Pharmacists, Narcs, and why you think we’re assholes

Some people think that pharmacists are assholes. Funny how these are the same people who want their 30 day supply of Vicodin filled after 10 days. I’ll just give you all at home an insight as to why we are the way we are. If you’re a pharmacist at home (or play one on TV) comment and help me out. 🙂
— What makes us angry —

  • We’re lied to almost all day. My medication got lost/stolen/flushed/eaten/left on vacation/etc. The list goes on and on and on. So when you come and want an early refill for your pain medication and give us that excuse; unless you can prove otherwise (first time its happened, you get 30 other maintenance meds at our place, we /know/ you), we’re going to think you are full of shit. Thats just the way it goes. You think we get smoke blown up our asses every day of work and aren’t jaded because of it?
  • We are people to. We like to be talked to, to asked how we are doing. All day I get screamed at because the doctor didn’t okay pain pills or soma. You reap what you sow, and if you throw shit in my face then i’m going to throw it right back.
  • If you /only/ pick up vicodin/soma/valium at my store (like 5 years going back of nothing but vicodin/soma/etc. You all at home know those kind of profiles), we’re going to give you looks when you come in. We’re also going to have assumptions when this is the 4th month in a row you need them early because of some bizarre excuse. We understand shit happens, but if you’re telling us the truth, then I dont want you in the store because a meteor is going to land on you. Oh, did I mention that we also know you pick up your hypertension meds at another pharmacy?
  • If you are going to sell your fucking vicodin, dont leave it in the fucking bottle you picked it up in for the police to see. We dont like seeing policemen walk in holding our vial saying “Did this person pick this up here? Heres a subpoena, have a nice day.”
  • If you have the balls to pick up your soma, turn around and hand 2 pills to each of your friends IN THE STORE, we’re going to boot you. Plain and simple. Diversion is always assumed but extremely hard to prove except if you are a fucking idiot.
  • When I have to tell you 10 fucking times that your pain pills are EARLY because you are too stupid to divide 90 by 3 to find out WHEN they are due. Then argue with me about it!
    Notice a trend here? All deal with narcotics. Think about that. Now:
    — What makes us Happy —

  • When you bring in that Rx for Vicodin, and you tell US right off the bat “please put this on file, i’ll pick it up when its due on the xth”.
  • When you are a true chronic pain patient who comes in on the day that he/she is due (or maybe a few days late) with a new Rx, waits patiently, and never ever asks for anything early. If there is a snag with your insurance/work comp; you are very polite and helpful to get it resolved.
  • When you treat us like human beings who care for you and not a licensed dope dealer who you can swear at when things go your way.
  • When you get your pain pills changed, and you bring back THE OLD ONES for destruction and to pick up the new strength.
    So really, it boils down to honesty and taking medication how its prescribed.

  • Addiction vs Dependence

    I know with the latest Oxycontin crap hitting the fan, people are throwing around the word “addiction” like its going out of style. Let me clarify a few points here.
    Addiction is NOT the same as Dependence. People associate withdrawal symptoms with addiction. Fact of the matter is, it appears with both. Example:

  • Patient is on a beta-blocker for years and years. You take away the beta-blocker and guess what, they patient goes through withdrawals (higher heart rate, higher blood pressure, etc).
  • Patient is on Fentanyl patches for chronic pain. You take away the patch, and bingo, withdrawals.
  • Patient is on avandia and you take it away because you’re dumb and think its going to suddenly kill the patient. Guess what, withdrawals (higher blood sugar).
    Withdrawals is the body’s natural response to a sudden change in receptor block/activation. If I dump 500mg of atenolol into someone, they are going to have (among other things) a very abrupt reaction. Because I am not withholding medication, its not really withdrawals, but it illustrates the same principle.
    Now lets look at Addiction. The basic difference between the two is mostly psychological. Why are they taking it? Are they taking it for a euphoric effect or are they taking it so they can live a decent quality of life with a broken back/cancer pain/whatever.

  • A person who is addicted will snort oxycontin illegally, and do illegal things to obtain more oxycontin so they can get the same high. If you buy your oxycontin on the street to snort/crush/inject (ie: take it how it was NOT supposed to be taken) you are an addict.
  • A person who is dependant on oxycontin takes it as prescribed and lives a normal quality of life. They will bitch and moan if the drug is discontinued, but will generally work with you to move to a different agent.
    Now the line gets blurred by patients who are on narcs for legit reasons, but their pain is uncontrolled, so they take it upon themselves to go and doctor/pharmacy shop to obtain more to control their pain. Even if it resorts to doing illegal things.
    Nothing fries my wires more than having some doctor refuse to prescribe oxycontin or fentanyl to a chronic pain patient because they are afraid they will be “addicted”. Sure, and giving them 200 Vicodin ES/month (wtf?) and blowing out their liver is the correct way to go. Theres a reason why these things are C2 narcotics. They have very abrupt and euphoric effects and guess what… THEY ARE REALLY REALLY GOOD FOR CHRONIC PAIN! Of course trying to explain this to a doctor is about as useful as a debating with a turd. They just get all pissy and hang up (so much for “patient care”). Then you have the patient ask the question “Will I become addicted to these?” The answer is “If you are dosed correctly, you will become dependent on them to live a normal quality of life. Its like insulin or any other medication.”
    Sometimes it just amazes me as to how much fear doctors put in patients that is 100% unwarranted and unneeded. Maybe it’s just a CYA move, but it ends up doing tons more harm than good. So there you have it. Be it right or wrong (in your opinion) thats my take on Addiction vs Dependence.

  • Lies part Duex

    Why do patients think they can boldface lie to us and we won’t find out? It boggles my mind. Case in point:
    Woman brings in an Rx for Tylenol #4 #200. I run this Rx through her insurance and it comes back rejected (surprise surprise) saying she recieved 125 from another pharmacy 4 days ago.
    I ask her if she picked them up at another pharmacy. She said “No, you are the only store I come to.” Riiiiiiiiiiiiiiiiiight. So I call up her insurance company, wait on hold, then find out she got them filled at another pharmacy across town. Happens to be another independent. I call said pharmacy and talk to the pharmacist (whom I know) and he said “Yeah, she came in 4 days or so ago and picked them up, I remember exactly who she is”.
    I hang up the phone, and ask the woman (who now is complaining that its taking too long and she wants to just pay cash and leave) if she is sure she didn’t get them filled at pharmacy X across town. I waited for the “no” before I layeth down the verbal smack. At this point shes screaming at the top of her lungs to either fill the Rx or give it back to her (gee, wonder why).
    Needless to say, she didn’t take too kindly to me telling her that the other pharmacy remembers her coming in to pick up the Rx, and if she wants to lie, she can lie to Walgreens.

    Oxycontin, addiction, and general stupidity

    So, it looks like Purdue got dinged like 600 kerzillion dollars because “misleading the public about the painkiller‘s risk of addiction”. There are websites cropping up about class action lawsuits against the company, blah blah blah.
    AMERICA! THIS IS WHY THE COST OF YOUR MEDICATION IS SO FUCKING HIGH!!! You think a bullshit lawsuit like this would fly in Canada or Mexico? NO! Lets sue God because water could be misused and we could drown in it.
    The article is here:
    Now I’m not siding with Purdue one bit, but I think the doctors themselves are partially to blame. Purdue got dinged because they were “claiming to doctors that OxyContin was less addictive and less subject to abuse than other pain medications.”
    One question. If that was the case, why is it a C2 and not a C3 or C4? Doctors, get your head out of your collective asses and start using COMMON SENSE rather than listening to dumbass drug reps. Oxycodone has been out for a bazillion years. Why all of a sudden would it become less addicting/habit forming/etc just because its in an extended release tablet? How can you expect a morphine analog that has a lower first pass clearance than morphine to be LESS addicting/habit-forming/etc? Here, I have this nice drug called Heroin thats a less addictive alternative to morphine (its a joke, if you knew the history of heroin you’d understand) AND I have this wonderful bridge for sale! Gimme a break. When Oxycontin came out I could see a mile away that people were going to be hooked on this stuff. I saw it with MSContin too. Thats why its a C2 people! High potential for abuse! Same class as cocaine!
    If I were a doctor, this is how the conversation would go:
    HotRep: Doctor, this Oxycontin is a less addictive pain medication.
    Me: O RLY? Why is it a C2 then?
    HotRep: Well, because it has a high abuse potential, but its less than morphine.
    Me: Oh, if its more bioavailable than morphine, then how does it make it less abusive?
    HotRep: Dont make me explain this to you *bending over to show her clevage* Have some free pens and pads.
    Me: YES! I SHALL WRITE FOR IT FOR ALL MY PATIENTS!
    HotRep: I knew you’d see the light.
    Heres what gets me:

    Attorneys for the three executives said giving them criminal convictions was punishment enough, and noted they were charged because of their job titles, not because they themselves promoted OxyContin as a drug with little addiction potential.
    The speakers, many of whose children died after trying the drug only once, disagreed.
    Nuss held up a stone urn slightly larger than a pill bottle that she said contained her 18-year-old son‘s ashes.
    “By pleading guilty they acknowledged that doing nothing was not good enough,” Assistant U.S. Attorney Randy Ramseyer said. “We cannot bring those people back. It‘s not something this case can do.”

    Oh, I’m sorry. Your child died after he ABUSED A C2 NARCOTIC. Gee, go figure. Maybe you should stop blaming other people for your child’s death, and start blaming your CHILD and YOURSELF because you raised an IDIOT who couldn’t say no? Lets sue Clorox because little Jimmy drank a bottle of bleach and died. Am I the only one here sane enough to realize that people have a huge problem with taking personal responsibility for their actions here? How could Purdue even remotely be responsible for a child’s death after he/she got Oxycontin ILLEGALLY and abused it? Should the drug magically know that its being used in a child and not work? What in holy fucking hell are people thinking here? Has the world gone mad? Do people think that these drugs are safe?
    Wait, this gets better:

    Survivors of the victims want the Food and Drug Administration to reclassify OxyContin for use only for severe pain. The drug currently can be prescribed for moderate pain.

    Arrrrg!! Im dying here! Moderate vs severe pain? How can you tell? If I get my skin ripped off, am I classified as moderate or severe? Now comparing this with getting my nuts slammed in a drawer I would have to say I am in moderately severe pain. Lets put a label on something that is very person specific.
    So next time you’re bitching as to why your medication costs $300 bucks a month, think of this and all the lawsuits that are going to be flying around. Oh, and when your loved one is dying of cancer pain and your doctor only prescribes him Tylenol #3 or Norco for fear of being sued, this is why.

    The woman who cleared our store.

    This is so bad that I just have to make it its own entry.
    A few weeks ago (yeah, its been that long) this woman came into our store. Now I’m in the back doing what I do best (filling vicodin and soma), when I noticed the girls in front start go get funny looks on their faces.
    Then it hits me. There is this stank erupting from this woman. It smelt like expired chinese food, mixed with crab that had been sitting in the sun for about a week all mixed in with unwashed gamey crotch.
    Now I have a strong stomach. Really strong. This stank made me run to the back and dry heave into my boss’ garbage can. As I looked through the one way glass, I could see the entire store just clear out. The girls were spraying Lysol into the air and turning on the fans. The woman didn’t even notice. She just kept on shopping away like nothing ever happened. Eventually the girls figure the Lysol is losing the war, so they retreat to the back. My eyes are watering from the heaving. The store is completely empty at this point. I can handle guns shoved in my face for money, but I was ill equipped for this womans chemical warfare.
    Then I see the unexpected. Our pre-Intern (he starts pharmacy school next month) bravely walks up to the front, and fucking helps her. I sat there in admiration and awe. Like a solider that jumps on the hand grenade to save his friends, he took one for the team and helped this woman buy her $2 worth of earrings and sent her on her merry way.
    Ever use Ozium? That really really strong air sanitizer? Well we used a bottle of it to make the store habitable again. Not the small bottle, the BIG bottle. Thank you pre-intern, to allow the Angry Pharmacist to blog another day. I will never forget you.

    Oh Boy!

    Ah, you all know that I love a good hate-mail. 🙂

    you’re all a bunch of ingrates. like WE’RE supposed to read your minds? ya’ll make a TON of money and have the nerve to have a power trip about it at the same time.

    We don’t expect you to read our minds. We assume that you have enough common sense to realize the information that we need right off the bat so we dont spend an hour wasting our time to fill your Rx. I mean who goes anywhere without their insurance card? Do you drive without you drivers license? I realize that people forget stuff at home, but then demand that /I/ call /your/ insurance to get your ID number that /you/ left at home 5 mins away. No, thats not a power trip, thats respect for someone who is providing you a service. Next time you’re at the store and forget your credit card to pay for your food, whine at them because they wont call your credit card company to get your CC#.
    I don’t see what making a ‘TON of money’ has anything to do with this. Yes, we get paid normally high wages compared to ditch diggers and waitresses, but they aren’t really responsible for your life are they? They didn’t to go college for over 5 years nor are saving your life when two doctors refuse to talk and prescribe the same thing.
    I get high wages for my schooling and my knowledge of pharmacy. I don’t get paid high wages to be your bitch and errand boy because you’re too lazy to either call in Rx numbers or run home for your insurance card.

    I’m sure this will either not get posted or it will and the indigent flames will then come…

    I would of just glossed over this and blindly approved the comment. However I figured you shouldn’t get off that easy.