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.