A couple weeks ago a woman called our pharmacy asking if we had Oxycontin 60 mg in stock. We informed her that we did, but the only tablets we had were of the old formulation.
I swear that she couldn't have been more excited if she shouted Eureka! into the phone. "I'll be right down," she said.
A few minutes later, this perfectly able-bodied woman shows up at our pharmacy counter with a prescription in hand for the Oxycontin. "How much is it for 30 tablets?" she inquired. Surprise, surprise... She wanted to pay cash for them.
We looked it up, and she decided 30 was too expensive for her, and she wanted to know the price for 25. Apparently, 25 tablets wouldn't completely wipe her out, so she then asked us to fill it for 26 tablets.
To enlighten those of you who might be uninformed about drug prices, 26 tablets of Oxycontin cost in the neighborhood of $200. Moreover, the script was from a doctor's office located over an hour away, and she was a new customer to us. There was no way this prescription could be legit. Therefore, we called the office to find out just what was going on.
The nurse gets on the phone and she listens as we tell her how shady this woman appears to be. The nurse checks with the doctor and a couple minutes later, she returns to tell us, "Dr. Dipshit said you can definitely trust her."
OK... Whatever he says. So we document the shit out of the situation, and fill the script for her 26 Oxycontin. Several minutes later, she returns to the pharmacy counter holding about $200 in cash, and proceeds to slap $20 after $20 on the counter as she pays for the prescription.
Yeah... Really trustworthy.
A couple weeks later, the woman calls our pharmacy inquiring once again if we had Oxycontin in stock. Once again, we did, and once again, she gleefully remarked that she'd be down in a few minutes.
Same prescription from the same doctor, only this time, the full 30 tablets would be just fine. Little did she know, she had nearly wiped us out of the old formulation last time, so we had to dispense the new formulation to her. I decided not to tell her this little fact because I was curious to see what would happen when she found out.
The technician went to ring her up at the register, and she almost had a heart attack because the price of the tablets was $22 more expensive than she thought it would be. "That must be some kind of mistake," she proclaimed. "Is that the new formulation?"
I confirmed her suspicion, and she immediately asked whether we had any of the old formulation left. Alas, we only had 10 tablets left, not enough to fill her script.
"No problem. I'll just take the 10," she responded.
Yup... completely trustworthy.
In the end, she did us a favor because she helped us get rid of all the old formulation tablets we had left. In addition, I'm reasonably sure that she'll never come to our pharmacy ever again.
Here's the thing though... All you people out there who have legitimate reasons for taking narcotics don't realize that these kinds of stories are closer to the norm than the exception. We fill ridiculous amounts of Oxycontin and oxycodone prescriptions and a good majority of them are for very sketchy people. However, every time we call the physician, we get the same response. "Yes, fill the prescriptions."
Just recently we had a guy and his buddy come to the pharmacy both presenting prescriptions for 240 tablets of Oxycodone written on the same day by the same out of state doctor. We called the office, and they didn't understand why we'd be questioning it. Yeah... two well built young men who happen to be friends getting the same narcotic prescription for massive quantities from the same out of state doctor on the same day. I have no idea why that's suspicious at all.
How about the woman who takes Percocet 7.5, Avinza (extended release morphine), and Exalgo (extended release hydromorphone) twice daily? We called the office wanting to know not only why she's taking two different 24 hour extended release narcotics, but also why she's taking one of them twice daily. Moreover, she has a sister that goes to the same office, and the doctor writes Avinza, Percocet, and Tylenol with Codeine prescriptions for her as well. The nurse didn't take too kindly to us questioning these pain management regimens. In fact, she was quite annoyed.
How about the woman who was getting 120 Vicodin a month from one doctor and also getting 90 Percocet a month from another doctor? We called to let one doctor know she was getting pain meds from another doctor, and we were told that they were aware of the situation. You see... She's taking the Vicodin during the day, and the Percocet when she needs pain relief at night. Oh, I see... I totally should have figured that one out. After all, it's not at all unusual for someone to chew through 120 Vicodin and 90 Percocet per month, especially if the Percocet is only supposed to be taken at night. Completely normal.
See... the biggest drug dealers in this country aren't slinging dope on the streets or cooking up meth in a basement laboratory. They're actually the doctors who will write for whatever narcotic patients ask for as long as they say they're in pain. As pharmacists, we're told that we have to be constantly vigilant for signs of drug abuse and misuse. We're forced to keep tabs on pseudoephedrine because it's apparently OUR job to stop meth junkies and sellers from cooking up meth in their basement laboratories. We're encouraged to use controlled substance databases to help reduce doctor shoppers and people who pay with cash at multiple pharmacies. Our license could be on the line if we don't document that we at least tried to verify any suspicious prescriptions. However, prescribers have free reign to allow patients to basically write their own prescriptions for narcotics.
My biggest issue is if doctors don't care, then why do I have to care? If they're prescribing habits are going to facilitate drug abuse, then why do I have to try to clean it up? I just can't seem to figure it out.