[Swatgen27]

I have encountered time and time again issues with filling my monthly prescriptions. (Such as my pain medicine.) It frustrates me that I have to take the medicine in the first place and then to encounter problems. I often think to myself, if I was a diabetic and this was insulin would I still have problems??
Yesterday the pharmacist did not want (not the WANT) to give me my medicine. It was Saturday, so I could not reach my physician so I had to go out of my way and see another doctor. That doctor called the pharmacist and really ripped them a new one (I got some pleasure out of that.) and low and behold I got my medicine filled right away.
I know what happened, it was not the normal pharmacist working that day and the one that happened to be working was extremely biased about my medicine. Has anyone encountered this???
I normally don’t like talking about my medicine for fear of how I will be perceived. I think society has some major judgments on the medicine that helps me live my life. However, after this happening time and time again I want to know if others feel / have the same issues.
Now I feel like bringing this to everyone’s attention (sending a complaint) to the pharmacist headquarters.
I feel like it was a case of discrimination because of the medicine I have to take to live my life. I'm I alone on this issue or do others sometime have the same problem.

[mrsD]

I know it feels like discrimination.

But the general public does not realize that everything a pharmacist does on that shift comes back on THEM legally. (on their private license which may be suspended, or fined, often starting at $1000per)

I worked contingent for many years, going to a new different pharmacy often, sometimes every day, sometimes every week.

When working that way, one does not have the history of the patients to the extent and understanding that the regular staff has. C-II substances can be problematic. I used to go into the computer history, and do a little detective work. But I can tell you I saw some horrific abuses with C-IIs and C-IIIs in some places I worked.
I did not return to those places. If a pharmacist has been sanctioned for an error or involved in a legal problem with anything including pain meds, they will tend to be guarded with everyone after that.

I certainly don't consider myself biased, but I have refused a few on occasions. And I have found many FORGED situations with actual illegal activities where I have called police and/or confiscated the written order. So it is very hard to generalize and say BIAS when there may be another reason(s) for what you encountered. This is my 40+yrs experience talking.

If I had my say....I'd say DOCTORS are far more problematic that Pharmacists. The younger ones today, are a bit more afraid of C-II abuse than the more experienced ones.

[Swatgen27]

Thank you for posting, it is great to gain the perspective of a pharmacist. I understand there are laws / guidelines with medicines. Per my discussion with the doctor that spoke with the pharmacist, they had no reason to hold my medicine. My situation had nothing to do with forged scripts, or abuse of medicine.
I agree that the issue is a communication issue between the doctors and pharmasicts and I cant believe that happens.
When that type of situation happens the only one who is left suffering is the patient. I dont like extra suffering for no reason so I took a stand yesterday and I was found to be right by a third party. If that is not a bias situation, than I don't know what bias is..

[ali12]

Sorry to hear that you have had to deal with all of this too, Swatgen!

My mum like you, has had issues with getting my medications (I'm not able to get my own as I am under 16 years of age)! I have to take Ketamine when I am in a really bad RSD flare as it is the only thing that helps lower my pain and the Pharmacists look at us as if we are drug addicts and refuse to give me my medication. Unfortunatley, Ketamine is used by a lot of young people over here in the UK illegaly as a drug and the pharmacists seem to think that that is why I have to take it despite me having a letter from my Pain Management Doctor, copies of all of my medical notes etc.

A few months ago, I was in a severe flare and the Pharmacists wouldn't give me my medications so we had to wait a week and get it from my Pain Management Doctor. Thankfully, I only take the Ketamine when I am in a severe flare otherwise, I would have had lots of withdrawal symptoms from it! We now get my meds from my childrens hospital ... it's an hour away but it saves all of the arguments with the Pharmacy!!

I really hate how people just seem to think that anyone who takes a certain type of drug, is a drug addict without realising that they are used for many other illnesses. Yes theres drug addicts out there, but theres also genuine people like us who hate taking the meds but have to to try and function in normal day to day life!!!!

I hope you get all of this resolved. Try and speak to your prescribing Doctor and see if he/she can do anything to help.

Take care!

[Swatgen27]

I'm so sorry to hear that you to have had this same problem. I just can not believe that they did not help you for a whole week, when you clearly needed the medicine and had proper documentation.
I plan on bringing the situation up with my regular doctor first thing Monday morning. I'm not sure what that will solve because I have to agree with you that the problem is that the medicine that I use so that I can get out of bed everyday is the same that many addicts misuse. However, that does not mean I misuse or abuse my medicine and thats how I feel I was treated. I'm 27 and I'm told I look like I just graduated high school (cuz I'm so short and petite) so I wonder if they only do this with young people....
It makes me so sad to hear that others are having the same problem and being treated in the same manor. With everything that a patient has to deal with... its a shame that medicine can add more stress and drama and I just dont think it is okay for them to treat you that way or me.

Thank you for responding and I'm usually not this fired up but they really got me upset over this. My name is Sarah and it is nice to chat with you and I hope to talk more again.

[SandyRI]

Just yesterday there was an editorial in our local newspaper which addressed this issue - but on the physician level...it is VERY disturbing:

http://www.projo.com/opinion/contrib...6.3f89ba6.html

I am incredibly fortunate that I have a PCP that writes my scripts for my meds, and that I can go to my local Walgreen's and get them filled. I have known my PCP for at least 15 years, and have had RSD for the last year and four months. It never occurred to me that my pain WOULDN'T be treated, or that I would be hassled by my pharmacist.

XOXOXO Sandy

[fmichael]

Originally Posted by SandyRI

Just yesterday there was an editorial in our local newspaper which addressed this issue - but on the physician level...it is VERY disturbing:

http://www.projo.com/opinion/contrib...6.3f89ba6.html

I am incredibly fortunate that I have a PCP that writes my scripts for my meds, and that I can go to my local Walgreen's and get them filled. I have known my PCP for at least 15 years, and have had RSD for the last year and four months. It never occurred to me that my pain WOULDN'T be treated, or that I would be hassled by my pharmacist.

XOXOXO Sandy

Thank you. The editorial you've linked to* suggests - shall we say - some context against which to evaluate the assertion, above, that:

The younger [doctors] today, are a bit more afraid of C-II abuse than the more experienced ones.

Afraid of being pilloried by the DEA, et al may be more like it. Not unlike the problems Planned Parenthood and other groups find themselves in when seeking to find young OBGYN practitioners willing to become abortion providers in, say, Wichita, where their predecessor was gunned down for his efforts.

And as to the statement that:

If a pharmacist has been sanctioned for an error or involved in a legal problem with anything including pain meds, they will tend to be guarded with everyone after that.

I certainly don't consider myself biased, but I have refused a few on occasions.

To see the problems that are implicit in such a statement, in light of well documented disparities between White and minority communities gaining access to prescription analgesic medications in the United States, needs look no farther than the marvelous "Topic Brief" presented by American Pain Foundation, PAIN MANAGEMENT & DISPARITIES, November, 2008, http://www.painfoundation.org/learn/...isparities.pdf, and the 20 studies cited therein. As set forth in something of an executive summary to the Topic Brief:

RESEARCH ON DISPARITIES IN PAIN CARE HAVE SHOWN:

• Blacks were less likely than whites to receive pain medication and had a 66% greater risk of receiving no pain medication at all.
• Hispanics were twice as likely as non-Hispanic whites to receive no pain
medication in the emergency department (55% of Hispanics received no pain
medication vs. 26% of non-Hispanic whites).
• Minority patients were less likely to have pain recorded relative to whites, which is critical to providing quality patient care.
• Only 25% of pharmacies in predominantly nonwhite neighborhoods had opioid
supplies that were sufficient to treat patients in severe pain, as compared with 72% of pharmacies in white neighborhoods.
• In a study of minority outpatients with recurrent or metastatic cancer, 65% did not receive guideline-recommended analgesic prescriptions compared with 50% of nonminority patients (P < 0.001). Hispanic patients in particular reported less pain relief and had less adequate analgesia. [Footnotes omitted.]

It was perhaps an awareness of these issues that led the Wisconsin Pharmacy Examining Board to adopt the following position on December 7, 2005:

A survey of Wisconsin pharmacists’ knowledge and attitudes about dispensing opioid analgesics for chronic cancer and non-cancer pain was published in the March/April 2001 issue of the Journal of the American Pharmaceutical Association. http://www.medsch.wisc.edu/painpolic...k/01japhak.htm The study found that not all pharmacists knew what constituted legitimate dispensing practices for controlled substances under federal or state policy in emergencies or for patients with terminal illness. Also many pharmacists were unaware of the distinction between addiction, physical dependence, and tolerance. The Board encourages pharmacists to re-educate themselves with current literature on pain management. Appropriate pain control can improve or at least maintain a patient’s quality of life. It is the pharmacist’s duty to provide medications along with proper counseling to ensure pain control. The PEB considers refusal to fill a Schedule II prescription based on speculation or ignorance unacceptable. [Emphasis added.]

http://www.aspi.wisc.edu/wpi/Documen...mentofPain.pdf

Mike

* In the event that the link expires, I have copied the editorial, Claude A. Curran: Physicians and the problem of pain, The Providence Journal Co., October 30, 2009 as a text file. For ease of reading, go to "Format" in the bar across the top of the page, and then click on "Word Wrap."

[mrsD]

Each state is vastly different in how they handle this issue.

I worked in inner city locations, and HMO clinics. I saw no problems based on minority issues for pain control. But in Florida, they are having major problems with drug diversion, and dispensing controls.

It is sad that the abusers make problems for the legitimate pain patients. But this is basically a multipronged social problem.
In fact I have had to field DOCTORS unethically obtaining medications for themselves(sometimes in great quantities), which in my state is in violation of
the Health laws we have. I have REPORTED them as well and discussed issues with state drug inspectors over the years.

Diversion in my state is huge. In fact I thwarted a Vicodin robbery one night, by a guy posing as an electrician who somehow got the manager to give him access to the pharmacy.
It took 3 hrs and 2 police cars, and my rising blood pressure trying to keep some elderly shoppers in the store safe, while I arranged for the police to save us. (a male customer helped with this task-so we did not spook this guy into violence). Turns out this guy had done this twice before at other locations, but he didn't get anything from ME! There had just been a huge arrest of a drug mill and that location (in Detroit)was raided and dried up the street Vicodin. It began with a simple traffic stop, finding 500 ct bottles of Vicodin in the truck of the car. This guy was aiming for stock bottles kept behind the counter in
community settings to supply what was lost during the raid. He even had all the tools to test electrical sockets, and a real toolbox.

On a daily basis, the stresses on pharmacists are huge. As this problem with diversion escalates, efforts will be concentrated on the diversion. There are only so many minutes in a hour, and hours in a day, and when you have over 300 Rxs to fill there is not time to be perfect and satisfy EVERYONE.

One is going to run into problems with everything these days.
Doctors don't want to give opiates. The new laws coming out of Washington will restrict this further. Vicodin and other mixtures with acetaminophen may be taken off the market, etc etc. The problems just keep coming.

What is really needed is for Big Pharma to stop making me-too drugs like ANOTHER bladder control drug, another toxic fluoroquinolone antibiotic, another antidepressant, etc and focus on REAL PAIN relief without the added baggage of opiates (which may increase pain over time, that is showing more and more in studies). When safe effective pain interventions appear, the problems associated with opiates --their prescription ordering by the physician and dispensing at the store level will diminish the problems that exist now. Creating drugs that provide pain relief without euphoria, that will be the solution IMO.

The other issue, in dispensing is trained opinion. Some of the doses used in chronic pain are enormous. This alone can alarm a contingent pharmacist in a outpatient setting. In fact I have seen doses of drugs far in excess of what I see in long term care settings! In long term care, you also have the nursing staff which are eyes and ears for drug reactions. Not all overdosing is caught by nurses either, but they do afford a sort of insurance because of their presence and experience. A person alone at home can stop breathing on high dose Methadone or their heart can stop and that is IT. The fourth leading cause of death in the US is medication mismanagement (overdoses, interactions). And the growing rate of prescription drug abuse is not going down, but up. So in the end there will be caution in pharmacies, because the truth of the matter is that it is the last stop before someone goes home with a medication. ANY error by the doctor, any omission, any irregularity etc has to be caught then.

This original post is rather vague in specifics. And I assume that is for privacy reasons and respect that. But without details, other responses here can get off the track.
Was this Rx for 120 Vicodin ES every week or month ? or for 120 Oxycontin 80mg every month? To determine real bias, fairly,
more facts are really needed. Did the insurance stop the sale?
Things like that.

I've had Rxs filled for myself by others --- filled with errors. I understand when people get angry...I get angry with the mail away system too which I have to use with my husband's insurance. I just chalk it up to the complex life we all seem to lead now in every area, not just the medical one!

[fmichael]

mrsD -

Thank you for the clarification. Florida (and I presume you refer to So. Florida) is truly a world unto itself, where from everything I understand, and sad to say, they usual rules don't apply.

Glad we cleared that one up right way.

Mike

[AintSoBad]

What a topic!

Mrs. D, here's a show about FLA!

After taking methadone since about 1990, I've seen some situations.
One, was back when my pharmacy, owned by a really great pharmacist (sold 6 stores to Rite-Aid). Good for him.

Anyway, one of his pharmacist's was caught selling oxycontin's and methadone, etc., to street people, a gang thing I believe. This had nothing to do with the store I was using, btw. But, they(who are they?) shut down the entire string of stores from selling that class of medications.

I couldn't get my script filled! You don't just Stop taking methadone!
NOBODY would tell me anything (the manager), told me that there's a hold up with the supplier / wholesaler.... Ok.

I went downtown Philly to Jefferson. Got it filled on the spot.

Anyway,

Here's a show you need to watch, when you have the time...
It's on Hulu, and is open to the public..


http://www.hulu.com/watch/100279/van...ion#s-p1-so-i0


http://www.hulu.com/watch/100279/van...ion#s-p1-so-i0


PS If you've never used hulu, you may need to sign up, which is just a statement saying you're over 18 for certain things. (R rated)
I don't know what this is rated.


pete