Terra Sigillata

Back in February 2007, we had a lively discussion on a post about pharmacist objection to filling prescriptions for drugs they felt went again their personal moral stance: from morning-after pills to garden-variety oral contraceptives. I held that since pharmacists are licensed by the state to provide a service to the citizenry (and they make about as much money as a full professor at a US research university), they should be required to fill prescriptions. Some commenters argued that ethical practice of one’s profession dictate that one apply moral standards. I disagree. As an agent of the state, one is required to execute the responsibilities of one’s license.

Back then, we discussed where a pharmacist could then draw the line if allowed to be a “conscientious objector.” Could a pharmacist refuse a legitimate narcotics prescription, outside of clear fraud? Could they refuse to fill for an HIV medication or drug to treat a sexually-transmitted disease?

Well, this comment came in from attorney and cancer patient, Sharon Red Deer, former faculty member at the College of Law at the University of South Dakota in Vermillion (MS Contin is an oral, controlled release form of morphine sulfate):

What an interesting discussion. I came across this website researching a law review article I am writing about the hysteria of opioids from the medical community due to my disciplines “war on drugs”. My interest is both professional and personal.

A pharmacist at Walgreens (where I have been customer for several years) refused, on Sunday, to fill a prescription for MS Contin (obviously from my doctor) because he “that I should find some alternative pain relief”. Of course, he doesn’t know that I am terminal or anything else about me. I have had a prescription for MS Contin since I was diagnosed 2 years ago; every month I have it filled there. This was pharmacist I have not seen before. When I asked what I should do, he shrugged. How do these people sleep at night? In my discipline and all PROFESSIONAL disciplines that I am familiar with; your own personal views cannot be allowed to interfere with your obligation to you client (or patient).

In fact, if you are a court appointed attorney, you are obligated to represent that person to the very best of your skill and due diligence unless the person is so repugnant to you as to impede your defense of him / her. No mention of how we may feel about it. Only if the client would be affected. All personal moral and ethical issues are negated. Only the best interest of the client is relevant. It isn’t about the lawyer; it is ALL about the client. I thought that was the standard for all true professionals.


I can’t argue with the counselor’s view of professional responsibilities. I’d personally file a complaint with management of that Walgreen’s store and the regional and national offices. Walgreen’s is one of the better pharmacy chains whose management line is often populated by former pharmacists.

We’ve also noted that people in sparsely-populated areas often don’t have a choice of another pharmacist for literally tens of miles away:

In addition, I just now returned from my doctor, had my unfilled script in hand (now this is Tuesday) and asked her I should do. No answer. Then she suggested I select a new pharmacy. The next one is 30 further miles away. And the kicker: she sided with the pharmacist. Yep. I said to her that this man doesn’t know my history; doesn’t know whether I am terminal or in severe pain from anything.

Her response: (Laughs) and says “he probably gets more drug seekers than terminal patients”. What a ridiculous statement, I don’t know how he would think I was an “illegal” drug seeker when I had a history there for the same drug and the “script” was in hand. It really is enough to shuck it all, and just suffer. The indignity is unspeakable. It is similar like drowning and begging passersby to help you; and instead they ridicule you and say “swim!”.

So we have a cancer patient in pain, in a rural area, unable to obtain opioid analgesics.

I am very sensitive to the fatigue of my pharmacist and physician colleagues with all the tricks used by professional narc seekers. This attorney does not seem to be one of them.

Should this pharmacist have had the right to refuse the prescription?

How do you in practice differentiate between legitimate narcotic use and illicit seekers whose pills keep falling down the toilet?

Comments

  1. #1 Joshua Zelinsky
    March 11, 2009

    I’m aware (at least by anecdote) of pharmacists getting in trouble for fulfilling prescriptions to people who turned out to be addicts or dealers. If we are going to condemn the pharmacist in cases like this one we need to minimize their liability when the drugs do end up going to someone they shouldn’t.

  2. #2 N.B.
    March 12, 2009

    No.

    End of line.

  3. #3 PalMD
    March 12, 2009

    I deal with drug seekers every day. I also take care of my own hospice patients.

    If I had been told this story, i would have called the pharmacy and tore everyone there a new cloaca, and personally contacted national management, and, with the patient’s permission, the press.

    The behavior is unconscionable and unethical, and unintelligent. It violates the health and dignity of the patient. It’s very simple—if a pharmacist suspects a phony rx, simply page the md for verification. I get those pages all the time.

  4. #4 T. Bruce McNeely
    March 12, 2009

    The response of this patient’s doctor is appalling!
    Why didn’t she (the doctor) immediately get on the phone and set the pharmacy straight? I simply don’t understand this!
    Incidentally, I am a doctor who did 5 years of general practice before training in my specialty field. Yes, drug seekers are a real problem, and probably a lot worse than when I was in practice. However, a doctor is his or her patient’s advocate. Not following through is a dereliction of duty, in my opinion.

  5. #5 T. Bruce McNeely
    March 12, 2009

    Oops, I just looked this over again and realized that Ms. Red Deer was probably talking to a pharmacist on Tuesday, rather than her doctor. Sooo…
    1) Shame on BOTH pharmacists!
    2) My apologies to the doctor
    3) The doctor should still IMMEDIATELY get on the phone and start tearin’…

  6. #6 Breezy
    March 12, 2009

    I have worked as a Senior Certified Pharmacy Technician for Walgreens for over eight years. Something is missing in this story.

    Companies all over America are barely holding on, and this Pharmacist turned away a prescription that would have netted the company HUNDREDS of dollars “just because” he/she wanted to. As I stated before, “something” is missing in this story. A “days supply” is generated according to the Sig of the prescription. If this person has been taking the same drug, in the same strength, with the same Sig for two years, I doubt the medication is as effective now, as it was two years ago.

    I am not arbitrarily sticking for some Pharmacist that I do not know. I know that Walgreens has uniform rules, and procedures that are in place to protect ALL parties involved. The needs of the Customers are at the top of the list. I have seen Walgreens Pharmacists go above, and beyond for customers with cancer, as well as sick babies, although we try so hard to please all of our customers, too many times to remain quite.

    With all due respect, the comment by PalMD really irked me because half to the time, when there is an issue with a controlled substance prescription, it us usually missing the date, eligibly signed, the Sig is unintelligible, the patience has a drug allergy listed on file that poses a problem with a drug prescribed, not signed by the Doctor, does not have the Doctor’s D.E.A number, or the Sig for how the Patience is to take the drug, and how the patience is actually taking the drug are not consistence, which could potentially harm the patience. If that were to happen, the Doctor that wrote the prescription in question, expect his orders to be executed at Pharmacy as written in order to protect his patient. Although sometimes the Customer maybe sick, and hurting, misplaced compassion could kill them, or contribute to them becoming addicted to a highly addictive drug. The Law, is the law, and they are in place in order to protect all parties involved.

    I will say it again, “something” is missing from this story. Walgreens does not play when it comes to customer complaints. They take them very seriously because they know that customers are the life of the business.

    I am not accusing anyone of being untruthful. If by chance this did occurr exactly as stated here, The Pharmacist involved had better thank God he/she is not in my district. I got my butt chewed today for just entering a Customer’s coupon wrong.

  7. #7 Breezy
    March 12, 2009

    I have worked as a Senior Certified Pharmacy Technician for Walgreens for over eight years. Something is missing in this story.

    Companies all over America are barely holding on, and this Pharmacist turned away a prescription that would have netted the company HUNDREDS of dollars “just because” he/she wanted to. As I stated before, “something” is missing in this story. A “days supply” is generated according to the Sig of the prescription. If this person has been taking the same drug, in the same strength, with the same Sig for two years, I doubt the medication is as effective now, as it was two years ago.

    I am not arbitrarily sticking up for some Pharmacist that I do not even know. What I do know is Walgreens, and Walgreens has uniform rules, and procedures that are in place to protect ALL parties involved. The needs of the Customers are at the top of the list. I have seen Walgreens Pharmacists go above, and beyond for customers with cancer, as well as sick babies, although we try so hard to please all of our customers, too many times to remain quite.

    With all due respect, the comment by PalMD really irked me because half to the time, when there is an issue with a controlled substance prescription, it us usually missing the date, eligibly signed, the Sig is unintelligible, the patience has a drug allergy listed on file that poses a problem with a drug prescribed, not signed by the Doctor, does not have the Doctor’s D.E.A number, or the Sig for how the Patience is to take the drug, and how the patience is actually taking the drug are not consistence, which could potentially harm the patience. If that were to happen, the Doctor that wrote the prescription in question, expect his orders to be executed at Pharmacy as written in order to protect his patient. Although sometimes the Customer maybe sick, and hurting, misplaced compassion could kill them, or contribute to them becoming addicted to a highly addictive drug. The Law, is the law, and they are in place in order to protect all parties involved.

    I will say it again, “something” is missing from this story. Walgreens does not play when it comes to customer complaints. They take them very seriously because they know that customers are the life of the business.

    I am not accusing anyone of being untruthful. If by chance this did occur exactly as stated here, The Pharmacist involved had better thank God he/she is not in my district. I got my butt chewed today for just entering a Customer’s coupon wrong.

  8. #8 photon
    March 12, 2009

    1) To the pharmacist – you don’t prescribe the drugs, the doctor does. If there is a problem with the prescription (missing information, potential drug interactions, etc) you have a professional obligation to contact the doctor to sort it out. If you find that your morals interfere with your ability to perform your duties, it’s time to find a new career!

    2)To the doctor – think carefully about your ethics. What kind of health professional sees one of their patients potentially in severe pain for several days as a result of a pharmacist ignoring a legitimately written prescription, takes no action to correct it, and even sides with the pharmacist against the patient? Apart from the personal insult of a pharmacist overriding your prescription without any reference back to you, don’t you give a shit about your patients? (I do wonder if the Dr actually intended to side with the pharmacist, but she certainly seems to have left her patient with this impression – might need to work on communication skills!)

    Thankfully the situation has never arisen in my practice (actually it’s almost unthinkable!), but if any of my patients ever told me that a pharmacist refused to fill one of my prescriptions, I’d be giving the pharmacist about 60 seconds to come up with a really good reason, as well as a very good explanation of why they had not contacted me.

  9. #9 Joe
    March 12, 2009

    Breezy | March 12, 2009 2:26 AM wrote “… half to the time, when there is an issue with a controlled substance prescription, it us usually missing the date, eligibly signed, the Sig is unintelligible, the patience has a drug allergy listed on file that poses a problem with a drug prescribed, not signed by the Doctor, does not have the Doctor’s D.E.A number, or the Sig for how the Patience is to take the drug, and how the patience is actually taking the drug are not consistence, which could potentially harm the patience.”

    Is it too much to ask you to read Abel’s post? None of your objections is relevant. And PalMD was spot on.

  10. #10 bob koepp
    March 12, 2009

    I don’t think there’s enough information here to comment responsibily on this particular case. But at the level of general statements, I note that Abel thinks that having a license issued by the state makes one an agent of the state. This is directly counter to the traditional view that a professional has a fiduciary duty to act as the agent of his/her client — the view, in fact, expressed by Ms Red Deer.

  11. #11 Joe
    March 12, 2009

    bob koepp | March 12, 2009 9:14 AM “I don’t think there’s enough information here to comment responsibily on this particular case.”

    There certainly is. The pharmacist refused to fill the prescription and did not call the doctor to discuss it. That is incompetence.

  12. #12 leigh
    March 12, 2009

    wtf?! the pharmacist is there to dispense the drugs as ordered by the doctor. what drug is to be given is the call of the doctor, who has actually evaluated the patient and determined the course of treatment. now i understand that pharmacists can catch grievous errors with allergies or miscalculated dose or etc, and they should call the doctor to verify. but to flat-out refuse a patient a narcotic for whatever reason is beyond unprofessional; it’s petulant whining from a position of supposed authority. it’s imposing one’s will upon another. as a pharmacist, this person should know that narcotic analgesics have legitimate uses and if the script is valid, then the patient is legitimately using them. especially with an established history.

    my spouse had a regular prescription for narcotic analgesics for multiple years while he recovered from spinal injury and several surgeries. (to the pharmacist who commented above: narcotic holidays were designed to re-establish drug efficacy in patients who no longer respond to the drug.) he never once had a problem with the pharmacy, but if he did i would have personally ripped everyone down from their lofty, judgmental, chronic-pain-free positions.

  13. #13 Interrobang
    March 12, 2009

    I think I spot a further issue here: With a name like Sharon Red Deer, it’s entirely likely that the patient in question is Native American. Are we seeing latent or not-so-latent racism here? I could certainly see a racist pharmacist jumping to the conclusion that a Native American woman with a prescription for MS Contin was a drug-seeker, which, to my mind, makes it doubly imperative that if there were any doubts at all, the pharmacist should have called the doctor.

    The more I think about this, the more disgusting it gets.

  14. #14 Joe
    March 12, 2009

    leigh | March 12, 2009 10:12 AM wrote “wtf?! the pharmacist is there to dispense the drugs as ordered by the doctor.”

    No! Pharmacists are not automatons. They are medical professionals who must critically evaluate a prescription. They are required to intervene if there is a potential problem. However, if there are any doubts about a prescription, the pharmacist must consult the doctor. The RPh in question did not do that.

  15. #15 Steve
    March 12, 2009

    For years Florida has been searching for the best solution to the growing problem of prescription drug abuse that now comprises 30% of our illegal drug use and claims the life of approximately 6 Floridians each day. In the past, there was no ideal answer since systems were too expensive, took 35 days to provide information rather than immediately in “real time“, and created privacy and theft identity issues. We now have technology which will do what has been done for years with license testing and other situations requiring secure information….biometric ID for the purchase of Level II-V drugs. HB 143 (Domino) and SB 614 (Aronberg) provide an economical system to pharmacies and dispensing doctors which simply does a biometric scan, gives the scan an ID number without disclosing the name, social security number, driver’s license number, or address of the patient to anyone other than the pharmacist who already has the information. That scan then allows the pharmacist to see immediately if there have been numerous other controlled drug prescriptions already dispensed. It can also assist pharmacists and dispensing doctors in identifying a medication prescribed which will not interact well with others the patient takes. Florida has one of the bigger problems of prescription drug abuse in the nation. This legislation will allow us to take the lead with effective technology while providing Floridians both privacy and safety. FACTS FOR POSTERS AT PRESS CONFERENCE Bill numbers and sponsors – HB 143 (Rep. Domino) and SB 614 (Sen. Aronberg) Prescription drug abuse accounts for 1/3 of the illegal drug abuse nationwide and is rapidly rising to the #1 drug problem. In 2004 48% of the drug overdose deaths (6,035) involved prescription drugs and directly caused 2,181 – approximately 6 per day. HB 145 and SB 614 FACT SHEET THE PROBLEM Prescription drug abuse accounts for 1/3 of the illegal drug abuse nationwide and is rapidly rising to the #1 drug problem. In 2004 48% of the drug overdose deaths (6,035) involved prescription drugs and directly caused 2,181 – approximately 6 per day. In 2004, Schedule IV drugs (such as Xanax and Valium) were found to be present in more overdose deaths than cocaine. The number of Americans who abuse controlled drugs nearly doubled from 7.8 million to 15.1 million from 19992 to 2003 and more than tripled among teens in that time. Over the past few years, Florida has seen a high demand for prescription drugs on the street where the profit margin is high. The majority of illegal prescription drug diversion begins with a stolen, forged, counterfeit, or altered prescription form. Patients may seek out multiple doctors to prescribe (doctor shopping), fill the same prescription at multiple pharmacies (pharmacy shopping), or present fraudulent prescriptions to pharmacies. There are also some unscrupulous physicians who simply sell prescriptions to patients (known as a drug mill). HISTORY In 2001 Florida passed a law making it a 3rd degree felony for doctors to write prescriptions for fictitious persons, write prescriptions solely to make money, or knowingly assist patients in fraudulently obtaining controlled substances. It also makes it a 3rd degree felony for a patient to withhold information regarding previous receipt of a prescription for a controlled substance (doctor shopping). The National Schedules Prescription Electronic Reporting ((NASPER) Act in 2005 provided a framework and incentive for all states to establish an electronic database to monitor the prescription and use of Schedule II, III, IV and V drugs. However, lack of funding and HIPPA privacy issues have hindered the implementation. To date roughly half the states have a monitoring program in place. FLORIDA HAS NOT PASSED A PRESCRIPTION MONITORING BILL DUE TO COST, NO SYSTEM TO ADDRESS THE PROBLEM IN “REAL TIME” PROVIDING THE PHARMACIST/DISPENSING PHYSICIAN IMMEDIATE INFORMATION, AND PRIVACY CONCERNS. HB 145 AND SB ADDRESSES THOSE CONCERNS. HB 143/145 AND SB 614/612 1. The War on Drugs has changed. It was focused on heroin, cocaine & marijuana in the 1980’s. Now 30% of the drug problem involves prescription drugs Prescription drug abuse is rapidly rising to #1. 2. In Florida, 8% of all prescriptions or 18 million scripts annually are written for medicines with high abuse potential. 3. In 2005, the National All Schedules Electronic Reporting (NASPER) Act was signed into law. The provisions were not funded, so only around half of states have a prescription monitoring program (PMP) 4. The current programs are little more than passive databases. Each suspicious script must be individually queried to the database and does not interrupt drug diversion at its point of occurrence. 5. Past proposed database systems raised security & confidentiality concerns. They also did not operate in “real time” and required approximately 35 days to discover abuse. Solution: 1. The system uses unalterable biometric data such as fingerprints which are already in frequent use for such events as license testing when privacy and security is needed and to prevent identity theft. The biometric is obtained at the time a controlled substance is dispensed, delivered or administrated to an outpatient. 2. Biometric data, prescription information & notes are sent anonymously using only an identifying ID for the print to a secure server. The patient’s privacy is completely secure. 3. The system analyzes all prescription information associated with each individual’s biometric data. An alert is generated to the pharmacist and the physician if there are changes to the script, there has been over prescribing, the patient is attempting to fill scripts from multiple providers, there are potentially adverse interactions between the various medications a single individual is taking. 4. Pilot programs are currently running successfully at 14 sites in South Florida on voluntary basis. 5. Doctor shoppers and organized prescription diversion are already being identified & prosecuted. HB 145 and SB 614 PROVIDE THE LONG SOUGHT AFTER SOLUTION AND TECHNOLOGY FOR A SECURE AND SIMPLE SYSTEM. FLORIDA CAN NOW LEAD THE NATION IN THIS GROWING DRUG PROBLEM. ADDITIONAL INFORMATION COST: Approximately $300/system if implemented in volume and $150 or less per month to operate. Many financial incentives and saving to this cost are available also, such as continuing education credits. THERE IS NO REQUIRED COST TO THE STATE OF FLORIDA. HOW WILL SURROGATES (OTHERS PICKING UP THE MEDICATION) BE HANDLED? All pharmacists currently have in place some system by which they determine to whom they will dispense. Working within that framework, the identifying code can be provided by the patient to the surrogate and then the surrogate can be given an ID. The system provides room for comments. Consulting Team: Louis Fischer- retired DEA pharmacist; was one of DEA’s top managers in drug diversion program; national speaker on drug abuse Mike McManus- retired DEA investigator; was chief of DEA’s Central & South American operations; a well known speaker nationally on drug abuse Marcella Gravalese- extensive experience in healthcare administration in Michigan & Florida; has managed programs at North Broward Hospital District and Nova SE School of Medicine Steve Ballenger- practicing attorney experienced in health law; professor of health law at Nova SE law school Moe Afaneh- practicing pharmacist; extensive experience in multiple types of pharmacies; owns & operates successful pharmacy in Ft. Lauderdale area Larry Hooper, MD- medical physician; extensive & varied clinical background; current CEO of a medical device company in the R&D stage; previously chief flight surgeon for US Air Force’s B-2 Stealth Bomber
    ———————————-
    http://www.bioscriptrx.com
    800-797-4711

  16. #16 Marvin L. Zinn
    March 12, 2009

    Drugs are far over-subscribed. Besed on my personal experience, in this case, unless I know the circumstances not in the description, I would give the pharmacist a pay raise and pulled the license from the doctor.

    marvin

  17. #17 PalMD
    March 12, 2009

    Wow, marvin, you are a genuine wackaloon. Denying comfort meds to cancer patients? Nice.

    Oh, and anything bob koepp says is automatically filed in the “blinded by idiocy” box.

  18. #18 TEBB
    March 12, 2009

    fkng “steve” of “bioscrptrx” needs to be BANNED – this is not a place for someone to put a fkng ADVERTISEMENT, we are talking about a major ethical issue which our country is failing to address here.

    i hope walgreens gets enough pressure from emails and news outlets to be forced to address what happened to this customer of theirs. they don’t have to violate confidentiality – they can just tell us whether their investigation found failure to fulfill a properly written prescrip or not, and if so, what disciplinary action the co has taken.

  19. #19 S. Red Deer
    March 13, 2009

    First, Let me say that I appreciate the support from some of the posters. Second, I am not surprised at some of the skepticism; i.e. “something is missing” from the scenario.
    Here are the facts:
    1. I have the lowest dose possible of MS Contin (15); 3x day.
    2. I have prescription for break through pain for hydrocodon; maximum of 30mg day.
    3. I have been on this “maintenece” program for over two years ( I also jump through all the other hoops “they ” wish)
    4. Both scripts are filled at this pharmacy as per my “drug contract” I was forced to sign. Which means I cannot go to another pharmacy even if this one is out of my specific meds or dosages. I just have to suffer and wait.
    5.The pharm visit was Sunday; my doctor was out of town, until Tuesday, which is the day I saw her. (just for clarity)
    6. It doesn’t make any difference if I have Cancer, or a 2 level C-spine fusion, or a brain tumor, or was the victim of a horrific auto accident or industrial accident.
    7. The script was not “missing anything”. The script was proper; as was the one for the hydrocodone.
    8. Neither were filled.
    9. I haven’t had any pills “fall down the toilet”.
    10. The earliest I have ever asked my Dr for a new script was 5 days, and that was due to my travel schedule.
    11. There is no rest of the story; no mental illness, no previous treatment for any addictions. Nor, just for the record, have I ever done any illegal drugs. ( I fact I have a both needle and pill phobias)
    12. I do think my “last name”; i.e. race is a factor with some people; pharmacists or not, in their judgment of my subjective explanation of pain.
    Now that the housekeeping is out of the way. I did have a longer discussion with my Dr. on the day in reference. I did ask her about the pharmacist’s interference of the Doctor and Patient relationship. And that it appeared he was substituting his “medical” opinion for my doctor’s, without knowing my medical history. She had no comment.
    I find this beyond disturbing. I am very concerned that, since this can happen to me (and has happened before), who else is this happening to. I used to not take getting refills very seriously. I was not aware of the hysteria involving prescribed opiods. I ran out during travel last year, I did have the script with me (since you must present a hard copy ). I tried to get it filled in a strange city. Absoultely no way! Out of state doctor and all. So, I guess I understood that to a degree. So, I thought I could just tough it out. 14 hours later I was in the ER with Cardiac Ischaemia. My blood pressure (normally 120/ 90 thereabouts) was 189/ 137. Now I take the refill timing much more seriously. The pain was beyond mind numbing.
    My anecdote is important because once again, I am concerned that denying a legitimate refill or any medication can have consequences for the patient (should I add a “duh”!).
    “Just” because it is “pain medication” doesn’t make it an “optional” treatment.
    I really take issue with the “over prescribed” myth about opioids. If that is happening “somewhere”; it certainly hasn’t been in my rather wide universe.
    For people (People, not patients) that are non-operable (as I am) and will never get better, only worse. What would be our option ? Is there some virtue of living the rest of you life in agony ? Staying bedridden? Taking a cocktail of non-opiods, hoping they work while affecting your brain chemistry and enjoying the significant side effects ? Or is is better to take the route of the most natural, well known, inexpensive, and most important: it works. Well I tell people I am on morphine, the looks I get! People , literally look me up and down. I expect they are looking for missing limbs or bandages. Believe it or not, I do not blame the medical profession for this medical and social mindset. I blame my own discipline. It is the justice system that created the list of “bad drugs”; some of which ARE very bad, and do not serve humanity. Others, mostly the opiods, are very beneficial to mankind. I am writing a substantive law review article on these issues; legal, moral, ethical, and medical. I truly believe we need a new epistemology regarding the roles of the professionals and opioids.
    A final thought; the therapist I work with (dealing with my health issues) relayed to me that she has a client that has an inoperable non-malignant spinal tumor; and he has been denied opioids for pain treatment. The rationale was that he could live a very long life, and “addiction” would be inevitable, therefore he should not be given the pain relief he needs. Evidently, non-narcotic relief has not worked. This is unconscionable. Obviously, she would not reveal his state of mind; but couriously, subsequent conversation revolved, theoretically, about suicide and those with chronically acute pain. I thought our common goal was to relieve suffering of humanity.

  20. #20 S. Red Deer
    March 13, 2009

    Regarding “Steve” and his private enterprise:

    His post really did identify the problem. The DEA wants to run our health care system. And they would like to enforce the law by turning the medical profession into “private cops”. There is just so much wrong with “Steve’s post; including his statistics and how they are applied, that I can’t even get started. But, I suppose if you scare enough people, they will gladly turn themselves over to the government.

    How will a doctor shopper be indetified? Can we not seek another opinion without that taint?
    If I am too ill to pick up my own meds; then what?

    The problem with “Steve’s” assertations is that his approach starts from the negative, or how to stop the “bad” without regard what the impact on the “good” will be. Though I am not discounting the 6 deaths cited by “Steve” :
    “…prescription drug abuse that now comprises 30% of our illegal drug use and claims the life of approximately 6 Floridians each day. ” (It isn’t clear if the alleged deaths are from prescription drugs precribed to the victims or the victims died as a result of unspecified illegal drug abuse; this is the type of “red herring writing”; less than honest articulation, that receives knee jerk attention from law makers)

    Before everyone thinks : “Aha, another one of those liberal, ACLU defense attorney types”; I will save you the speculation. My entire 35 years career was in law enforcement and prosecution; except for teaching and judicial tenure.

    Any legal restriction, criminal or administrative, needs to be viewed, crafted, and implemented with the least restrictive means as necessary for the benefit of the patient. Not for some new technology to make loads of cash from the suffering of humanity.

  21. #21 Comrade PhysioProf
    March 13, 2009

    fkng “steve” of “bioscrptrx” needs to be BANNED – this is not a place for someone to put a fkng ADVERTISEMENT, we are talking about a major ethical issue which our country is failing to address here.

    I don’t know about banned, but Steve does need to learn about this coolio new innovation in writing called the PARAGRAPH!

  22. #22 Lab Cat
    March 13, 2009

    While I realize the discussion here has moved on, I think it is wrong of the pharmacist not to fulfill a prescription and wrong of the doctor not to ream out the pharmacist once they had found out.

    I agree with Abel that it is a violation of the pharmacist’s duty to refuse to fill a prescription especially without checking with the physician first.

  23. #23 PalMD
    March 13, 2009
  24. #24 T. Bruce McNeely
    March 13, 2009

    Thanks for the additional info, Sharon. Now I really don’t understand your doctor’s attitude. She needs to grow a spine. I’m in PalMD’s camp, and would have immediately got on the phone to ask WTF etc.
    I gather there’s been a real tightening up of scrutiny of narcotic prescriptions since I was in clinical practice 30 years ago. However, what happened to you should not happen!

    Oh yeah, Mr. Marvin Zinn, I hope that the next pharmacist you see has the same attitude as Ms. Red Deer’s. Idiot.

  25. #25 Monado
    March 13, 2009

    This seems very odd. The pharmacist would obviously have record of this customer coming in with prescriptions from the same doctor. There’s no suggestion that the prescription wasn’t properly filled out. The professional response would be to fill it. If the patient came in next week asking for another month’s worth, that is the time to question a prescription. But if the pharmacist had any doubts, why would he not simply call the doctor to verify the amount or some such? That would confirm whether the prescription was legitimate. It smacks of racism, prejudice, and general jumping to conclusions.

  26. #26 leigh
    March 13, 2009

    Pharmacists are not automatons. They are medical professionals who must critically evaluate a prescription.

    if you read my comment, the implication is that the *doctor* is the one who decides the course of treatment, based upon an actual evaluation of the patient. the pharmacist does not have enough information to make the call on which treatment to give the patient, and unless the patient is under risk of harm or something illegal is going on, pharmacists do not have the right to deny a patient a legitimate opioid script. that does not mean that i’m saying a pharmacist is an automaton or less than professional. (though in the case described…) i’m saying that the job of the pharmacist and the doctor interact but that each has their distinct set of duties and responsibilities. just a doctor is not qualified to be a pharmacist, so a pharmacist is not qualified to be a doctor.

    ok, now on to further discussion:

    especially for someone who is on chronic opioid therapy, denying a prescription fill can have serious results. the more i think about this, the more irritated it makes me- maybe just because i’ve lived with a chronic pain patient. on a 3x/day dosing schedule, i’m sure any withdrawal effects would show up fairly quickly. that is actually inflicting harm and even greater pain upon someone to carry out your own will upon them. (and what if this person felt such great uncontrolled pain that they committed suicide to escape? it happens far too frequently in chronic pain patients- see firbomyalgia.) everything about that is wrong.

    opioids do have a very negative connotation to society in general, though their use in pain is simply unparalleled. pain is a subjective term, sure. we can’t very well quantify it. but does that mean we can’t restore at least some of the previous quality of life either? moral objection to opioid therapy is itself ignorance of the data. inflicting ignorance upon others from a position of authority is irresponsible and unacceptable, in the medical field especially.

  27. #27 Monado
    March 13, 2009

    Thank you for clarifying, Ms. Red Deer. It really sounds unjust.

    As I understand it, the professional duty of a pharmacist is to ensure that the patient is instructed how to take prescribed drugs properly and to be alert for bad drug interactions, not to substitute his opinion about what the patient should get for the doctor’s. People seem to confusing the two kinds of judgement.

  28. #28 Joe
    March 13, 2009

    @leigh | March 13, 2009 6:50 PM “if you read my comment …”

    I did read it. You were mistaken.

    BTW, on either side of your keypad there is a key labeled “Shift” if you learn to use it your posts will be easier to read.

  29. #29 DuWayne
    March 13, 2009

    Marvin –

    Go fuck yourself. Seriously.

    Joe –

    I am all for pharmacists paying attention to whats being taken by a particular patient and making sure that we’re safe. I can even accept the necessity that pharmacists need to pay attention to the scripts that people bring in, to deal with problems of doctor shopping and abuse, though I really don’t like the direction this war on drugs has gone. But ultimately, unless there is an explicit contraindiction or there is a great deal of evidence that the patient in question is a drug abuser, then the pharmacist needs to be a automaton and fill the damned script.

    Steve –

    Use para breaks. I can’t say for sure what the hell you’re talking about, because reading very far into your comment gave me a headache.

    S Red Deer –

    I am so very angry about what happened to you, I can’t be particularly polite at the moment. This crap really freaks me out, because I could see it happening to me.

    I have severe ADHD and bipolar. I also have a history of substance abuse that I have come to understand was largely attempted self medicating. At the moment I am on Ritalin and Xanax (the latter not daily). I have been working with my therapist and my doctor to closely monitor how things have been going and today got a script for a mood stabilizer, Seroquel. If that doesn’t work, I will get switched to something else, probably something more potent. All of the drugs I am filling scripts for are rather potent and open to serious abuse. Anything I am likely to be switched around to is going to be of a similar vein.

    The bitter irony of it, I don’t even want to be on them. But I need to get my head straightened out so I can be successful in school and ultimately my career. The notion that some stupid motherfucker would randomly decide s/he didn’t approve of the drugs that my doctor and I have decided I should try, just makes me angry. Very, very angry. And I know there are plenty of people out there who really don’t approve of the drugs I am taking – hell, some of them have reared their ugly heads here. Odds are, there are pharmacists out there who feel this way.

    This is the danger of this fucked notion that state licensed professionals should have a right to decide to do their jobs, based on their conscience. Where exactly do we say they just can’t not fill a script, no matter how they feel? I’m sorry, but this is not acceptable to me. It’s not acceptable in the case of birth control. It’s not ok in the case of pain meds. And it’s not ok with psych meds either. Yet under the logic that allows the first, we must allow the rest.

  30. #30 leigh
    March 13, 2009

    @joe-
    then why don’t you clarify for me, where i am mistaken in saying it’s the doctor’s job to evaluate the patient and determine course of treatment, and how the decision of who gets to take what drug does indeed fall to the pharmacist.

    and i write this way on purpose, thanks. i spend enough of my hours cranking out the formal shit, this is informal.

  31. #31 DuWayne
    March 13, 2009

    Apologies for all the cursing – this made me really irritable.

  32. #32 Joe
    March 14, 2009

    DuWayne-

    I said the pharmacist plays a professional role in dispensing prescriptions. You replied, essentially, aside from that the pharmacist should just give out the drug. Of course, an acceptable prescription is simply filled.

    leigh-

    Why don’t you find a pharmacist and ask about it? The pharmacist went wrong by not consulting the doctor. After consultation, the pharmacist may refuse to fill a prescription only if it is technically wrong. This I learned from the pharmacists I worked with in the 1970s. Since it never came up, in practice, I don’t know what they were supposed to do after making such a determination.

  33. #34 Silver Fox
    March 15, 2009

    @Joe – dissing the way leight writes won’t get you any points in this corner of the blogosphere! (In case, maybe, you wanted any.)

  34. #35 SilverFox
    March 15, 2009

    Obviously, I meant leigh. Too many t’s.

  35. #36 Spike
    March 15, 2009

    Dear Ms. Red Deer,

    If you are still following the comments, I hope that you could do some or all of the following, based on your professional training and personal experience:

    1) File complaints in your state with the appropriate licensing agencies against both the pharmacist and your doc.

    2) Find others who have suffered similarly and help develop a class-action lawsuit against this sort of practice on the part of pharmacists.

    3) Provide testimony to the new “drug czar,” Chief Kerlikowske, who might be characterized as nearly a concientious objector in the war on drugs.

    4) Talk, talk, talk to any kind of news outlet there is about your experiences.

    Based on what has been reported here, you have a high level of credibility in this matter and woudl be a very effective advocate.

  36. #37 Luna_the_cat
    March 15, 2009

    I was wondering, IS there any form of legal comeback against the doctor for something like gross dereliction of duty? Because yes, I would think (in common with many other commenters here) that the doctor’s duty, having prescribed medicine for pain control, would be to advocate for the patient to be able to get it. Ignoring, dismissing or mocking your patient’s inability to access pain control is not acceptable, or shouldn’t be.

    I realise that an ability to move effectively on this front might also depend on the availability of an alternative doctor, and this might not be possible. But still….

  37. #38 Sili
    March 15, 2009

    I note that Abel thinks that having a license issued by the state makes one an agent of the state. This is directly counter to the traditional view that a professional has a fiduciary duty to act as the agent of [their] client
    Posted by: bob koepp | March 12, 2009 9:14 AM

    fi⋅du⋅ci⋅ar⋅y
    3. of, based on, or in the nature of trust and confidence, as in public affairs: a fiduciary obligation of government employees.

    Would you kindly explain to me how substituting one’s own irrational opinions for the professional prescription from a GP is not a betrayal of trust? The pharmacist(s) in question are acting in their own interest with no regard for their customers (patients and doctors both).

  38. #39 Diane G
    March 15, 2009

    DuWayne,

    Thank you for your comments–I appreciate them, understand them, and would choose the exact same language. ;-)

    I should be on anti-depressants, but was once so humiliated by a pharmacist, and by getting no support from my physician, that I simply walked away from treatment totally. That was several years ago. I am sure my life would be much better if I had stood my ground, but one can only take so much.

    –Diane G.

  39. #40 Kaye Reeves
    March 15, 2009

    Re “pharmacist as agent of the state”: maybe a better way to say it is that the pharmacist holds the privilege of being licensed by the state to dispense medications, and to retain that privilege he or she must comply with state law — which includes respecting the also-privileged doctor/patient relationship.

  40. #41 GILGAMESH
    March 15, 2009

    This thread affects me deeply. I use the minimum amount of palliative drugs necessary to keep me from self euthanizing.

    My body has built up a resistance through many years use making the minimum dosages look like large amounts to people believing they may judge me by their ignorant standards.

    The pharmacist who refused to fill Ms. Red Deer’s prescription should be prosecuted for practicing medicine without a license and pharmacology malpractice (if such a thing exists.)

    The pharmacist and the troll Mr. Zinn should pray they do not become afflicted with one of the many conditions that cause intense, constant, intolerable pain.

    Those misguided martyrs who think they can ‘tough’ pain out; look around you before your self satisfied pat on the back, people near you are the ones suffering your pain through the bad temperament you display. Pain always extracts a price.

  41. #42 DuWayne
    March 16, 2009

    Hey Diane, Thank you for that. I would really love to talk to you. My email is duwayne.brayton (at) gmail (dot) com. Or it can be found at my own blog, along with discussions about neuro-issues and some great resources linked in the side bar.

  42. #43 S. Red Deer
    March 18, 2009

    First , I have so much empathy for the poster that ‘slunk away” in the face of adversary in filling her prescription. Why should anyone have to suffer because someone, arbitrarily , decided not to fill.(?) I am just gobstopped. I do know pharmacists that dedicate their lives to relieving pain and making certain that the chemicals are pure and appropriate. Without them, we would have many deaths from contaminated drugs, unstable compounds, and drug interactions; they are scientists devoted to a high standard. Personal morality must not interdict at the patient level; but at the research level.(There the chemist has a choice of what road to take via their discipline) Once again; thanks for the support. And I am (now) well aware of those, that have suffered the further loss of dignity, simply attempting to fill a prescription written/authorized by their physician. My research has been (WOW!) enlightening. I have found out that my GP was reluctant to “grow a spine” and take the pharmacy to task because some pharmacists have been turned into snitches; an actually keep their own personal “logs” on doctors that they think have an “unusual ” number of opioid prescriptions. Therefore; doctors don’t want to draw the attention of the DEA via a pharmacist, a pharmacist that may have personal issues regarding opioid use. Therefore, much like the “big ” clinics that take the “hopeless cases” and lose a lot of cases (death) and receive a low survival rate; doctors that will help “us” could end up on the DEA’s watch list just by virtue of accepting patients (people) like myself.
    Now, the pharamacist in question, on that Sunday, claims (now) he told me that they were out of hydrocodone and that my refill for MS Contin was 36 hours early , as per my insurance. I will take a polygraph, that would prove he never said any such thing. I find it hard to beleive that Walgreens was “out” of that drug; and further that he choose to reply to these circumstances (if the circumstances were as he states) by saying; “find some other pain relief” and shrug of his shoulders. But I did want to relay the official response to my compalint and situation. As I stated before, I have used this pharmacy,as for almost 2 years. The records were there. I expected some plausable deniabilty on the part of the corporation. I felt sorry for my doctor; the she is so under seige, she has to chose between her patient and her license. Horrific. The bottom line is; I am trying to be as productive, pleasant, interactive, and as full of optimism as these simple cheap effective “drugs” allow me, for whatever time I (and the rest of us) have to offer. As I stated before; I find no virtue spending the time remaining(whether it be 5 months or 15 years) bed ridden, dependent, in agony , but “virtuously free of opioids”. Sad, this is all so sad. I get so wore out by the neurosurgeon(s) asking me to describe the pain I could just_____ (DEEP SIGH); it makes you childish because you have answered this so many times so may ways. But this is the most accurate. With out any pain releif: Imagine having mousetraps on every toe and finger; while someone holds a lighter on top of your feet; while another person takes a tazer to both thighs; meanwhile someone else whacks you continously with a wooden paddle on your buttocks and lower back. A vise is placed upon your head catching your left eye and squeezed enough to make you vomit, then another vise is placed upon your c spine with similar results. In addition , when you lie down, you loose your vision and your arms and shoulders begin, within seconds, feel as if they are severely burned, as if from scalding water, and eventually those mouse traps are replaced with no feeling whatsoever; until you try to move, where upon , it starts all over again. And imagine that, 24 hours a day, forever. Every day for the rest of your life. Now, I would like that pharmacist to trade places with me for one 24 hour period, he would go mad. Meanwhile, I have to go on with “everyday” life; just like he does.

  43. #44 steve
    March 21, 2009

    tebb – U D-bag . . . Read threads before you make ignorant comments. U R an example of why we are facing this problem; irrational, ignorant people. There is no advertisement – it’s a thread to help good folks know where they can garner support to overcome this problem.

  44. #45 pill_pharm
    March 22, 2009

    I’m just reading this for the first time.

    Pharmacists are allowed to exercise judgement even if that judgement is bad. So are other health professionals.

    S.Red Deer – in your last comment you mentioned the pharmacist said he didn’t have any hydrocodone in stock. Why would he say that? Was the script you handed in that Sunday for MS Contin and hydrocodone? You said you were looking to just get MS Contin filled, not hydrocodone? Just curious.

  45. #46 S. Red Deer
    March 24, 2009

    To: pill_pharm. Let’s be ultra clear. After I complained (after my initial posts here) to The manager of that Walgreens( who has been the one to fill most of my prescriptions and a caring man, I may add); the forthcoming response from the Pharmacist on duty that day in question was as I posted above. He claims he told me they were out of hydrocodone and could not refill the MS Contin because it was “hours” too early as per my insurance. That is simply not true; but I am certainly not naive enough to expect he would risk his job by telling them the truth; he simply didn’t think I needed that level of pain relief; which is what he (nutshelled) told me.That was his collateral response. Not the one he provided me at the time (please re-read my posts) And yes, I presented both, at the same time, as they prescribed at the same time , for the same length of time, upon my in-person visits, as I see my Doctor twice a month at minmimum. She sees me every prescription re-issue. and for other issues inbewteen. I believe, once, in 18 months have I received my prescriptions without an accompanying office visit. Now I am curious, why would you ask that question, as being merely a lawyer, I do not catch on to the implication.
    As to “Steve” and his Ad; please explain to me as a lawyer (and former lawmaker) and patient, how your program would make “good folks over come this problem”. What is the problem you are helping people overcome? From your post, it sounded to me , that you would be helping the DEA and law enforcement to catch people that deal illegally in prescription drugs. That is not the problem of patients, doctors , or pharmacists. That is a fact that has escaped many people for many years. Making it more difficult for patients to receive authentic pain relief is not helping “good folks”. Forging prescriptions is a matter for law enforcement; burdening people at the end of “their quality of life” is not “helping” us. There is no possible way, that with Walgreens computerized system, that that pharmacist could have thought my prescription was forged, illegal, altered, etc. It is the same every month. Nor did they ask me for ID; they never do. It wasn’t a matter of idendity or “wrong doctor”. Believe me, I was as confused and outraged as anyone. I did not understand “what was going on” until the epiphany during my conversation with this pharmacist after he refused. Maybe I should have looked less Native and worn a suit, and not been in such a hurry. All profiling , that I think helped make his “Sunday-I -can’t -call- the _doctor” decision. Which is what will happen with Steve’s DEA drug management program.

  46. #47 Zachery
    May 4, 2009

    I just had a problem with Wallgreens pharmacist myself. I just had my right shoulder operated on. (I fell at work, Tore ligiments completely in half on front, and back side. and broke my rotor cuff.) I went in Saturday to fill a refill on my medicine. (I get a weeks worth at a time, just in case the pain goes away, and I don’t need it) Well the pharmacist informed me that she had altered my dosage to extend 4 extra days. (I hadn’t been informed or nothing) And my grandmother had passed away the day before which made the stress of it worse. The lady actually tried to make me seem like a bad person for needing the medication. After getting very very pissed off at how the lady treated me. The other pharmacist actually complained due to the fact that I was one of their usual customers, who never caused any trouble. The lady tried to make me out to have a drug addiction, just because I needed my medicine filled? I mean honestly what the hell is with that. But it’s alright, I just won’t go back.

  47. #48 sandee
    May 21, 2009

    I had a similar experience…….

    My regular pharmacy (Walgreens) did not have my prescription that I have filled every month so I took my presciption to Publix to have it filled as they did have them , my pharmacist called them for me.
    So I get there and I give her my prescription and she ask for my ID and I realize I have lost it and she says I can’t fill this without a valid ID. I understand completely I say no problem and I then go to the DMV and wait and wait and finally get a copy of my lisence and I then go back. She then states I can not fill this presciption! I said well why not I went and got a copy of my ID as that is what you said you needed! She said well I can’t verify it with the doctor. I said well why not? Can’t you call them? So she says she will call. I immediately call them while standing there as by then it was 4:45 and I spoke with my doctor and told him what happened and he said he spoke to her already so I should be good to go now. WRONG! She waited 30 more minutes making the total time I have tried to get it filled now 4 and a half hours and she tells me I can NOT fill this. By then I am livid! I lose my temper and say why not! You tell me I need a valid ID so I spend two hours getting that and come back and then you say you need verification which I KNOW you got so now whats the problem? She states I don’t feel comfortable filling it !!!!!!!!!!!!!!!!!!
    She had NO INTENTION of filling it to begin with she just made me run around and waste my time and now I can’t have it filled until wednesday because another pharmacy will need verification and the doctors are now closed until then.
    I am so mad and I will do what ever I can to make sure she gets what she deserves! I will call her boss and the bosses boss and so on and the pharmacy licence and tell them about her poor behavior and professionalism.

    This is UNEXCEPTABLE behavior!!!!!!!!!!!!
    These rouge pharmacist need to realize they are there simply to fill the prescriptions the doctor orders!
    I felt like a common criminal and even had a sheriff’s deputy behind me comment that he was appalled at the pharmacist’ behavior towards me!

  48. #49 TIM Rpth, Ph.D.
    July 3, 2009

    call the ACLU, and the pharmacist’s manager and tell them that the pharmacists did not give you the med cuz you were indian decent and say that he said that he does not fill meds for “stinking indians”. that will put his ass in a real bind! Serves him right. Why can’t pharmacists get it through their thick skulls… you are NOT physicians!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
    So quit trying to be one! That is the physician’s job! The pharmacist’s job is to fill the frigging script!
    When in doubt, SUE the pharmacist! You will possibly lose the lawsuit, but the pharmacist will lose TONS of money fighting the lawsuit and get a bad reputation that will follow them for life!
    Stupid wanna-be physicians! (pharmacists)

  49. #50 Mike S
    July 12, 2009

    What the hell is wrong with these pharmacists? I’m on methadone for neurological pain. I have both a Walgreens and a CVS near my house. Sometimes I go to one, sometimes I go the other. I never thought much about it. I’ve done this for two years.

    I have to go to my Dr. every month to get my Rx filled, and I understand why and it’s cool. I get 240 pills at a time. I have good days and bad days. On bad days I take it every six hours but on good days I may skip the day. I have a small quantity of pills in reserve because of this.

    Anyway, today my wife is going to CVS so she took my RX that I got from my doc a couple of days ago. She was just doing me a favor. This pharmacists calls Walgreens and tells her that I am a week early on my pills and furthermore that I am addict. He told her he put an “alert” on me at all CVS and Walgreens stores.

    I called this guy and and told him I didn’t know that I was under surveillance…and that I have enough pills to get by, that this was just a matter of convenience. She was there, may as well fill the Rx. I told him I thought he was on a power trip and he threatened to call the DEA on me! I’m serious. I laughed and told him to keep crawling out on this limb. He also insisted that I call him DOCTOR. When I told him rather angrily I would be contacting his district manager, calling him doctor as sarcastically as I could.. he said “you do that. So I tersely told him good day and when it became evident that I was hanging up, he said “now wait just a minute” but all he got was “click”.

    I think he’s used to pushing around frightened drug addicts who are out of their meds and in withdrawal. He really acted like an ogre to my wife and I bet he plays cop dress up at home.

    I have contacted CVS management about this and I await their reply. This guy needs to be fired in my opinion and if CVS has known that he’s been a problem before I may just sue them if I have a case.

    What a jerk!!!

  50. #51 PharmIT
    August 10, 2009

    I know I’m late to the party, but what it seems to me if the RPh has questions about a script, they should contact the prescriber, and if they have questions about the prescriber, they should contact the DEA.

    As for Ms. Red Deer’s example of a court appointed attorney, that doesn’t seem to apply. An attorney has the right to turn down a client, for just about any reason, unless they are appointed.

    If the attorney is appointed they can refuse the case on moral grounds, if their prejudice will affect the case.

  51. #52 Ed
    December 12, 2009

    Hi,

    First of all to the person that works for Walgreens and said there is something missing from this story. BULL****
    I live in Easton MD. I have been going to this Walgreens for over a year and getting the same prescription every month 100mg MS Contin. I have been on it for 3 years, Anyway a new pharmacist started there and I went in a few months ago and the exact same thing happened to me. Not only did she not fill it.But she was nasty and treated me like a drug addict. My Doctor got on the phone and told her off and went over her head to the manager, But the next month I got her again and again she did the same thing. I filed a complaint with corporate. Now she fills it But like this month she had me sit there for 2 1/2 hours before it was ready. I dont have a choice of pharmacies so I am stuck with this. She should be fired. I am filing another complaint to corporate. This is not the first pharmacy to give me a hard time. It is insane what you have to go through even when you have a legitimate terminal disease.

  52. #53 erpicture
    January 28, 2010

    Dear Ms. Red Deer:

    You need to search for “fda ms contin recalls” to see if your manufacturers/dosages were on the list of recalled items. They also post MS Contin that is still approved, so make sure you read the post under each list to make sure it was recalled. It involved an error which resulted in an increase of 2 and 3 times the amount of morphine in each pill. This could be deadly to some folks who were already taking a high dose.

    It would take too long to go into the grief my husband was put through as the ER staff said he was “overdosing on MS Contin”. We knew he wasn’t, but 60 days after his hospital release, we got a letter from Humana that listed recalled MS Contin and similar drugs that they would not be covering. There were over ten manufacturers involved and several different dosages. My husband’s manufacturer/dose were listed. He was “overdosing”…… unknowingly. I copied and hand delivered Humana’s letter to the hospital and all of my husband’s doctors and asked they put a copy in his file to vindicate any comments and/or diagnosis that indicated he was self abusing his pain medication. The next day I called all of them and was assured all was corrected. We waited 30 days, pulled hospital and physician records and they were all changed.

    Strange, I was told by Walgreens they didn’t have a notification of the recalled items, but would investigate.
    The pharmacist thanked me. A few days later Walgreens called me to advise me all MS Contin products would be pulled. We also use Winn Dixie and they pretty much reacted the same.

    How quickly patients are judged by the medical community as being drug abusers or selling pills on the street.

    I hope you were NOT affected by this, but I think it is something you should investigate. I know you are on the lowest dose, so if your med is on the recall list, it still would not be a very high dose. If you were affected, I wonder how your Walgreen’s pharmacist and physician would react? The both of them were certainly opinionated how they feel about MS Contin. When the tables are turned, I wonder what explanation they would have as why they didn’t notify you if it were the case your med was affected by this recall. I wonder how they would explain the lack of communciation between drug manufacturers and the pharmacies that they do business with. Most of all, the lack of positive communication to the majority of patients that use pain meds to get some relief in their lives.

    My husband and I wish you peace and comfort.

  53. #54 Wade Johnson
    April 30, 2010

    I can relate to all you people who have been DONE WRONG by pharmacists that think they own the store that they are the SO CALLED HEAD MAN OR WOMAN..like Rite AID for instance. My wif has to..I repeat HAS to take (PRESCRIBED NARCOTIC PAIN MEDICATIONS) AND MORE THAN ONE!!! She has had twelve abdominal surgeries due to severe scare tissue and adhesions, She can not have any more cutting done on her abdomen but the scar tissue and adhesions are still growing inside her body so she is riddled with abdominal pain every hour of every day. She visits a pain clinic and has been going there for upwards of 7yrs now and has been on one medication the entire time.(METHADONE) 10mg 14 times a day=140mg daily which by most standards is not alot. That means a thirty day supply is 420 10mg tablets she also takes demerol 50mg by mouth and now she is on the fentynyl patch 25mcg one every two days as of today. We did use WAL-MART until the head guy there Keith Jones pulled my wife aside one day and told her she needed to find another place to get her meds filled. His excuse was that the DEA guy had come in and looked through all the hard copy scripts and questioned him about my wifes doctor.ALL LIES.Her Dr. called the DEA and asked if he was under investigation and they assured him that he was not. there were some shady things going on here in Eastman Ga though with faulty scrips and I think Mr. Jones wa in on it and was just trying to cover his ass because he was scared. My wife had never ever asked any person there to do anything wrong like trying to fill meds early or anything.I feel that these people are trying to be doctors I think that had they wanted to be a dr. they should have went a little further down the hall in school..We did find another pharmacy..Rite AID in Hawkinsville Ga. We did call to verify that they carried ALL the meds my wife used and they gladly told us yes and from then on we had NO PROBLEM getting meds filled,Every month without even calling her meds were ALWAYS there,Until one month her doctor was arrested for WILLFUL CONTEMPT Due to a Divorce proceeding not anything to do with his medical practice.It came time to get her meds filled so she called and told them she was coming in to get them filled and this is when Mr. James (Jim )Oneal proceeded to tell my wife after he asked who the script was on and she told him and he rudly said yeah he just got out of JAIL, and my wife said yes but not for medical reasons,And boy he lit in on her and said things like YOU NEED TO BE GOING TO A CLINIC,AND that doctors NO LONGER prescribe METHADONE for pain,he also made statements about her being the reason that the doctor was being investigated ( He prescribed DILAUDED) to her trying to find a medication that would help with an entirly different situation that she had going on at the time.EXTREMLY bad headaches..NOT MIGRAINE!! we could not find the source of her problem.It was not any type of bleeding of the brain she had several MRI”S and MRA scans to rule all this out.But my complaint is the way that my wife was treated by this person that is supposed to be professional..Well he was not very professional that day..He went over the line by a long shot.I did call the Dr.’s office and told them what had happened,he suggested I file a Formal complaint,And I did I figured it was a waste of time,But I was contacted by A SPC.Agent Mr. Sonny May with the drug task force and he talked with both my wife and myself about what went on I typed it up just as it was spoken and I feel that this gentlman got what he deserved. I have been in and had several things filled without any problems yet, But it was really only for a prescription of dermogesic patch 25mcg..,But I feel that as soon as we go in with her full regemin of medications to be filled which ever one of the two that fill prescriptions there will most likely try to nut up and show out because they won’t want to fill that much pain medication, But again what business is it of theirs just as long as the paper it is written on is right and it has not been tamperd with?? They have to verify each controlled substance scrip anyway,So what is the big deal? I wonder if the people in Upper management would agree with people like Jim Oneal losing major money for the company…By NOT filling legitimate prescriptions..They even gave me the spill about they could lose their licence if they filled a medication and the person overdosed onit..How is that? They as a pharmacist didn’t prescribe the medication they only did what they are paid to do,which is to fill what ever prescriptions any legit doctor sends their way..Am I not right?? I mean that would be the exact same as me buying a new car from a dealership and driving off the lot and crashing the car and getting killed..Is it the car dealers fault I got killed in a car he sold me?NO it’s not So If myself or my wife were to overdose on medication prescribed by our doctor WHo by the way is responsible for telling you how ANY medication he or she were to prescribe is to be taken,and also what dangers the medication prescribed would have, should you decide not to take it as DIRECTED!!! Now if the person filling the medication were to put the wrong directions on a medication that has been prescribed to you or me and you were to overdose,Then I can see where the pharmacist would be liable for the loss of his or her licence,But that my friend is the ONLY way I see that a pharmacist would be in ANY such danger of losing their licence because it is not their place to say how much or how often you are to take ANY medication because they CAN”T prescribe medication they can ONLY FILL medications that a doctor sends their way,And unless a person that is a pharmacist owns the place of business they practice in they should not have any say if they want to fill a prescription or not. ANY prescription whether it is for the DAY AFTER PILL or for a narcotic pain medication. IF you have issues with filling ANY medication due to religious beliefs or just because you don’t believe in abortion then you ought to be FIRED BECAUSE OBVIOUSLY YOU DO NOT BELONG IN A PHARMACY. And one more thing,,NOT EVERY PERSON that come into a pharmacy with a prescription for narcotic pain pills or patches,or even injectables are DRUG SEEKERS. SOme people have a real legit reason for that prescription,And I don’t see where that is any business of the person filling it either. It’s real simple people..JOE Blow brings in his prescription for OXYCONTIN 80mg call his Doctor’s office to verify it if it is a good prescription then fill the DAMN thing and let Mr. Joe Blow be on his way because obviously if he needs 80mg oxycontin then he most likely don’t feel like standing around in a pharmacy where he knows he is being judged because of the type of meds he is getting filled,And that is what outrages me,I wonder if Mr. James Oneal would refuse to fill a prescription of oxycontin for his best buddy if he knew that best buddy was in chronic pain??? Hell no he would do it NO QUESTIONS ASKED!!! The good ole BUDDY SYSTEM it’s been in place here in Georgia for years and years,,Some things never change..It’s all in who you are or who you know in these small towns..Nothen but a buntch of bitch ass cock sucken bastards that want to cause as much trouble for people as they possibly can.WE have been driving a 120 mile round trip the past several months to get my wifes meds filled in Macon Ga. Just because we get excellent service there and are not questioned and certainly don’t get the feeling of being judged..Pharmacies are in business to make money just like grocery stores and hardware stores im sure they don’t refuse to sell sugar to certain folks at the Food Max or sell a shovel or some nails to a guy that is not a carpenter just wanting to fix his broken porch..That aint how it works folks these smart ass pharmacist that work for companies like Rite Aid and Wal-Greens,CVS that refuse to fill legit prescriptions should all be reported to the coorperate officials just to let them know that certain employees are costing then major money by refusing to fill legit medication prescriptions.Ayway im done bitchen I just hope that as law abiding citizens that just want to do our thing and go home and mind OUR OWN BUSINESS can get done right and stop being treated like lepers just because certain individuals HAVE to rely on narcotics to have some small quality of life..Not all people on narcotic pain meds stay high or geeked up as it was said to me..SO ONCE AGAIN FROM ME TO ALL YOU KNOW IT ALL PHARMACIST IF IT’S LEGIT NO MATTER WHAT IT’S FOR FILL THE DAMN THING AND MIND YOUR OWN FUCKING BUSINESS!!!!

  54. #55 Pharmguy
    May 5, 2010

    I also work at Walgreen’s, I have been reading the comments to try to figure out any reason for a refusal and I think I’ve narrowed it to 3 things.

    “He claims he told me they were out of hydrocodone and could not refill the MS Contin because it was “hours” too early as per my insurance.”

    Now if it was a refill too soon, which is a fairly common occurence, it is very easily verifiable with just a call to the insurance company. What happens is that when a doctor writes a prescription for say Hydrocodone/APAP 5/500 (Generic Vicodin) and writes the quantity for 24 tablets, then writes instructions of 1 every 6 hours for pain as needed, max 8 per day.

    Although technically you could safely use all the medication in 3 days, the way the doctor wrote it meant it was intended for 6 days and as such when we bill insurance they ask how long it will last we tell them 6 days, now say the pain is worse then when you see the doctor and you take 8 per day instead of 4, you run out in 3 days and return to the doctor, He writes you a new prescription with instructions for 8 per day, If you come in and try to fill that, the insurance will reject the claim, because the last time you had it filled it was supposed to last for longer than it did. With a change in directions it would require a call to insurance to ask if they will override the claim, but often with controlled substances (especially schedule 2s like MS Contin) they will not override the original billing, Which leaves the person to do without until the date they authorize it. If you decided that you really need the medication and would like to pay cash, it would be against the law for us to sell it to you if the insurance had previously rejected it as a refill too soon.

    If he told you the hydrocodone was out, pharmacies in slower areas do run out of certain medications from time to time, and since the closest one to you is 30 miles away, that could very well be the case in this situation.

    Lastly, if you didn’t recognize the pharmacist, he could be what is called a float pharmacist, these are pharmacists that don’t have any one store they work at and they travel around filling in for pharmacists that may be ill, These are commonly recent graduates or some of the more eccentric ones (and there are some eccentric ones), and may not have the best communication skills, they also won’t know anything about you other than what the computer tells them. I would have tried back the next day if your normal pharmacist was working and talk to them.

    None of these would justify anyone being rude to you but I have seen similar things happen. The patient can sometimes leave with a completely different idea of whats going on than what we’re trying to communicate to them.

    I’m not saying any of these apply to your situation, I’m just explaining what might have happened.

  55. #56 Keith Jones
    May 5, 2010

    To Wade Johnson,
    ” She visits a pain clinic and has been going there for upwards of 7yrs now and has been on one medication the entire time.(METHADONE) 10mg 14 times a day=140mg daily which by most standards is not alot. ”

    First off, if by “not alot” you mean enough to keep most people unconscious the whole day then sure, that is one of the highest doses I have every seen a patient on. Much more would be fatal.

    The rest of your post just goes off on a rant,

    “.They even gave me the spill about they could lose their licence if they filled a medication and the person overdosed onit..How is that? They as a pharmacist didn’t prescribe the medication they only did what they are paid to do,which is to fill what ever prescriptions any legit doctor sends their way..Am I not right?”

    You’re not right, if the pharmacist knows a dose is too high and dispenses it, and someone dies, they will lose there license, your comparison to a car dealer is one of the stupidest things I’ve ever heard.

    “That aint how it works folks these smart ass pharmacist that work for companies like Rite Aid and Wal-Greens,CVS that refuse to fill legit prescriptions should all be reported to the coorperate officials”

    Those “smart ass pharmacists” went through more schooling and have know more about drug interactions then your doctor,
    Most corporate officials for pharmacies have been pharmacists in the past.

    You also complain about the “buddy system” and the pharmacist being out to get you, I can’t really take those out of context because the context if right there.

    You are a one angry nutcase, better hunker down because Obama is gonna take your gun next!

  56. #57 Steven Thomas
    May 12, 2010

    Hello Ladies and Gentlemen. I wouldn’t exactly say this has been enjoyable reading but I must say it has been engrossing. I have been sitting here reading it for well over an hour. And now I feel compelled to add my 10 cents. I am accutely interested in the subject matter of this discourse because I too have been a victim of the prejudicial narcissism evident in too many Walgreens pharmacists. While Walgreens is not the only pharmacy cited in your comments, in my perception it is fairly dominant in the discussion. Like many of you, I too suffer from intractable pain. I don’t think it a coincidence that my pain management physician posted a notice to the effect that he would not get involved with any difficulties encountered when trying to fill prescriptions at Walgreens. Actually, my grievances with Walgreens did not even involve prescriptions written by him.

    I do understand that the linkage cannot be established by anything said here. But I ask you, does anyone suspect that these issues may not be isolated to a small number of defective pharmacists but may somehow extend to attitudes or policies promulgated within the Walgreens organization? If not, then it seems that Walgreens has more than their fair share of these discontented pharmacists. I would bet a dollar that this discussion represents only the tip of the iceberg in terms of the depth of this issue.

    As many of you have very persuasively stated, this kind of behavior must not be allowed to stand. I pray that if any of us encounter this kind of unacceptable conduct in the future, we will adopt the incident as a personal crusade, and take whatever steps possible to bring it to the forefront of the attention of anyone and any enforcement entity that may have the authority and inclination to take measures to correct, or at least initiate positive action toward the demise of, whatever the underlying source of this intolerable reality is. This is another segment in the debate of the principal that would allow a person to suffer needlessly in favor of the use of narcotic pain relief in whatever quantity/quality deemed necessary and appropriate by one’s physician. In my opinion, the “ugly” side of the debate is based solely on predjudice and misconception regarding the relative evils of the dread poppy and the true nature of chronic pain.

    I hope the english teacher in the bunch will forgive my grammer, punctuation or whatever.

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