ATAP: What we think by looking at your Rx's

I know at our pharmacy, there are a few times we will joke about people and their valtrex or something like that. However, Suboxone/Subutex are not ones we joke about. We may talk about it though, but for many of our patients it is sympathy or pride. We have one patient who was one of our druggies for a while. Recently he brought in a Suboxone prescription and apologised for all the trouble he had given us. We talked with him for a while and let him know that he had our support. He is doing very well and will come in about 8 when we aren't busy anymore and talk for a while with us. I am glad he is taking steps to improve his life. There are two or three patients we have that we are part of their support group. I never think duragatory things about suboxone patients. I have only respect for those who are trying to improve themselves.

When I see Suboxone I usually think "Good for you."

Same for Chantix. If I even bother having a thought about it at all.

I neglected to mention that I'm more likely think "Fruit loops!" when I open a bottle of Suboxone than I am to think about the background of the person I am filling the Rx for.

I love the smell of Suboxone. :)

i am the only pharmacist who sat on the discussion panel regarding the rules for prescribing Suboxone/Subutex. It was an amazing discussion and I was blown away by the lack of knowledge by most health professionals regarding the dispensing life of a retail pharmacist. I fought the 30 patient per prescribing group caveat. I argued that no pharmacist in the real world would be able to verify the special "X" DEA number for each prescription to make sure the prescribing maximum was not violated.

One of my interests for which I pursued post-PharmD training is substance abuse treatment and research. I have done retail pharmacy as a technician for 11 years and as a pharmacist for 6 years. I now work in a clinical capacity with our veterans and wounded soldiers (who have issues with drugs of abuse following lengthy treatment for pain management). Each person who chooses to be treated for their abusive behavior has my support. It is a difficult thing to face - not only to admit that there is a problem, but in finding a pathway to health. Up until recently, admission to a methadone treatment program was the only way. Prescribing methadone on an outpatient basis for treatment of opioid abuse is actually against the law.

If you bring me a script for buprenorphine I guard your privacy, I respect your decision, and I quietly cheerlead for your recovery. I would never think "junkie". I only think "junkie" when you bring me a Dilaudid RX written in marker.

We once had a psych patient on naltrexone, and yes, I did think "recovering addict" then found out that this person was using it off-label for OCD.

TAP, I'm surprised you haven't done a rant on ADD meds. When is that coming - or do you restrain yourself because you have the condition yourself? The media says it affects 3 to 5% of children (and adults, as you don't outgrow it but rather learn to compensate) but around here, I'd say it's more like 30 to 50%, and I have heard about school districts (not mine) who are pushing, consciously or not, to get 100% of their students on some kind of ADD medication. I'm quite aware that many parents (okay, single moms) who face being kicked off welfare are coaching their kids to misbehave in school, or act like they are retarded, so they can get SSI payments for them. This, IMHO, is not what SSI was intended for, nor was it meant for drug addicts but that's another story.

In addition, I have never heard of a child being evaluated for it who wasn't diagnosed, usually by the first practitioner who saw them, 10 minutes after they walked into the door.That is, with one exception. I once worked for a pharmacist who thought his B-student daughters could be turned into A students by taking meds, and took them to 10 or 15 doctors until he found one who would write prescriptions, no questions asked. I told him what I thought, which probably contributed to my being fired a few months later but it was a temp job anyway. I later learned that this man has a long history of walking out on jobs without giving notice, and signing up to do relief work and not showing up and being unreachable.

Go figure.

If it's for Suboxone, and you haven't caused a scene in my pharmacy or insulted my staff in the past, then the only thing I'm thinking is, "Do I have enough tablets?" I guess I'd also be thinking about how I should tell you (nicely) that you should come back here and get your script next month so I don't have pills sitting on the shelf.

And heaven help you if you have been on a zolpidem product for an extended period and you sudden come off it. Psychosis ensues....

I try not to judge people (Im just a tech though). I do agree with AP.. I would be likely to think less of someone if they were a dick, came in frequently or even worse, CALL frequently about their Vicodin/Lortab/Xanax being called in yet.. about 10 times an hour. [Yeah, we have a problem.]
I can't think anything bad of someone trying to get their life back on track.. good luck to you!

The other patients we joke about are the Viagra, MUSE, or Caverject patients who probably couldn't find a sober partner if their lives depended on it.

I am on bupe also, i take subutex. i have a great working relationship with both my pharmicists that work at the only pharm i go to now. I pretty much abused the hell out of u people when i was using and i have made amends several times. i was that person calling and bugging and pleading if my ins dont pay for it can i pay cash. i dr shopped so much and pharm shopped i was put on lock down by my ins. i am allowed one pcp to write all my scripts, if they arn't by that pcp they have to call and override which is a pain in the ass. so my bupe script has to be overridden. the one pharm was so neg to me back when i used, now shes a good friend of mine.. bupe is a lifesaver. it does not get u high. it makes an opiate addict feel normal, cause we are endorphine deficiant due to dumping tons of opiates on our brains.

I take subutex, so i call a few days early and they order it in for me. I have heard of people getting put thru hell tryin to get bupe scripts filled. also the one baltimore newspaper just wrote a fucking awful article on the diversion of bupe(diversion is going to happen with anything with a c in front of it. hell it happens with viagra at 12 a tab retal priced). anyhow thanks for being so understanding, and the limit for a bupe doc is 100pts now which is great. i come from an area of high opiate abuse here by pittsburgh. please check out our bupe advocates site at www.naabt.org list ur pharm at www.naabt.org/local to help the addicts find someone that carries bupe or can have it for them. addiction is a hopeless disease as i am sure u all know by the people who call 10 times a day and come in dope sick shaking with an oxy script its sad but true. o well im going now ttyl.

thanks all, i appreciate the feedback, it's been very encouraging! it's unfortunate that not everyone is as understanding or supportive, even close family and friends who are supposed to be the least judgemental of me...

AP, thanks for sharing your thoughts, it's really put my mind at ease.

What do I think? And I also tell you why. First of all I feel, then think. Must say that I feel pity for all those shit who lives on percocet, vicodin, xanax, and especially dislike even despise and scorn - adderall, concerta and retalin takers (or their parents). And therefore I think that if you have pain (severe or moderate) it is not the reason to go into opiates. Then, if your kids have attention disorder there much more (more effective) therapies that pharmacological. But after all this is my way to put food on the table, my money is weak and mind destroyed poor people, thank to all you crackers:)

I pretty much feel the same way as everyone else. The only negative thought I would have would be something like 'shit, I hope I have this in stock'. Even though we all love to bitch and moan about our junkies, this isn't really one of those times when those thoughts cross the mind. Like everyone else, the mulitiple call, screaming harrassers are the ones that bug the living shit out of me! Btw, I never realized until I worked graveyard that so many people picked up a 10-pack of syringes for 'grandma' at 3AM. :)

Was Emma writing in English?

....just curious. Her entry reads like someone who could use a retard pill.

Yes, I'm horrible.

Yikes, I hope the above pharmacist(?) counts better than she spells. Seriously, until you know anything about what it's like to be in chronic pain, don't judge. And until you know anything about psychology or psychiatry, don't presume you know how to treat either.

TAP-
you know you are having a rough day, when you are 45 min behind, with 3 pharmacists and 6 techs. On top of that, when you call for a transfer, the other pharmacist thanks you for taking the patient away, and offers to take you out for a drink.
I need a glass of good wine...

Rebecca,

I commend you for your work in the area of substance abuse, and especially on behalf of our veterans, who deserve the best care our country can offer. I was a V.A. pharmacist for seven years, and saw the pain our soldiers/sailors/marines bring home with them. Thank you also for watching out for the needs of the pharmacists who would be filling suboxone prescriptions. I was a retail pharmacist for 13 years before switching to hospital practice 14 years ago.

I have only praise and respect for people seeking recovery from substance abuse. In the world of drug abuse, they are the heroes.

When people come into the pharmacy I work in, I usually try not classify them in my head as a druggie or not. Some are on some serious pain meds for good reasons, the only times I'll classify them as a probable drug abuser is if I get a script written in marker, one that looks like a photocopy and was brought in 15 minutes before closing with them asking if they can get it in a couple of minutes, or my favorite is having "no controls" written into the address line of their central profile.

I applaud people who are trying to get their lives back on track and live a normal life. I'm willing to give anyone the benefit of the doubt and not think they're a drug abuser as long as they aren't harrasing me about getting pushed to the front of the line to get their half a dozen narcotics.

Been lurking here for months, Emma's comments, once I figured out what the hell she was trying to say, really pissed me off.

Chronic pain affects every aspect of my life, and the life of my family. Thank God for the pharmacists and techs at the Walgreens that I go to. I've have 12 surgeries on my kidneys in three years, 6 of them in the last year alone, losing half of one a few months ago, all to stones. Horrible, horrible pain. When it was so bad I was on a 50 mcg duragesic patch and percocet for breakthrough pain, my pharmacist gave me a hug, told me to hang in there and that it would be over soon. The narcotics dulled the pain enough so that I could make it through the day, cooking, cleaning and taking care of my children.

Thank God you're not my pharmacist, Emma. To think that I would have had to deal with your disdain in addition to the agonizing pain I was in, would have made me feel so much worse.

TAP, I love your blog.

As a pharmacist, I know that I must leave my preconceptions of people at the door when I go to work; if I want to be as compassionate and helpful as I can. If I don't, I shouldn't be practicing this profession. Sure, there's plenty of bad people out there who abuse the system to get a free chemical ride, but, in the end, they pay for it sooner or later. The way I see it, Suboxone, Methadone and a lot of psychopharmaceuticals are only helping people function in society. No one is perfect so why judge? You can't cast the first stone if you are addicted to something: TV, money, food, beer; whatever. I could go for a cigarette right now tho' Cheers

Just saw this:

>>RJS said:

I neglected to mention that I'm more likely think "Fruit loops!" when I open a bottle of Suboxone than I am to think about the background of the person I am filling the Rx for.

I love the smell of Suboxone. :)<<

Oh...I love the smell of Benicar. Some say, "mmmmm....popcorn!", I say, "mmmmm...cake batter!"

I once worked with a tech who loved the smell of KlorCon 10 mEq. Said it smelled like "childhood". Wha...??? She said: "Yeah..kinda like..ummm...construction paper and crayons?" Oh. Ok.

And...jaded old CPhT's that we are, when we get a newbie tech, we make 'em sniff a bottle of Armour Thyroid and ask for their opinion. After they stop gagging, they'll usually go with the "rancid raw bacon" smell..every time.

Heh Heh...cruel, I know.

I've always loved the smell of Midrin. The generics have a similar odor, but they don't measure up to the real thing. Thank heavens I don't have to take it!

Ever gotten a whiff of Geocillin? How could anyone swallow that? (Yes, I have dispensed it - once.) But nothing can top Chemet, not even acetylcysteine! You can even smell Chemet through a sealed glass bottle - it's that strong. Oh, and with one exception, every time I've dispensed that, it was for a dog. Interesting.

Procalamine's pretty nasty too.

I just came across this site and it is really awesome!
I too am on Subutex due to being on Lortab for 2 years straight for herniated disks with a compression fracture at L1. One day I just woke up and decided I was so sick and tired of being on the Lortab. I felt like I was in a fog, although it did take away my pain. I wanted to see what it was like OFF the narcotics, so I went and was put on Subutex.
I actually go to CVS because I had a really bad experience with Walgreens and it wasn't even for narcotics. My son was diagnosed with ADHD by 3 different doctors (yes, I wanted SEVERAL opinions before putting my child on anything controlled). A new pharmacist was hired at the Walgreens right by our housing addition and boy was she a feisty one! Basically told me I was a bad parent and bordered on abusive by giving my child Metadate (note that he had already been on it for about 2 years and doing absolutely PERFECT). I wrote a formal complaint, which I'm sure sat on a desk somewhere. I swore to never use Walgreens again and I haven't.
The pharmacist I took my first script of Subutex to was absolutely WONDERFUL. We talked for about 15 minutes about it and he just made me feel completely comfortable.
Just thought I would put my little story in.
BTW...I think the bad pharmacists name was EMMA. You seriously need to find another profession...oh say one that involves a BROOM maybe?

I intern in an urban pharmacy. I love patients who are picking up their Suboxone. I make an effort to be attentive to them and to make sure that things are going OK. It takes guts to give up addiction.

In fact, I've even teared up while filling a script for Suboxone. I think it's powerful that we Americans are slowly embracing the theory that addiction is a disease and that its treatment is being mainstreamed.

Keep coming back.

Oh yes I always shed a tear for the local Drug Addict....The other day a couple of, lets just say Dirt Bags come in for their first Suboxone scripts and proceed to tell me how wonderful the drug is and how much better it is to take than the Vicodin,morphine and methadone that we were having to pay CASH for at every pharmacy arround. yeah its great to getget off drugs just call me when you do. Take the time to do it right and go cold turkey. Its the only way. I just want to tell them if they have any plan to stop is stop now and gut it out.. What gutless wonders. But the sure could score 3 or 4 prescriptions in a weekend if they tried.

I don't care what my pharmacist thinks when I fill my suboxone presciption. Or the fact its filled with valium and carisoprodol ;)
All I care about, is that although I made some shitty choices in the past (young and naive), I'm back on track and living a great life now.
BOOYAH!