Thursday, May 21, 2009

I Hate Being the Controlled Substance Police

I know I should. Every other pharmacist seems to care. However, I really couldn't give a flying fuck about people who abuse controlled substances. I don't care if Mr. Smith has gone to 20 different pharmacies paying cash for Vicodin in the last few days. It doesn't bother me one bit. If he wants to get high and blow out his liver, he can go right ahead. It doesn't faze me in the least bit.

That's not to say that I just hand out Percocet, Vicodin, and Valium like candy. I don't allow early refills. I won't knowingly fill a script for someone that paid cash for the same thing at another pharmacy just a day earlier. I do everything that the board of pharmacy and federal laws ask me to do for filling scripts for controlled substances. I just hate doing it.

I will not go out of my way to find out if the person is a drug seeker. I know some pharmacists who will call every pharmacy in a 20 mile radius if a suspicious looking cash customer brings in a Percocet prescription late in the evening. I just don't care enough to do that. If a new, cash customer brings a Percocet prescription to me late in the evening after the doctor's office has closed, I just fill the damn thing.

The way I see it, due to these wonderful $4 generics, controlled substances are some of the only drugs that net us a decent profit. We have to make money somehow. It might as well be from the drug addicts.

These people all eventually get caught anyway. Inevitably, they screw up and come in early for a refill, or bring in a script from a different doctor that sets off some red flags. Trust me, I am looking to bust these people. When I catch them, I do cut them off. However, I don't waste 30 minutes of my time to track down the multiple pharmacy filling history of one drug addict. I have more important things to do.

Retail pharmacists probably have the most varied list of responsibilities of any professional. We're responsible for accurate dispensing. We're responsible to make sure that the prescriptions we receive are in compliance with both state and federal laws as well as being up to the standards of the insurance companies. We're responsible for preventing drug interactions. We're responsible for counseling patients on new prescriptions. We're responsible for being the liaison between the customer and the insurance company. We're responsible for maintaining the business end of pharmacy. We're also responsible for being the controlled substance police.

Know what's the sad thing about all those responsibilities? Pharmacists seem to be the only ones that take them seriously. We call doctors about interactions every day, and they mostly ignore us. We attempt to counsel patients, but they don't have time to listen because they're in a rush, and they swear the doctor has already explained everything to them. We constantly try to keep our inventories down and dispense as many generics as possible in order to improve our gross profits. At the same time, corporate decides to give out $4 prescriptions and free antibiotics, not to mention all the $20 gift cards.

It's the same thing for the controlled substances. We've caught several customers trying to pass off fake scripts at our pharmacy. The police show up, arrest them, and then they're right back out doing the same thing 2 days later. We call doctors about patients who are filling Vicodin scripts all over the place, but the doctors keep writing them more scripts.

I don't know about everyone else, but I always feel like I'm fighting a losing battle trying to adhere to all the laws and regulations in pharmacy. I feel like we expend so much energy trying to do things by the letter of the law, but in the end, we're the only ones who care because ultimately, we seem to be the only ones affected by the regulations. Doctors, insurance companies, and seemingly even patients do whatever the fuck they want, while pharmacists are the only ones that get penalized by not following the standards.

Therefore, my response is "screw it." I'll do what I can, within reason, to ensure that my pharmacy doesn't become a Percocet addict's paradise. However, if I have to waste too much of my time to catch a drug seeker when I could be providing counseling to a good patient or filling scripts, then it's not worth it to me. After all, my time is money. Catching a drug addict brings no money to my store and is actually a waste of money when you factor in my salary for my time spent trying to catch him.

Now if the DEA starts offering rewards for pharmacies that catch controlled substance abusers, my opinion may change. Until then, sure, I'll fill that potentially sketchy (but at the moment entirely unprovable) Oxycontin prescription 10 minutes before closing on a Friday night. It won't affect my conscience one bit if the asshole OD's on it. In fact, it would probably be doing the world a favor.

16 comments:

Anonymous said...

I couldn't agree more. I am really getting tired of wasting my time arguing with people about early refills and the such.

The Ole' Apothecary said...

Mike, if DEA and the boards really want us to fulfill the "corresponding responsibility" clause of the various controlled substances acts, they MUST give us the tools to do it. As you so correctly note, we cannot take time to do it manually, so since we are stuck with the responsibility, we ought to have an electronic friend---all U.S. pharmacy databases should be interconnected for informational purposes regarding controlled drug products (see my January post at http://oleapothecary.blog.com/4486783/).

I understand it is this way in New Zealand with ALL prescriptions, but we surely need it here, at least for controlled substance. We can't go calling all day. Why have state departments of health or law enforcement agencies been collecting CII info all these years and we can't access it? A common database, for ALL schedules and also state-level controlled subsances (e.g., Soma is controlled here in Texas) would assist law enforcement in reducing controlled-drug diversion. The responsibility of pharmacists is to help stop this diversion. We just need help.

I agree with you, Mike, that we are the only ones who have to care about these. But, hey, we did choose pharmacy as a profession, and, to paraphrase Harry Truman, the pill stops here. DEA and boards, please help us to help YOU!

The Ole' Apothecary said...

Hey, Mike, wouldn't you know it, but an idea similar to mine surfaced in the latest Drug Topics:

http://drugtopics.modernmedicine.com/drugtopics/Associations/Senators-line-up-to-support-e-prescribing/ArticleStandard/Article/detail/599316?contextCategoryId=47443

pharmacy chick said...

I have to agree with you in spirit on most of this. I dont care what goes on in other pharmacies. I care what goes on in mine. I am the PIC and responsible for use and abuse within my walls. The BOP holds me responsible for my judgement in dispensing. it must be legal, it must be appropriate,so if Joe Seeker comes in with vicodin scripts from more than 2 urgent care centers in a short enough period of time, somebody is going to get called. Dont let your senses get too dulled. Just cuz the dr wrote it doesnt mean you are absolved of all liability in filling it. Personally, we are past due for a narcotic registry.

Jaded Rx Intern said...

I'll admit I tend to have my BS detector on a little much. I'll look a little too hard for sketchy orders. I've tried to tone it down recently; it's a matter of keeping one's sanity.

Anonymous said...

pharmacy mike i hear you, though dr's were getting into trouble for overprescribing ala anna nicole smith and her jillion scripts, so the docs would have to care too ?

Anonymous said...

The asshole isn't always going to be the one to OD on the Percocet, the middle school and teenage kids the asshole sells it too could also OD on it. I agree we are fighting a losing battle but if I have the time to help keep some drugs out of the hands of kids, I will try.

Pharmacy Mike said...

Call me heartless, but I don't really care if some teenage kid ODs on Oxycontin.

No one goes out there and shoves drugs down teenagers throats. They buy the drugs. They are told over and over again that drugs are dangerous, but they do them anyway. If some dumbass teenager ODs on some prescription drugs he bought off someone, it doesn't bother me at all.

Honestly... I have very little sympathy for drug abusers. I don't find their lives to be tragic. When a 15 year old dies from an overdose, I don't lament over a wasted life. I don't care. They chose their own fate.

People want to hold everyone else responsible for their own problems. Abusing drugs is YOUR decision. Anyone can choose not to do drugs. If you choose to do drugs and die from them, it's not my problem.

Michelle said...

Hey! You took your post down! I had read it before work and was planning on commenting later in the day…oh, it’s still on my feed thingy. Good.

“I have a better chance of developing cold fusion than getting married.” Oh man, me too. Science for me is so easy and logical – I sometimes get frustrated when those around me aren’t getting it. But this social stuff, it is baffling. Did everyone but me get a handbook on what to do and how to act? And now it seems everyone around me is getting married, and having babies…and I’m just left behind.

I have been following your blog (along with a good chunk of other pharmacy blogs) for around 2 years, and it always amazes me how much you remind me of myself, particularly with posts like this. Have you ever looked into Asperger’s Syndrome? I am not saying you have it, because, how the heck would I know, I do not know you nor what is going on in your head. However, it may be worth considering if you haven’t already. AS is not a bad thing! I am not unhappy with myself nor do I want to change. I do not seek out therapy or medication, because, really, what is that going to do? It was just nice to know that I am not the only freak in the world that can’t figure it out, and that my frustration isn’t due to “not trying hard enough” or any failure as a person. It was a relief when I found out about AS.

And now that I have thoroughly offended you, I shall continue commenting. Marriage does seem like the most unattainable goal, but I think it is key to remember that “marriage” =/= “happiness” or “successful life”. It is what society expects of everyone, but it is not necessarily the BEST thing for everyone.

Think about it…there is so much WORK involved, and anxiety, not to mention loss of privacy, and ability to do what you want whenever you want. I like coming home from work and relaxing with a book, which probably wouldn’t fly if I was married. My husband would probably expect me to cook for him or something. Blah, I say. Let’s see, other negative things about marriage…dependence, loss of control over finances, being expected to show outward interest and spend massive amounts of time with someone else, having to clean your apartment. Yeah, marriage sucks! You don’t want any of that shit! :)

“It's just useless rambling from an inconsequential person.” Oh no no no no no no no. No.

-pharm-km

Pharmacy Mike said...

I took down the post because I didn't like the way it was written. The tone didn't accurately describe the way I was feeling, and it seemed to mislead several commentors.

I do not have Asperger's Syndrome. I thought about this, but I don't really fit the criteria at all. I don't really have any problems with social interaction other than I just don't like to do it. I'm not clumsy. I really don't have any of the characteristics of Asperger's.

You never have to worry about insulting me. I don't think I can be insulted anymore.

Brother Frankie said...

post that was taken down and this post combined.

its a sad thing no one but you has visited your home in over seven months. as a counselor, i call that a red flag. (just as you pharm guys have red flags for seekers).

as i read your posts i find you dont enjoy much in life.

you are quick to note how superior you are scholastically, or how much better you are than those others, the less desirable folks we meet.

brother, make some friends, cut people some slack. smile a lil. God has an awesome way of turning the tables on guys like you. its happened to me.

invite someone over this week. smile at someone that just might not be a drug seeker, but someone who just needs pain pills and had a dentist appt the same week as a hemroidectomy.

you are intelligent, it must really suck to not have a visitor at home.. wonder why.

be blessed brother..
lighten up.

Brother Frankie
A Biker for Chrst

Michelle said...

My apologies; it is not my business. I guess it is easy to forget when the internet makes it so easy to read the thoughts of people you do not know...

Peon said...

Sometimes I think the government regulatory agencies are picking on us pharmacists. We are the ones with no strong organization to protect us. The number of laws and regulations that apply to us is becoming mind boggling. The chains are dumping all the responsibility for anything that goes wrong on the pharmacist.
As far as drug abusers, I have stopped trying to have them caught or informing docs. I abide by pharmacy board regulations, but I don't feel compeled to do anything more. And, like one poster here, I am not very concerned about people that overdose on drugs. All these teenagers have been warned, time and time again, about drugs. If they OD, it is their fault.

Anonymous said...

I busted a druggie today and I loved every second of it. I don't care that I fill 700 Rx's a day. I've been a pharmacist for 2 years (maybe that makes me a youngin who doesn't know better) but I will ALWAYS find you drug seekers. Don't come to my store. I love getting MD's to void your Lortab Rx's cause you just got Percocet at another pharmacy from another MD YESTERDAY.

I LOVE busting them.

Pharm.D. Student said...

I agree with your viewpoint. If someone else decides to ruin his/her life, that's his/her problem.

Do they expect pharmacists to be the enforcers of these addictions? Like you said, it's one thing to catch them red-handed, but it is another to go out of the way to track down abusers.

Tobacco is completely legal and probably as addicting or more addicting than some of these meds.. The government doesn't seem to care about that as they are getting paid off.

Ron said...

Brilliantly written. I'm 2 years into the profession and while I started off like this chick I know, who investigates their narc histories until the store closes, now I could give a rat's ass if they want to load themselves up on OTC codeine products and gravol (a local favorite). They're grown adults who should know better. Hello emergency room!!