Dont you love it when a patient of yours just bold-face lies to you? Hell, some of them are so good at it that even my bullshit detector doesnt go off (the first time).. Sometimes I think they actually believe the crap that is coming out of their mouth.
If you say that you ‘lost’ your Soma in the rain, at least throw your empty bottle in the sink or something. Paper labels say a lot when they are perfectly dry and the tape isn’t coming off.
After your rain excuse; when I wipe a layer of perfectly dry soma-dust from the inside of your bottle, hold it up so your stupid ass can look at it, and say “Rain eh?” the correct response is NOT “well i’ll pay cash for it!”. Brrrp! Sorry! Wrong! I’m not going to be bribed so you can get your dope early.
State Program + Gold Chains/Fubu Everything/Escalade + Early Refill because it got lost/stolen/eaten/vaporized = Bullshit story. I was born at night, it wasn’t last night. Money doesn’t just spontaneously appear, it needs to be generated, and since you are not working, and I know the state doesn’t pay that well, we can all make a good assumption where you are getting the cash for your bling.
For gods sake, if you plan to go to 10 different doctors and 10 different pharmacies, do NOT use your fucking insurance for your dope! See, although our computers aren’t linked together, we all bill to the same insurance company system. Like Santa, they know where you’ve been and if you’ve been bad.
When I offer to call the police because “someone” picked up your narcotics that you didn’t know, the correct answer is “sure” not “OH NU-UH! DONT CALL THE PO-LICE! WE DONT NEED THE PO-LICE INVOLVED!”. Amazing how the P word seems to jog people’s memories.
Please use a pen that at least is an attempt to match the color of the doctors. Light blue ballpoint 1 in front of an dark felt-ink 30 isnt really trying.
If you’re going to offer sexual favors for an early refill, please at least be somewhat good looking (and have all your teeth). It makes me feel better to not laugh/make that ‘oh fuck no!’ look in your face when I tell you no.
Last but not least; please don’t start every single conversation with me with “Ok, heres what happened”, or “You’re not going to believe this”.
But to all of those out there who need a reminder of how to make a story believable, heres some pointers:
Now I know i’m going to get lots of hate mail on this one (like my rant about poor people and pain) saying “wah wah wah, I have chronic pain, you dont understand, wah wah wah”. Yes, it sucks that you have chronic pain, and yes, you shouldnt be treated like an addict, but laws are made because of the BAD people, not the GOOD people like yourself. So yes, the shit I deal with on a daily basis makes it harder for legitamite people to get medication. Thats life. So until we can wipe all the crackhead addicts off the planet that ruin it for the legit people, you’ll have to just float to the surface of the retard wave and show your local pharmacist that you are indeed not one of those crackheads.
For those who need to take this further:
We have a lot of stake here, our licenses, our jobs, our homes, etc. Shit that we spent up to 7 years of college for the slip of paper that lets us legally do our job. Does the DEA care that we are just trying to ‘Help People” who come in and feed us line after line of bullshit? Hell no! Does the State Pharmacy Board? Hell no! They see a vial from YOUR store with YOUR initials for 200 lortabs off of some street seller which (upon getting refill records via subpoena) they see that you’ve been filling a month supply every 10 days for the last 6 months because they were (according to them) “in chronic pain”. Will that patient bail your ass out of jail? No! Will they pay your house payment? No! Will they put your kids through college? No! Will the Doctor say “Yup! I supplied that addict!” FUCK NO!!!@#!@ Pharmacists get good gut feelings about people. If you’re on-time, a regular patient, and get other shit filled there than your Norco/Valium/Soma (better if your whole family comes there and yanno, talks to us) then we’ll believe you when you say you lost them.
To just assume that everyone who starts every conversation with “OK, heres what happened” is in chronic pain and not trying to get dope to sell is a bit naive and quite silly. Why put locks on our front doors? Everyone is a ‘good person’ that wont try to rip you off. Why do I even need to be at the pharmacy? I’ll just open everything up, put a little collection box in front for people to slip their copays in, make a kiosk that prints the labels, and people can scoop their pills out of big bins into vials like you see in the supermarket.
Soma in 55 gallon drums with a big clear plastic scooper. My god.
Apparently you have came across neuropathy .. did you ever think that many/most of these people on all these meds & caid was because their pain has developed to such an intensity that they can no longer work and end up on Medicare disability and Medicaid.
Those people are standing at your front door mostly likely because their doc is under-dosing them and they are either out and/or going into or suffering from withdrawal & pain .. not from ADDICTION but DEPENDENCY..
The quack doc my mother-in-laws goes to just told her not to call her pain meds refills in UNTIL she takes the LAST PILL.. as we all know .. docs don’t take refills on nights & weekends
It would be nice .. if everyone was on the same page
I used to work in pain management dealing with patients who are on a whole boatload of opioids just so their QoL would be somewhat normal (3 x 100 mcg fentanyl patches, or 2-3 grams of Morphine SR/day). I dealt with diabetics with neuropathy to terminal cancer (hospice). I can tell when someones in pain and when someone is blowing smoke up my ass.
When someone laughs, bullshits, and walks normally from their car to the parking lot (from which I have a complete and plain view of) to be instantly be struck by the pain machine and limp, moan, cry once they hit the pharmacy doors, i doubt they are truly in pain. Anything that comes out of their mouth is bullshit. To make things worse, they limp out of your store to walk normally and bullshit with people in the parking lot just fine. Wonderful.
When you see people on vicodin, valium, and soma (three times a day on each) filled once a month for the last year (from your store). Then see they are getting it from 3 other stores (via 3 other doctors) per month when you request the Bureau of Narcotic Enforcement CURES data you begin to wonder how much pain they are in.
Plus, what doctor writes for Vicodin or any short acting opioid for truly chronic pain (including neuropathy), thats stupid and silly. Adding Soma and Valium? Why not Baclofen or Flexeril? Oh, because the patient is requesting Soma because it works ‘better’ even though they have never tried any other one. Somethings not adding up here.
The real chronic pain patients (for those at home) are the ones who are on MS Contin, Oxycontin, Methadone, or Fentanyl Patches. Plus add on some sort of NSAID, Neurontin, and a short acting opioid (usually Norco) for breakthrough pain. If they are tuned perfectly, the breakthrough med would be hardly used at all. They are compliant, will call you (and the doctor) to let you know mid-month that stuff needs to be adjusted, and will not sit and yell at you on Friday night after everyone has gone home that they are out of their pain meds (when they should of known a few days ago they were getting low). They are responsible patients who treat their pain as seriously as anyone with hypertension or diabetes. The doctors who prescribe them are responsible, willing to take input (you talk to the patients a lot more than they do), and just generally a pleasure to work with.
But like all laws we have, the bad apples just ruin it for the good apples. People want to error on whats not going to jeopardize their license, not whats best for the patient.. So yes, everyone is on the same page. If you want to keep your license, and /not/ become a ‘Soft Touch’ pharmacy thats a big red dot on the DEA’s (and every addict in town’s) list, you have to be aware and not just fill everything assuming everyone is honest and legit. I mean seriously, how many excuses can you take on why the patient needs their narcs early before you stop and think that maybe they are lying to you.
I feel that I was ill-equipped for ‘real life’ in pharmacy school. Sure, I know pharmacology, mechanism of action, anatomy, etc. Thats all fine and dandy.
The doctor is an idiot, how do you politely say so without making him mad.
The doctors staff cant speak english, let alone say drug names. How to bitchslap the hoe over the phone.
You cant understand what the nursing staff is saying! How do you deal with this?
The patient is demanding his pain pills and soma early, do you fill or not?
Phonies, how to spot, deal with, and skills to collect the inflated cash price /before/ you tell him its a phony and the police are on their way (my personal favorite).
Stereotypes, so funny because the’re true!
Insurance companies, and how to enjoy getting bent over (or getting even) for that cost + 1.25 reimbursement
How to handle drug reps
Ghetto math, “is an Rx for 90 Soma tablets taken 3 times a day really a 30 day supply”?
Copies, Transfers, and getting even with Walgreens for leaving you on hold for 20 min.
The list of 1000 patient types that you all contributed.
Mind reading and crystal ball use
And Much Much More!!!
What I didnt learn was how to deal with dumbfucks, addicts, and retards that I see day in and day out. What pharmacy schools need is a class dedicated to “real life” pharmacy. Who else would be the best people to teach the class but non other than myself and the DrugNazi!
We could cover interesting topics such as:
Sign up now! Space is limited, and im sure we can con some CE out of the deal as well!
I wanted to slam my face in a drawer today.
I hate the holidays. Not only is it prime season for armed robberies, but people always seem to be going places. Whats with the welfare folk taking 2 month vacations? Oh! Its because they dont work! Thats why! What pisses me off is when you fill a bunch of Rx’s for a person, who then comes in 2 days later asking for a 2 month supply because they are going to mexico for 2 weeks. Uh, why couldnt you fucking tell me that 2 days ago when I filled everything!!! Of course the insurance company only pays for 1 month at a time, so it’ll take some paperwork and phone calls. What? You’re leaving right now? I swear, its like they intentionally do this shit to piss me off. Why cant they send someone in to pick up their medications when they are due, and mail them to Mexico? They dont seem to have a problem finding someone to pick up and cash their welfare check and send them the money.
Lets see what made me mad today:
Thats what pisses me off. The state pays these people so they can live. Then they take 2 months to head down to Mexico. Im sorry, but we’re paying you to live in THE UNITED STATES, NOT IN MEXICO! It amuses me when people ask for 3 month supply of birth control when they go to mexico for 3 months. Uh, i’m sorry, but arent you on the UNITED STATES system? What’s mexico done for you lately? Do they give you free money, a place to live, and ‘send me your poor and hungry blah blah blah’ bullshit? No. But of course I give it to them, because I dont want them producing any more crotchfruit. The DrugNazi would be proud.
Yes, i’m an asshole. Actually i’m jealous that I cant take 2 months off and get paid for it. But alas, I couldnt get on the welfare system if I tried. Spending a few weeks in mexico is doable, but 2 months? Give me a break. When I was in school they always had to cater to the kids who took 2 months off to go to Mexico. I realize that its not the kids fault their parents are douches, but lets use some common sense here. If I didnt go to school for 2 months then i’d be held back, expelled, arrested, etc.
Anyhoo, moving on:
On Friday, we filled a prescription for someone in one of those ‘assisted care’ homes. It was a phone in by the doctor himself. We deliver the Rx just like we’ve done a bazillion times. Sound good right? Well the home calls back asking for a copy of the Rx, so we fax over the paper with my scribble on it. They say that my scribble is not a legal Rx and wants someone with the doctors handwriting on it.
Now this is Friday after 5, so everyone is gone. So the patient is without his medications until today. We lay into this home with both barrels blazing. They say “its our policy to get written Rx’s for everything” to every comment we make about being unethical, having no regard for the patients health, etc. Finally we ask them “If we filled and sent out an Rx for some NitroQuick, and our patient was having a heart attack, would you withold medication?” by god they said “Yes”. For once I had nothing to say. I was astonished and bewildered. The doctors office is pissed that the patient couldnt start his medication Friday, we’re pissed because this is totally unethical and retarded, and the patient and his family are pissed because they couldnt get their medication due to “policy”. Looks like its going to be a fun day tomorrow when the shit hits the fan.
Other than that, it was your usually crummy day.
Got this comment in my inbox today. I swear, DrugNazi was right, these blogs just write themselves:
I have been on pain killers for years i called in my monthly re fills norco soma ativan and blood press rx well i called it in 5 days before i was due to let the pharmacy have time to fax the dr etc well a few days went by i called the automated system and they filled the soma only so i went the next day to pick it up and asked if the dr called in my other pills all i was told was its too soon to fill ok i understand but did the dr call back alls i got was its too soon so the weekend was coming up i wanted to make sure i was going to get my pills for the weekend because i would be out on saturday morning so i called my dr and asked her to call the pharmacy to re fill she said ok then the dr called me back in 5 minutes and said i have refills you just have to wait until saturday to get them it would be nice if the pharmacy could of just told me this but alls they said was its too soon well i picked them up saturday and every rx says 2 refills left i think they screwed up in there computer and added refills to my rx and they never even called my dr so i had 3 refills all along no wonder why they kept telling me its too soon but maybe the dr authourized 3 refills but if so its the first time in 3 years this happened next month i will transfer all my rx back to my pharmacy i use at least they always tell me yes your dr authourized refills but i cannot fill it until such date instead i was treated like a drug seeker at the pharmacy why cant they just explain things i hope they did screw up and gave me 3 re fills by mistake that way i dont have to be aggraviated next month i can just call it in the day before its due and i will know they will be ready at least for the next couple of months
Theres one thing that i’ve noticed about most of the patients that I deal with on a daily basis.
The amount of pain you are in is inversely proportional to your income.
Now you may be asking “Hey! Thats a pretty fuck up thing to say!”, but can you prove me wrong? Sure you can bring up examples of rock-stars and heroin use; and Rush Limbaugh and oxycontin, but this pales to the amount of vicodin, soma and valium that I dish out to people who are on the state program.
So what makes these people have so much pain? I half way feel sorry for them. I mean what could they possibly do to be in such excruciating pain that it requires 120 vicodin every 15 days?
Its not just pain, its muscle spasms as well! I go through gallons of soma a month. In fact, their muscle spasms are so specific, that only generic Soma made by Watson will work (You know, the ones with DAN inprinted on the tablet). In fact, it seems that any hydrocodone made by Watson Labs does a superior job at controlling the pain than any other manufacturer! Of course we cant leave out Tylenol #3’s (that must have the 3’s on the tablet), or Generic Valium (that have the 10 on the tablet). Tablet markings equal more potency, everyone knows that. Surprisingly, I had a patient ask me if these were the vicodin that had “Watson 349” on them (I think). I look, and sure as shit they knew the NDC number of Vicodin and Vicodin ES.
Now I have two blown out knees due to high-impact sports in my younger days. I need a motrin at most when the weather gets bad and my knees ache (this is beside the point that I spend 9 hours on my feet, 5 days a week). When I walk they creak more than an old ship. Do I need vicodin? No. Do I need soma? No. Valium? No. Have I ever taken Vicodin? Once when I had my wisdom teeth pulled, and I took 1 to get me through the night.
Why on earth would someone take 3 vicodin, 3 soma, and 3 valium a day? We all know the type: come in with that nice glazed over look in their eyes, dont respond properly to conversation or questions. Its like talking with a brainstem.. The highlight of their whole month is when they can come and pick up their dope–er–medication a month.
So what do we do? We have to sit there and grin and bear it fully aware that they are selling the shit, but we have zero proof to actually do anything about it. Humanity makes me sad.