I live in New York City. Maybe it’s just my experience. Maybe it’s the way I look. I don’t know, but it seems like I can’t get a prescription for anything. And I’m not a drug-seeker. I’m not a drug user. I don’t even smoke weed, for pete’s sake.
So, for example, the summer before last I broke my arm. It hurt like hell. I didn’t really want to take anything during the day, because I hate the way codeine or Vicodin or whatever makes me feel – just slow and stupid. But after about a week of not sleeping, I asked my doctor for something. He recommended Advil. Yeah, right, that will do it.
A few years back, I smashed up my knee. I mean, I really smashed it. A metal spike was driven through it. It had to be surgically put back together, with screws and wire and stuff. Painkillers in the hospital? OK, they gave me those. Upon release? Nope. Another few weeks without sleep. Actually, more like a couple of months.
And I’m not the only one. Other people I know who have seriously injured themselves tell me that doctors around here just aren’t prescribing painkillers any more.
I see stories like this a lot. They’re frustrating, because it sounds like you think there was something else he should have offered. What would that be, exactly?
You didn’t want “codeine or Vicodin or whatever,” because they make you feel slow and stupid. Totally understand. Opiates make lots of people feel slow and stupid. Vicodin is one of the lesser sedating opiates, so if that makes you feel slow and stupid, tramadol, dilaudid, oxycodone, fentanyl and everything else in that drug class is going to be even worse. So no opiates.
You didn’t want Advil, presumably because you think it isn’t strong enough. So…okay, no Advil. Let’s also strike naproxen, since that’s almost the same drug, also available OTC.
The only thing left for acute pain is Tylenol. Which you didn’t need a prescription for.
So what were you looking for him to give you? There is no magic painkiller that’s very effective but doesn’t make you slow and stupid.
Under the relevant circumstances, by law health care professionals may indeed to be required to render services. If a pharmacist does not follow the required guidelines in filling prescriptions he/she could be subject to pharmacy board sanctions and/or legal action.
Not what I meant. I was perfectly happy to take codeine or Vicodin or something like that when I was going to sleep – I just don’t like the way it makes me feel when I’m awake. But I really couldn’t sleep – it hurt like hell, and then I’d doze off and move a bit and get a stabbing pain in my arm and that would wake me up.
Vicodin would have done the trick. Tramadol, dilaudid, oxycodone, fentanyl – I don’t know anything about those medications. I’ve never taken them and don’t know if they’re super-strong or what. Well, I know what oxycodone is, but I’ve never taken it. I’m not familiar with the effects.
Right. The over-the-counter stuff didn’t work. I tried. No luck. Fine for a headache, but that’s about it.
I know that.
What I am saying that I and others I know have noticed that doctors (at least here) are resistant to prescribing painkillers (I guess I mean opiate painkillers) for anything. I am aware that there is a serious problem out there with abuse of these drugs. I think some physicians are reacting to that by simply not prescribing them for anyone.
I realize that my experience and that of the people I know may not be exactly representative of the the country as a whole, but on the other hand, it’s a noticeable phenomenon.
What I see is a very frustrating combination of people in pain who can’t get treated, and people who are not in so much pain but are overtreated, and the worst of all, those who are in pain because they’ve been overtreated. The last one is the hardest. Physical dependence on painkillers actually CAUSES chronic pain…and then what do you treat that with?
It’s that last category that doctors are, perhaps, hyper aware of, causing them to undertreat the first group. Once you’ve seen a patient whose pain is probably your fault, it makes you clutch your prescription pad a little tighter to avoid doing that again*. No one thinks they’ll be the one to get hooked when they get that first prescription, and we don’t have a good way to figure out who is at high risk of that happening to. I have hope that genetic screening will, someday, help us to make better prescription choices without trial and error.
*And, of course, that whole losing your license and going to jail if the DEA decides you’re too generous with the painkiller prescriptions, of course. That’ll put a damper on your enthusiasm.
Schedules have little to do with specific side effects. My patients report drowsiness, sleepiness and mental fog more commonly with short term use of tramadol than Vicodin, and more nausea, vomiting and constipation with short term use of Vicodin than tramadol. I can look up some comparison studies in the morning if you like, but it’s past my bedtime tonight.
Most of these side effects (although not constipation, and not others) tend to go away with long term use.
From the physician standpoint, let me tell you that they are really cracking down on narcotic prescriptions. I would estimate half of Medical Board actions against physicians are related to prescribing narcotics and you can get in trouble easily for refilling prescriptions too early or for not doing drug testing on patients to make sure that they are taking their medications regularly or for not checking the database regularly to make sure no other doctor is giving them controlled substances at the same time. Also, the CDC came out with new stricter opioid prescribing guidelines 2 weeks ago, which generally address chronic pain but there are recommendations, for example, that narcotics for acute injury not exceed a 3 day supply.
It may very well be that the pharmacists are also feeling some heat and are suspicious now of any refillable controlled substance prescriptions. They may want a new written prescription or new confirmation from the doctor for every refill.
Once, a number of years ago, I was driving my sister home from the hospital, where she had just had knee surgery. We stopped on the way to fill a painkiller prescription (I don’t remember exactly what it was, maybe Vicodin?). The pharmacist refused to fill it because he said she’d had too many painkiller prescriptions filled. She started to argue with him, telling him she’d pay for it herself, etc. He said it wasn’t an insurance issue, he simply wasn’t going to fill it. I don’t remember how it ended up (this was maybe 15 years ago).
Well, she had just had knee surgery a few hours before, but OTOH apparently she’d been using I don’t know what kind of painkillers (or in what quantities) for I don’t know how long before the surgery, because her knee did in fact hurt. And I do believe that she was the one who stole my painkillers out of my medicine cabinet a few years before that, when I’d had leg surgery (I hate using the damn things, and had a bunch left over, but DUDE, stealing your own sister’s pain medication??? but she has had a history of stealing since she was a child, and you could count on one hand the number of other people who had access to my apartment then, and none of the others had a history of stealing or substance abuse). And I do believe she also tried to refill my prescription after some leg surgery or another, too, because I got a call from the pharmacy to tell me that they were out of my refill - but I had never requested a refill, and she knew what pharmacy I had gone to, and was working for an oral surgeon’s office then and was pretty good at schmoozing the pharmacy staff.
I called my doctors (GP and ortho) and told them what I suspected, and that they should never refill a painkiller prescription of me without talking directly to me first. Walgreens seemed quite unconcerned about what I was telling them. But again, this was maybe 15 years ago.
OTOH, what on Earth do you do with someone who has an opioid painkiller problem, but does genuinely need pain relief (because, say, they just had surgery a few hours ago)? And this is one of the many, many reasons why my sister is no longer allowed in my home. It makes me sad, but I don’t see any other way to deal with her.
I guess I’m only allowed to agree with and support your unsupported position?
Your question was “how can a pharmacist decide not to fill a valid prescription?” A valid prescription allows a pharmacist to sell you the referenced drug. It does not require them to sell you the referenced drug. They can decide not to fill a valid prescription based on professional discretion or because you’re wearing the wrong color shirt or because they prefer to only serve customers whose last names start with the letters A-L on even numbered days or because their favorite telenovella is on.
The difference is that most of the time, if a professional refuses me service I can take my business elsewhere. While it is possible to transfer prescriptions from one pharmacy to another, if the OP tries to do so, there’s a high likelihood that the new pharmacy would also refuse to fill the prescription for the same unspecified reason, after being “warned” by his current pharmacist.
It’s like taking your car in for its scheduled oil change, but this time they won’t do the work and won’t give you back the keys.
I’d be calling the head office of the pharmacy and getting clarification on them not offering you ANY explanation. That cannot be protocol. Especially for a loyal customer, never had an issue, are wheelchair bound and need these meds.
Tell them you are considering switching to another pharmacy, due to this incident and want to know their policy/protocol. It’s important to remain calm. You’re only seeking clarification, just a mission to understand why you’ve been unreasonably refused and ensure this does not happen to you again, surely they can understand your concern.
Wanna bet this gets fixed pronto? This would be the first call I made. And if they couldn’t /wouldn’t answer, I’d keep going higher up the food chain until somebody offers a reasonable explanation. Take names of whom you’re speaking to, AND their supervisor’s name.
The pharmacist’s concern may not be with you, the patient, but with the prescribing physician. Physician’s are not above scrutiny for prescribing medicines. The pharmacist told you that he needed to speak with your physician first. Maybe the pharmacist has noticed a trend of questionable scrips made out by this particular doctor.
Do some google searches and you will find doctors charged all around the country involved in pharmaceutical drug trafficking.