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?)
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.
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.
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.
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.]
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”?
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.
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!
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.
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”.
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.
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.
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.
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.
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.
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.
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 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.
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.
(Or is the drug-seeker presumed not to know that?)
- I hadn’t even asked for anything for the pain.