Yay, moral hate mail!

The entire tirade about retail pharmacy is here

My last comment…the one I’m sure will draw fire, is regarding the
Birth Control Pill argument…. I am on your side that moral and
religious believes should play no role in pharmacy dispensing…
Refusal to dispense based upon those things goes against everything the
healthcare industry stands for (do no harm, yada, yada)… But I must
have read 15 comments you’ve posted over the past number of months that
all relate some story of a ‘vicodin addict or loser’ trying to get an
early refill or pull one over on you… Let me ask you…. What
percentage of vicodin (or pick your drug…I won’t go the route of
mentioning your personal favorite) prescriptions do you fill? Of 10
that you get, how many are legit in your view and you agree to
dispense? Does someone’s appearance play a role in determining that
script’s validity in your eyes? Some of your comments on the person’s
smell, clothing, hygiene all seem to imply that you do…. Is that a
‘moral judgement you’re making’? One person’s street drug is another
person’s morning coffee and cigarrette. The only difference is that one
is illicit and therefore hard to get, and the other is has entire store
chains devoted to it….(Starbucks…?)

First off, comparing a moral objection to dispense birth control vs refusing to dispense vicodin thats a week too early isn’t even an argument.  Its even stupid to even start to compare them.  How can you even start to equate “You know, God says that abortion is wrong so I refuse to fill your pills.. MURDERER” to “Uh, you just got 120 vicodin from another doctor 4 days ago, I’m not filling this until you are due”?  One is a 100% your own personal opinion and the other is doing what the DEA mandated our job to be (not to mention a huge safety/health/do-no-harm issue).  To answer your question, of those 10 Rx’s I have a pretty good assumption that at least 7 or 8 are being diverted (does everyone need Vicodin, Valium, AND Soma?).  However can I do anything about it? No. Why? I have no proof that there is, and there is that chance that they aren’t being diverted and actually used. So if they are on time, I dispense it without question.

So would you call someone who “loses/gets stolen” their vicodin Rx at least 3 times a month, always calls in 10 days early, doctor shops and is on every ER’s “do not dispense” list an addict?  Is that a call of morals like refusing to dispense Plan-B or a good statement of fact that you need to keep an eye on this person.  Its not even a moral call but a ‘get-you-head-out-of-your-ass’ call.

The personal appearance argument is vague at best.  I look at every Rx with a huge grain of salt especially if they are a new patient or an out of town patient/doctor.  I’m just as quick to call out doctor shoppers if they are a long-term patient or someone i’ve never seen before.  You know why? Its my job. 

Never in my career have I ever said “you know what, you look strung out and I think you are on way too much of this.  I am going to refuse it for no good reason other than my own”.  It doesn’t work that way.  I have however refused to refill based upon “Uh, if you take this how you are taking it, you are going to blow out your liver from 10 grams of tylenol a day, let me call the doctor”.  Thats a safety issue, not a “moral judgement”.

Judging by the rest of your comment, I doubt that you work retail.

An interesting tidbit of real-life info for those pharmacy students out there… One of the sucky part of my job is having to monitor diversion in a large setting… We use many tools to do this in order to track patterns.

Ah, I was right.

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10 Comments

  1. RJS says:

    While comparing apples and oranges, I wouldn’t exactly call that “hate mail”.

  2. Jill says:

    What does “doctor shop” mean?
    Yes, some non-pharmacist lay-folks actually read this blog.
    My bro is studying to be a pharmacist and reads this blog, hence I read it as well. Sometimes I’m not up with the jargon/slang.
    Maybe you could do a little “angrypharmacist slang dictionary”?

  3. michelle says:

    Doctor shopping is going to a bunch of different doctors and getting the same meds (in this case, pain meds) from each one without any of the doctors knowing that other doctors are writing for the same patient. It happens everywhere. And honestly? I can understand a plan b comment (even though it doesn’t cause abortion, if you don’t believe me, just ask – I’m pro-life and will dispense it)…but as far as the ENTIRELY separate vicodin discussion? I agree with angrypharmacist on this one. I like being a paranoid ass about pain meds because 50% of the time, it’s necessary. The doctor or the pharmacist is getting one pulled over on them, and it sucks. If you don’t have any idea why it’s an issue, get out of the “large setting” you’re in and work a few days on the weekend. See how much of an ass you have to be in retail.

  4. Carol says:

    I had a funny experience the other day. Had a scruffy loser type walk up to the pharmacy and I thought to myself,”He’s gonna want Tylenol #1’s” (I’m in Canada where it’s legal to sell otc) The tech approached me and said,”the regular pharmacist won’t sell them to him anymore.” So I told him no. He ranted a bit and left. But then I finally remembered where I had seen him before. In another nearby town, in a wheelchair claiming the Oxycontin we gave him (naturally he’s on disability) was short. Naturally we had triple counted it and told him to shove off. THAT’S why I tagged him as a “druggie”. I had seen him before in another pharmacy. And since I work relief, I see ALOT of druggies.
    Therefore, I can say with confidence that I have an instinct to help pick ’em out!

  5. boxdesker says:

    I am applying to pharmacy schools this year. Found this blog on google. Ironically, however, your comments make me want to go into pharmacy even more. Pretty messed up huh. But, you don’t get to deal with real life issues like what you deal with in most other health professions. Keeps life interesting and makes you feel like you’re doing something positive by stepping up to these dealers/addicts(or both), although it would be nice to be able to turn them away even when their prescription’s on time. What do you think pharmacy will be like in 20-30 years. Will retail pharmacy still be around?
    I live with almost all pharmacy students and it’s funny to think how most of them are going to make it in the real world. Most have no social skills, just quiet and study all day. I can’t picture them standing up to addicts and sending them away. Perhaps confrontation should be a course taught in pharmacy schools. What’s the common ‘personality’ of most pharmacists, if there is a stereotype?
    Anyways, great blog man. First blog I’ve ever read, only blog I’ll continue to read. Getting info about pharmacy from someone who thinks the same way as me

  6. DownonthePharm says:

    Honestly i have worked both retail, mail order, and hospital as a tech.. now that i’m in pharm school i can say i would rather work retail than anything.
    Mainly because you do get to socialize more with your patients. In the hospital you’re fighting against the doctors and everyone else just to get a word in on someone’s care. You get the same bullshit in both settings.. the nurses are going to be stupid and will continue to yell at you.. same with the doctors..
    Only thing is they can yell at you on the phone in retail instead of them being in your face. Talk about a way to get you going!
    There is a place for everyone.. but as you stated.. who is going to fill this guys script at 2am? it sure as hell isn’t going to be the pharmd’s workin in the hospital.
    Any JOB is going to run you down… retail, hospital.. blah blah.. its a JOB, thats what jobs do.
    I’m sick of these damn people coming into pharmacy school… most of the time they have never stepped foot into a pharmacy before they got in.. how the fuck do they “know” which is better?!?! give me a damn break!

  7. one_angry_tech says:

    Ah yes.. Patient got a prescription for Vicodin 5/500, 20 qty, 12T;Q46:;PRN, took all 20 in one day.
    Contacted MD.. gave him more.. came in to pick up, was shaking, disoriented.
    I’m just a tech, but methinks he should be weaned off this.

  8. Melissa says:

    When I started pharmacy school, I thought there would be no way in hell I would ever work retail. Now, as a 5th (or 3rd) year pharmacy student, I’m planning my rotations and future accordingly as I don’t think I would rather work anywhere other than retail. Retail is where I can see the effect I have on people and although I get yelled at more than I get thanked, the few times I do get thanked are truely genuine and it makes my day. Some people just can’t handle retail, so they do other things. It’s a personal choice and I don’t think anyone should judge someone else based on how they practice pharmacy.

  9. countrydruggist says:

    my dad-also a retail pharmacist may have stated it best. YOU CAN’T ARGUE WITH IGNORANCE. your pharmd candidate isn’t stupid, just woefully ignorant. if he keeps an open mind(questonable) and gets some front line experience he/she may gain some needed wisdom. I don’t remember being
    so niave even in pharmacy school but at my alma mater RETAIL pharmacy was and still is the bastard son nobody wants to talk about. just wondering? how many of these highly educated pharmd candidates end up working retail?

  10. anti-controlls says:

    hey. good work busting the druggies. sometimes i feel like overriding a early controlled script so they can take it till they cant breathe any more.

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