is known to be a pain in the ass when it comes to filling pain med prescriptions. I won’t use one anymore after they treated me like a junkie when I tried to fill one with them. ---
**Author:** ![GrumpyBunny](https://avatars.discourse-cdn.com/v4/letter/g/bc8723/32.png) [@GrumpyBunny](https://boards.straightdope.com/u/GrumpyBunny)\ **Post date:** [April 9, 2016, 2:39pm UTC](https://boards.straightdope.com/t/how-can-a-pharmacist-decide-not-to-fill-a-valid-prescription/751302/84 "2016-04-09T14:39:02Z")
One other comment – insurance companies are NOT making it any easier to use fewer/no opiates. Because you have to fill many, many months of Vicodin (generic) before you equal the cost of one spinal epidural injection. My own opiate use increased a bit earlier this year because my insurance company decided that a non-opiate treatment (spinal epidural injection) that worked for spinal stenosis plus an old injury needed prior authorization now. It took them two months to deny the treatment. In that time, I had to manage to drag myself to work and to function enough to keep my household relatively clean and handle all of the day-to-day stuff that you take for granted until something doesn’t work anymore. If we’re serious about reducing use of opioids, we’ll demand that insurance companies stop putting barriers in place to obtaining non-opioid treatments. It’s cruel to leave people in pain that keeps them from sleeping and functioning. ---
**Author:** ![aruvqan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/aruvqan/32/2891_2.png) [@aruvqan](https://boards.straightdope.com/u/aruvqan)\ **Post date:** [April 9, 2016, 9:53pm UTC](https://boards.straightdope.com/t/how-can-a-pharmacist-decide-not-to-fill-a-valid-prescription/751302/85 "2016-04-09T21:53:34Z")
> [@spamforbrains](#): > > pharmacists aren’t just clerks who fill prescriptions. They are highly trained professionals who are supposed to act as a final “watch dog” on the prescriptions to help patients avoid injury. For example, they are supposed to know enough to notice when a dose is wrong or when medication interactions might occur. However, they aren’t supposed to just refuse to fill a prescription-they are supposed to communicate with the doctor about the possible problem. > > In your case, is the medication some type of controlled substance or substance that can be abused? It sounds like the pharmacist, for whatever reason, thinks you consumed the last batch too quickly. > > I suggest calling your doctor and asking about it. Sorry, if it was a prescription for [as a wild assed example] tramadol 4x day and you have the specific number of pills for the specified number of days [say, 120 pills] and you are there 2 days before refill, and have the bottle with 8 pills remaining, there can be no option available if there is a valid refill scrip … [I get all my scrips filled at the same place, have for years myself, and I make sure any doc other than my PCP, endo, rheumatologist and cardiologist are all on the same page med wise.] ---
**Author:** ![Avarie537](https://avatars.discourse-cdn.com/v4/letter/a/48db29/32.png) [@Avarie537](https://boards.straightdope.com/u/Avarie537)\ **Post date:** [April 10, 2016, 1:44am UTC](https://boards.straightdope.com/t/how-can-a-pharmacist-decide-not-to-fill-a-valid-prescription/751302/86 "2016-04-10T01:44:51Z")
> [@slash2k](#): > > That fact, in and of itself, may have made the pharmacist suspicious: why does this person need to drive an hour instead of just obtaining/filling the prescription locally? You doubtless have perfectly good reasons, but instead of asking those reasons, the pharmacist may have just decided he was uncomfortable. (To my mind, the proper response would have been to call the doctor’s office while you waited, though, instead of brushing you off.) Maybe he lives in a small town and his specialist is in a big city? Is that so hard to comprehend? My cousin lives three hours away and when her child needed specialty surgery, she went to Riley Hospital in Indianapolis. Is her local pharmacy supposed to deny post op pain meds for a kid because the doctor’s office is “too far away”? ---
**Author:** ![Spiderman](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/spiderman/32/230_2.png) [@Spiderman](https://boards.straightdope.com/u/Spiderman)\ **Post date:** [April 10, 2016, 2:49am UTC](https://boards.straightdope.com/t/how-can-a-pharmacist-decide-not-to-fill-a-valid-prescription/751302/87 "2016-04-10T02:49:13Z")
> [@DataX](#): > > Also - for anyone that just thinks this is going to easy from now on - I’d highly recommend that you don’t try to fill an opiate or maybe even stimulant or benzo at your first visit at a new pharmacy by itself. > > I’ve developed a great relationship with the two pharmacists that work at my local pharmacy. Good pharmacists are true professionals that actually know a decent amount. I ask them advice on OTC stuff, get my flu shots there, and ask what they’ve heard about drug xyz. They have a different perspective cause they work with customers from different doctors. I don’t take any regular prescriptions. I could probably use one hand to count every prescription I’ve filled in the past five years, & still have a few fingers left over. Those few prescriptions were filled at Target, which is now CVS. I haven’t had a prescription since the change over (Dec '15 - Hell, I haven’t even had _any_ contact with the medical industry in the past five months), & since my opinion is eff CVS, my next prescription _will_ be at a new pharmacy. However, even if it’s at the CVS pharmacy @ Target, they don’t know me from Adam. What am I supposed to do if I have some illness/injury/accident where the doc prescribes me a controlled substance? Not everyone has a ‘regular’ pharmacist that they’re on first-name basis with. ---
**Author:** ![Doctor\_Jackson](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/doctor_jackson/32/32_2.png) [@Doctor\_Jackson](https://boards.straightdope.com/u/Doctor_Jackson)\ **Post date:** [April 11, 2016, 1:17pm UTC](https://boards.straightdope.com/t/how-can-a-pharmacist-decide-not-to-fill-a-valid-prescription/751302/88 "2016-04-11T13:17:18Z")
> [@septimus](#): > > I’m afraid I’ll sound like a right-wing bigot but … is it possible U.S. carries “correctness” too far? I purposefully included the final line in my post (“One can argue what is the right way to handle the issue…”) because I did not want to move the focus of this thread to a debate on how the issue should be handled. I was simply pointing out that there is indeed a huge problem with accidental deaths related to prescription opiates. The pendulum swings left, the pendulum swings right. Rarely does it pause in the middle. BTW, **WhyNot** , thank you for providing a separate account of the issue, you saved me lots of typing! ---
**Author:** ![SciFiSam](https://avatars.discourse-cdn.com/v4/letter/s/47e85d/32.png) [@SciFiSam](https://boards.straightdope.com/u/SciFiSam)\ **Post date:** [April 11, 2016, 1:50pm UTC](https://boards.straightdope.com/t/how-can-a-pharmacist-decide-not-to-fill-a-valid-prescription/751302/89 "2016-04-11T13:50:45Z")
> [@Ambivalid](#): > > I understand this, I never characterized pharmacists as “pill clerks”. I understand that certain flags can make a pharmacist suspect fraudulent activity or dangerous oversights wrt prescriptions. My point is that I did not have any such “flags” whatsoever and the pharmacist still refused to fill it. I can not think of _any_ scenario that would give this pharmacist any reasonable doubt or suspicion as to my prescription’s validity. And he gave me no explanation as to his reasoning, either. > > The med in question is tramadol HCL, a Class IV controlled substance. But like I said, there was absolutely no reason given for refusing to fill it. No scrips from multiple doctors, no contraindications with any of my other meds. I don’t even understand how he could’ve possibly thought it was a fraudulent scrip, as I was only refilling a pre-existing scrip. And, this same exact medication, at the exact same dosages, has been in their system for over two years. I’m stumped. In a completely different country and system I am on the same medication for similar reasons, and have been refused it briefly in the same ways too. I think it’s because I try to use as little of it as possible, partly because I find swallowing pills difficult and partly because of the “take your coat off or you won’t feel the benefit” idea, but then when I do re-order I make sure I have as much as I need in stock, because - as a controlled substance - I have to go in person to get it, and that’s not easy for me. That could easily look like someone reselling their meds for whatever highs some people apparently get from Tramadol and then getting a refill. Your usual pharmacist might well know you’re not like that - because they see you in person - but they need hard evidence in order to keep prescribing to you and others. I don’t think it would take much of a veer from usual prescription timing to have you flagged, IMO. ---
**Author:** ![robert\_columbia](https://avatars.discourse-cdn.com/v4/letter/r/e79b87/32.png) [@robert\_columbia](https://boards.straightdope.com/u/robert_columbia)\ **Post date:** [April 11, 2016, 5:18pm UTC](https://boards.straightdope.com/t/how-can-a-pharmacist-decide-not-to-fill-a-valid-prescription/751302/90 "2016-04-11T17:18:30Z")
> [@Elemenopy](#): > > Ah, but that’s just it. Your boyfriend IS a drug-seeker if he has expressed a desire for the “two stupid Vicodin.” You have sympathy for him but not the “drug-seekers.” I guarantee you that many of the labelled “drug-seekers” are just regular people in his boat. I am one. I have degenerative spinal issues, pituitary adenoma, polyarthritis, sclerosis, heel spurs, several autoimmune disorders not otherwise specified (heh), and more, and I am issued pain medication… I think most people define “drug-seeker” as a person who wants to obtain drugs _that they have no legitimate medical need for_. Pain medication is medically necessary for many people who suffer from debilitating pain that affects their ability to work, etc. If you just want the drugs to get high or to get rid of medically-insignificant pain, then you are a “drug-seeker”. ---
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [April 11, 2016, 8:34pm UTC](https://boards.straightdope.com/t/how-can-a-pharmacist-decide-not-to-fill-a-valid-prescription/751302/91 "2016-04-11T20:34:46Z")
This OpEd may be of interest:[The opioid epidemic: It’s time to place blame where it belongs](http://www.kevinmd.com/blog/2016/04/the-opioid-epidemic-its-time-to-place-blame-where-it-belongs.html). Can we get the same vigor of the anti-vax movement aimed towards this absolutely real debacle in pain management? Prob’ly not. ---
**Author:** ![Ambivalid](https://avatars.discourse-cdn.com/v4/letter/a/a5b964/32.png) [@Ambivalid](https://boards.straightdope.com/u/Ambivalid)\ **Post date:** [April 11, 2016, 11:16pm UTC](https://boards.straightdope.com/t/how-can-a-pharmacist-decide-not-to-fill-a-valid-prescription/751302/92 "2016-04-11T23:16:00Z")
> [@SciFiSam](#): > > I don’t think it would take much of a veer from usual prescription timing to have you flagged, IMO. Except, as I’ve tried to make clear, there _was_ no “veer from usual prescription timing”. ---
**Author:** ![Malthus](https://avatars.discourse-cdn.com/v4/letter/m/85f322/32.png) [@Malthus](https://boards.straightdope.com/u/Malthus)\ **Post date:** [April 12, 2016, 2:52pm UTC](https://boards.straightdope.com/t/how-can-a-pharmacist-decide-not-to-fill-a-valid-prescription/751302/93 "2016-04-12T14:52:24Z")
> [@WhyNot](#): > > This OpEd may be of interest:[The opioid epidemic: It’s time to place blame where it belongs](http://www.kevinmd.com/blog/2016/04/the-opioid-epidemic-its-time-to-place-blame-where-it-belongs.html). > > Can we get the same vigor of the anti-vax movement aimed towards this absolutely real debacle in pain management? Prob’ly not. The problem is that this seems to be a problem without an obvious solution. Patients are, understandably, reluctant to experience chronic pain; yet the best available pain meds carry a risk of addiction and death. From a medical standpoint I assume that the best solution would be to not use these meds except for palliative care or other rare circumstances, where the risks of addiction and death are less relevant. Yet patients may well be unwilling to accept that they have to suffer, day after day, because the risks of effective drugs to relieve that suffering are too great: unless the medical industry acts in unison on this issue, the patient will be tempted to “shop around” until they get a physician/pharmacist combo that provides relief from that - and take their chances with addiction and overdosing. I assume that in the past people were willing to put up with more in the way of pain, or did not know about or have the same array of meds; but that genie is out of the bottle (literally) now. I’m not sure how we could, without a lot of trouble, go back. And yet, we must, because the stats are so bad. ---
**Author:** ![RivkahChaya](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/rivkahchaya/32/8919_2.png) [@RivkahChaya](https://boards.straightdope.com/u/RivkahChaya)\ **Post date:** [April 12, 2016, 3:16pm UTC](https://boards.straightdope.com/t/how-can-a-pharmacist-decide-not-to-fill-a-valid-prescription/751302/94 "2016-04-12T15:16:23Z")
> [@Malthus](#): > > I assume that in the past people were willing to put up with more in the way of pain, or did not know about or have the same array of meds; but that genie is out of the bottle (literally) now. I’m not sure how we could, without a lot of trouble, go back. And yet, we must, because the stats are so bad. Because of advancements in surgery and medicine, people are surviving injuries, like car accidents, and living with illnesses, that were not survivable 20 years ago. There are people with chronic cancer, for example. There are probably literally more people in pain as the result of advancements in medicine. Just as an example, my husband’s sister survived a car accident that would not have been survivable 20 years before it happened, and 10 years before it happened, would have resulted in internal organ damage that probably would have left her sterile. As it was, she had a pelvic fracture, so when she had a baby after the accident, she had to have a c-section, because the way her pelvis had been set meant it couldn’t open to let the baby pass through. So there is a data point for the “rising c-sections” in the US that is actually attributable to improved medical care. Anyway, after the accident, she lived with pain for a couple of years and took opioids. Physical therapy and time got her odd of them, but there’s another data point for improved medical care leading to more pain med use. She just would have died at an earlier time, and not have lived to spend two years on pain meds. ---
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [April 12, 2016, 3:33pm UTC](https://boards.straightdope.com/t/how-can-a-pharmacist-decide-not-to-fill-a-valid-prescription/751302/95 "2016-04-12T15:33:37Z")
> [@Malthus](#): > > The problem is that this seems to be a problem without an obvious solution. Patients are, understandably, reluctant to experience chronic pain; yet the best available pain meds carry a risk of addiction and death. > > From a medical standpoint I assume that the best solution would be to not use these meds except for palliative care or other rare circumstances, where the risks of addiction and death are less relevant. > > Yet patients may well be unwilling to accept that they have to suffer, day after day, because the risks of effective drugs to relieve that suffering are too great: unless the medical industry acts in unison on this issue, the patient will be tempted to “shop around” until they get a physician/pharmacist combo that provides relief from that - and take their chances with addiction and overdosing. > > I assume that in the past people were willing to put up with more in the way of pain, or did not know about or have the same array of meds; but that genie is out of the bottle (literally) now. I’m not sure how we could, without a lot of trouble, go back. And yet, we must, because the stats are so bad. Quoting this whole darn post on grounds of extreme truthiness. Yes. These are exactly the problems. And no, there is no good solution with the current state of medicine. There are lots of little things that may help some people that I’d like to see more widely used (acupuncture, TENS, physical therapy) but nothing to fix it in one fell swoop. ---
**Author:** ![Mama\_Zappa](https://avatars.discourse-cdn.com/v4/letter/m/71e660/32.png) [@Mama\_Zappa](https://boards.straightdope.com/u/Mama_Zappa)\ **Post date:** [April 14, 2016, 6:38pm UTC](https://boards.straightdope.com/t/how-can-a-pharmacist-decide-not-to-fill-a-valid-prescription/751302/96 "2016-04-14T18:38:56Z")
> [@PunditLisa](#): > > The health care industry is crazy. My mother was on vacation but was delayed for two days past her planned departure. Long story. Anyway, she had only packed enough medicine for 6 days (5 days + 1 extra day), which was a finely balanced regimen of drugs in order to treat scleroderma, which is a chronic and very painful disease where your dermis hardens. Anyway, it took her and her doctor YEARS of trial and really painful errors to come up with a treatment plan that alleviated most of the pain with the least number of side effects (e.g. fungal infections, mouth so dry that she couldn’t swallow, dry eyes). > > Although the doctor called in a prescription, the 30 day window hadn’t closed, and it took both a papal fiat AND an act of Congress before the pharmacy would fill it. In the end, they relented and filled exactly ONE day. I don’t know what would have happened had her flight been canceled. It seems that they’d have been content to screw up her treatment plan because they were so concerned that she was abusing drugs…which is laughable given she’s currently taking about a dozen medications. > > And then you have me. I had minor wrist surgery (ganglion cyst removal) and had to specially ask for a local instead of a general. I delivered two babies without being put under, but they didn’t think I could endure a one inch incision while awake. After, they prescribed 2 weeks worth of Vicodin, with instructions to take it without fail the first night because it was really important that I “keep on top of the pain.” I took one, only because I took her at her word that I’d be writhing in pain without it. I switched to Tylenol after that and was perfectly fine. > > The health industry is crazy. So very, very true. I’ve mentioned here before the time I broke my elbow while out of town. Went to the ER, they decided “not broken, just a sprain” (I followed up after I got home and yeah, it was broken) - and sent me on my way with a scrip for Vicodin. 😕 - I hadn’t even asked for anything for the pain. And I vented on another thread recently: my daughter takes Vyvanse for ADHD. The mail order pharmacy screwed up and didn’t send the fill in time - so she had to go several days without it. My personal recommendation for anyone dealing with any controlled medications is to hoard up a small supply (if you can) to cover screwups like that. ---
**Author:** ![Anny\_Middon](https://avatars.discourse-cdn.com/v4/letter/a/bc79bd/32.png) [@Anny\_Middon](https://boards.straightdope.com/u/Anny_Middon)\ **Post date:** [April 20, 2016, 4:18pm UTC](https://boards.straightdope.com/t/how-can-a-pharmacist-decide-not-to-fill-a-valid-prescription/751302/97 "2016-04-20T16:18:37Z")
> [@Malthus](#): > > I assume that in the past people were willing to put up with more in the way of pain, or did not know about or have the same array of meds; but that genie is out of the bottle (literally) now. I’m not sure how we could, without a lot of trouble, go back. And yet, we must, because the stats are so bad. Is that true – that people were willing to put up with more in the way of pain? Laudanum was pretty popular over a fairly long period of time, and sold OTC. Many patent OTC meds also included opiates. Sure, over the long course of history people didn’t have access to meds to control pain, but that doesn’t mean they were willing to put up with pain, but rather that they had no choice but to do so. ---
**Author:** ![Malthus](https://avatars.discourse-cdn.com/v4/letter/m/85f322/32.png) [@Malthus](https://boards.straightdope.com/u/Malthus)\ **Post date:** [April 20, 2016, 5:42pm UTC](https://boards.straightdope.com/t/how-can-a-pharmacist-decide-not-to-fill-a-valid-prescription/751302/98 "2016-04-20T17:42:41Z")
> [@Anny\_Middon](#): > > Is that true – that people were willing to put up with more in the way of pain? Laudanum was pretty popular over a fairly long period of time, and sold OTC. Many patent OTC meds also included opiates. > > Sure, over the long course of history people didn’t have access to meds to control pain, but that doesn’t mean they were willing to put up with pain, but rather that they had no choice but to do so. The issue isn’t the use of laudanum and OTC opiates in in the distant past, but rather why prescription opiate use has skyrocketed _relatively recently_ - within a time when opiates were all prescription-only: indeed, in the last 20 years. Pain control drugs obviously existed then, maybe not wholly as effective as right now, but pretty darn close. So what has changed? According to the posted article, medical attitudes towards pain management. > [@](#): > > At around the same time as Oxycontin’s approval, the American Pain Society, introduced the “pain as the 5th vital sign” campaign, followed soon thereafter by the VA adopting that campaign as part of their national pain management strategy. This declaration was not accompanied by the release of any device which could objectively measure pain, as was done with all previous vital signs, making it the first and only subjective vital sign. > > The Joint Commission joins the list in 2001, issuing standards requiring the use of a pain scale and stressing the safety of opioids. According to the Wall Street Journal, they even published a guide sponsored by Purdue Pharma. This guide reportedly stated, “Some clinicians have inaccurate and exaggerated concerns about addiction, tolerance and risk of death. This attitude prevails despite the fact there is no evidence that addiction is a significant issue when persons are given opioids for pain control.” The Joint Commission framed pain as a patient’s rights issue, inferring that inadequate control of pain would lead to sanctions. > **[The opioid epidemic: It's time to place blame where it belongs](https://www.kevinmd.com/2016/04/the-opioid-epidemic-its-time-to-place-blame-where-it-belongs.html)** > > To fulfill my duty as an American, allow me to place blame for our current opioid crisis. Assuming this thesis is true (and ignoring for the moment the responsibility of pharma manufacturers for encouraging it), then patients with chronic pain issues are presumably being treated, in general, with more emphasis on pain management than in the (relatively recent) past. That, above all else, appears to be the source of the problem with the spike in opioid addictions and deaths. If that is true, than can physicians ‘turn back the clock’ and start treating patients with _less_ emphasis on pain management - more like they, on average, treated patients 20 years ago? The result, naturally, would be that, in general, patients would have to suffer more in the way of pain - which chronic pain patients were, presumably, willing to do before, but may not be willing to do now. Seems to me that the logic is inescapable. ---
**Author:** ![MsRobyn](https://avatars.discourse-cdn.com/v4/letter/m/90ced4/32.png) [@MsRobyn](https://boards.straightdope.com/u/MsRobyn)\ **Post date:** [April 21, 2016, 1:26pm UTC](https://boards.straightdope.com/t/how-can-a-pharmacist-decide-not-to-fill-a-valid-prescription/751302/99 "2016-04-21T13:26:25Z")
> [@Ambivalid](#): > > Yeah, at least when there is _any_ conceivable reason for that caution. I still have no earthly idea why my refill was refused by that pharmacist. From what you’re saying, this is what I think happened. In this pharmacist’s judgment, something was off with your meds. Perhaps two or more interact badly, perhaps he had a question about the dose or the schedule, whatever. He may have your refill history in front of him, he may have you in front of him, and to him, none of those things matter. In this one pharmacist’s professional judgment, giving you this medication could cause you harm. Ethically, he’s bound to withhold the medication from you until he has talked to the prescriber and clarified to his satisfaction that the drug is prescribed as intended. If he has reason to believe that there is a problem with a prescription, and he doesn’t act on that belief, he’s guilty of professional malpractice. It’s that simple. Most people think of pharmacists as technicians whose job is to count pills and hand them over to the customer. They’re not. [They’re highly educated professionals who spend years in school](http://pharmacyschool.usc.edu/programs/pharmd/pharmdprogram/curriculum/) and clinical training to learn specifically about drugs; how they affect the body’s systems and disease processes; how they affect specific populations; and how they must be adjusted in certain situations, and how to adjust those doses. Good doctors rely on pharmacists to answer questions about drugs and rely on them to make sure their patients don’t die because of a mistake. Patients rely on pharmacists to catch these mistakes and to counsel on how to take the drugs to make sure they work and don’t cause bigger problems. Be grateful that there was a pharmacist who cared enough to inconvenience you, and be grateful that it was a simple thing that could be cleared up quickly. As for the person who bitched about over-reliance on computers and how that replaces professional judgment, I had to laugh. Those computers are linked to the insurance companies for reimbursement and tracking purposes, and those store patient records and other information necessary for regulators and licensing. If you think the wait for a prescription is long now, think about how much longer it would be if the pharmacy staff had to spend time entering all that data after the fact. ---
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [April 21, 2016, 1:59pm UTC](https://boards.straightdope.com/t/how-can-a-pharmacist-decide-not-to-fill-a-valid-prescription/751302/100 "2016-04-21T13:59:33Z")
> [@MsRobyn](#): > > Most people think of pharmacists as technicians whose job is to count pills and hand them over to the customer. They’re not. [They’re highly educated professionals who spend years in school](http://pharmacyschool.usc.edu/programs/pharmd/pharmdprogram/curriculum/) and clinical training to learn specifically about drugs; how they affect the body’s systems and disease processes; how they affect specific populations; and how they must be adjusted in certain situations, and how to adjust those doses. Good doctors rely on pharmacists to answer questions about drugs and rely on them to make sure their patients don’t die because of a mistake. Patients rely on pharmacists to catch these mistakes and to counsel on how to take the drugs to make sure they work and don’t cause bigger problems. Kind off of topic, but an example, minding the HIPAA… I had a patient with a weird symptom that was very distressing and popped up out of nowhere. I (a nurse) scoured all the information I had about all her medications, and couldn’t find it listed as a side effect for any of them. She went to four different doctors (her Internist, her Dermatologist, her Oncologist and her Podiatrist) and none of them had a clue what might be causing it. As a last ditch attempt (when it should have been my first move, I now realize), I called the pharmacist. It \*is \*an extremely rare reaction to one of her breast cancer meds, rare enough to not be listed on the pamphlet or prescribing information. The pharmacist knew it immediately. Because pharmacists know drugs, and drug side effects, better than anyone else. [Previous page](https://boards.straightdope.com/t/how-can-a-pharmacist-decide-not-to-fill-a-valid-prescription/751302.md?page=4) [Next page](https://boards.straightdope.com/t/how-can-a-pharmacist-decide-not-to-fill-a-valid-prescription/751302.md?page=6)