Category Archives: Drug Trivia and Rants

Norpocalypse

It had the makings of a perfect fairy tale story:

There stood princess Norcoella, her yellow gown flowing in the slight breeze of the crackhead party.  Surrounded by her fellow patrons; crackheads, pushers, dealers, she was on top of the world.  Everyone bowed down to her yellow goodness.  The lied, cheated, faked to get the privilege of holding her hand just for a moment.  The twins, Tylenol #3 and #4 sat there, thumbing the big 3 and 4 on their chests in disgust and depression.  They were once the kings of the party, now pushed aside to this yellow bitch that everyone wanted.

Then on 12:01am on 10/6/2014.  Her party came to a close.  DEA agents stormed the royal  yellow palace, seizing Norcoella and throwing her into the big-boy party.  Demerol, Percocet, Morphine, Fenantyl, Dilaudid, Oxycontin.  She stood there shocked as they all mocked her for the lack of her analgesic potential.  Then, the undisputed king of the C2 party, King Oxycodone the IR himself made her bow before him.  Her crackhead reign suddenly came to a close, and soon, she’ll be forgotten.

On 10/6/2014, the DEA made all hydrocodone-containing products C2.  No more refills, no more phone-ins, no more faxes.  Hard copy (or EPCS e-scripts) only please.  A day known as C-Day, Norpocalypse.  A day where millions of crackheads screamed out in withdraws, and were suddenly silenced.

I have mixed feelings about having Norco go C2.  As I lurk on the various pharmacist forums, other than the billion of “Will I have a job/Whats being a pharmacist like” newb questions that get posted every fucking day, I feel the pain of some of my fellow brethren.

Some stores require all C2’s to be locked in a safe (rather than be inter-dispersed in your inventory).  Others require an RPh to count all C2’s.  Tons of new paperwork, filing, computer changes are dictated by this DEA decision.  Ambiguous laws and interpretations of said laws about existing refills of Norco run rampant.  Nobody really knows what to do for fear of the DEA’s wrath.  Its a mess, a huge fucking mess.

On the other hand, some doctors offices are closing up.  Last week everyone who comes in gets #120 Norco-10, today the office refuses to dispense any Norco.  If you’re an MD and feel that Norco is necessary for your patient to live a normal life, what difference does it make if its a C3 or a C2? Oh, probably because you can’t justify the bucket-load of Norco you shovel at them to get them out of your office.

This will cure one problem though, no more arguing about refills for Norco.  Doctors will be forced to move to ePrescribing C2s via EPCS to prevent their offices from being swarmed by people scrambling to get a hard-copy.  Nothing good can come of this.

I do however see a huge problem with Norco going C2.  That means the street value of Norco will increase since it’ll be harder to scam your MD with some ‘lower back pain’ bullshit story to get a handful of them.  Doctors don’t want to be under the gun from the DEA for writing C2’s.  You can guess what happens then.

10/06/2014 – C3 Norco, we shall never forget.  Save an empty stock bottle folks to reflect on a time where Norco paved your angst like a yellow brick road.

Purpocylpse

I cant believe I’m writing this.  The news is so shocking that my brain cant wrap around exactly how this could be.  I mean, part of me wants to do cartwheels, and another part of me just wants to sit and sob.  Its like I came home to find my wife making out with another hot chick and asked me to join while throwing me a huge dildo.   Shit I’m getting blue balls just typing that.

Hold on to your hats because……………

ACTAVIS IS NO LONGER MAKING PROMETHAZINE WITH CODEINE!

IM NOT FUCKING KIDDING YOU! THE INFAMOUS PURPLE DRANK IS FUCKING DEAD!

Dont believe me? Check your ordering system.  Amerisource has no listing.  McKesson has MANUFACTURER DISCONTINUED.  One of my sources reported that someone called Actavis and they stated that they have just decided to stop making promethazine with codeine.tumblr_mklix14Yc81rrotfzo1_500

No longer will we be getting “do ya carry da actavis?” calls.  No more bitching from the crackheads that the QT or Hi-Tech brand “Dont work” or “I be allergic to dat shit”.  No longer can people say “I can only take Actavis” because you know what, they can take a bunch of fucking nothing now.

Prometh with Codeine will no longer taste like ghettofab syrupy purple, it will taste like how all cough syrups should taste, like goat anus.  They aren’t meant to fucking mix with Sprite and enjoyed after a long night of fucking your bitches and collecting taxpayer-funded benefits; they are meant to be choked down because you’ll do anything to get rid of that fucking cough.  Wait, did I imply that ‘da Actavis’ WASN’T used for legit medical reasons?  Well unless theres an ICD9 code for “My life sucks and want to get high”; then yes, I did imply that.  If you want to get fucked up on cough syrup, deal with the aftertaste of pennies and last nights digested dinner in your mouth you fucking crackheads.

This is fucking great.  Hats off to Actavis for actually realizing that their name was synonymous for “Abuse and Diversion” like Kleenex is to facial-tissues. If Watson stops making the DAN Somas, I think I just might die.

Now if we can only get QT to take the yellow out of the Norco 10.

SOMABOTS, TRANSFORM!

So enough with the serious posts about the idiots of the world.  This one is going to give you the knowledge to impress your friends, and frighten your enemies.  In fact, this information might get you laid!

Full disclosure: I did only enough research as look on Wikipedia.  Seriously, I was looking up what the half-life of Soma was (since my Lexi was on the shelf and I didn’t have the ambition to flip through it) and I found this information out.  Laziness provides you with yet more entertainment!

Oh, and before one of you crackheads nitpicks me for this, I use the brand names throughout this post.  Yes, I know that the only dispensed **Soma** out there is that stupid-as-shit 250 mg crap out there (which if you stock, you are a fucking tool).

We all know the drug Soma (or its generic name Carisoprodol).  We get calls about it, we get bothered about it, some of you may even be on it! (No, you can’t get an early refill).  But how much do you actually know about it?

Soma was intended as an antiseptic.  A superior antiseptic!  No bullshit!  I guess if you consider the people who are hooked on this stuff have killed all the neurons that product truthful statements, personal hygiene, common sense, month supply calculations and other socially acceptable behavior then maybe the drug did work at intended.

So it came out instead as a muscle relaxant.  For all of those chemistry nerds, I present to you two images for your consideration.

800px-Meprobamate.svg

 

 

 

 

One of these is Soma.  The drug we all know and love.  The other is a drug called Meprobamate also known as Miltown/Equanil for those of you who are close to retiring.  See a similarity?  Are you old guys out there chuckling?  (hint: Soma is on the left).

The funny thing about Miltown (other than having a stupid name) is that its a tranquilizer, and is no longer used in the United States because the benefits do not outweigh the risk.  It is considered addictive at doses not higher than therapeutic.  Gee, does this sound familiar?

Soma was a chemical modification of Meprobamate to make it better, less potential for abuse, and thereby less risk of overdose…… Where have we heard this before?  Oh wait…  Heroin!

Soma just -recently- became a controlled substance (January 2012).  Miltown has been a controlled substance since 1967.  Most countries other than the good old ‘Merica has banned or severely restricted the use of Soma due to its potentiating effects with the narcotics, alcohol, and other fun shit leading to shitty dancing, unwanted babies, pharmacist alcohol abuse, and sometimes (but not NEARLY ENOUGH) death.

Are you slapping your head yet and wonder what the fuck is wrong with this picture?  Let me spell it out for you.

Soma converts (probably a good chunk) into Miltown in the body.  Miltown has been a controlled substance since the 60’s due to abuse, and Soma JUST FUCKING RECENTLY (sorta) became a controlled substance.  Now I’m only a stupid pharmacist, but didn’t someone at the FDA and DEA a long fucking time ago look at these two chemical structures and say; “Gee, MAYBE we should make this a controlled substance right off the bat since that fucking isopropyl group on the end will just get whacked right off in the body and make Miltown.. A CONTROLLED SUBSTANCE!”  Am I the first person on the planet to fucking realize this?

 

Swimming in the Porcelain Pool

I get a lot of drug ad crap in the mail, but once in a while one really attracts my attention in a real ‘WTF were they thinking’ way.

Take Exhibit A:

Why is my mouth open when I have to poop in a pool?!?

Now Miralax is like Metamucil, it makes you poop.  Now I’m not sure what floats your boat, but if I were constipated and needed something to soften my food-baby, the LAST place I would want to be in swimming in a pool with my mouth open when the brown tide decides to come in.  Is the woman supposed to represent a poop floating in the water?  How does swimming in a pool go with constipation?  Maybe if her skin were dissolving in the water it would be more along the lines of the ‘osmotic effect’.  Maybe the force of the poop is propelling her through the water?  Should the water be going IN her butt?  I took it upon myself with my awesome drawing skills to make this ad more realistic:

Remember kids, when you’re straining like a puppy pooping peach stones, grab your Miralax and head over to the local pool, because nothing gets your bowels moving like an osmotic effect on both sides of the ole turd-cutter.

XL, ER, and SR (Oh My!)

How many of those at home have gotten an Rx that looks something like this:

Wellbutrin 150 QD

or

Depakote 250 QD

or

Effexor 75 BID

Now how many of those at home after getting these prescriptions felt the urge to slam their face into the counter.  For those not in pharmacy (or for those douche-canoe asshat prescribers out there who are stuck in 1990) all of these drugs come in different formulations BUT in the same mg strength.  The regular-release is the SAME strength as the extended-release.  Its not like Coreg or Paxil which the extended-release dosage form has a different strength than the non-XR form. Hell, in that case its easy.  Dr writes for Coreg 20, and we know that he wants the once-daily CR caps (unless he wants the patient to start shaving the IR tablets, which would be rather funny).

Does the MD want Wellbutrin 150 SR given once daily? Or did he/she mean to write the once-daily XL?  Depakote comes in a 250 DR and a once-daily 250 ER, but depending on the patient they may want the DR given once daily.  I’ve seen Effexor plain given BID as well as the XR given BID.  Should I just guess?

Its shitty at best and outright dangerous at worse, and there is absolutely nothing that we can do to prevent this.  The only thing that we can do is to call the Dr, be left on hold while the patient gives us the “Why cant you fill it? It says the drug on the prescription!!” face, and be at the mercy of the *sigh* wonderful doctors staff to give us a call back saying “Doctor wants the extended release Wellbutrin” *headdesk* “IT COMES IN 2 WAYS!”.  What makes matters worse, is that ALL of these drugs are relatively new (compared to like Theophylline, Cardizem, or Verapamil) thereby removing all shred of hope that we could “guess” what the doctor wanted (since some doctors are stuck in 1990).  It requires a phone call/fax, which is just balls for everyone involved because 2 little letters could have solved this.  This isn’t something that the insurance doesn’t cover, this is just sloppy Rx writing!

Is there a good solution to this problem?  The one time we guess as to the release-mechanism it’ll be wrong, so there is no point doing that.  Of all of the examples regarding sloppy Rx writing, this has to be the most annoying for pharmacists.  I can deal with not having a quantity.  In some cases I can deal with not having a sig if I can tell from the quantity (I mean how many ways can a dentist give 28 amoxicillin caps?).  I can deal if you didn’t sign the damn prescription.  No IR/ER/XL/WTF designation? Boned-every-time.  Saving 2 seconds on your end just cost me (and the patient) 15 to 45 mins.

Just go give us one more kick in the balls, the patient wont understand what the problem is.  They see a drug, a strength, and some T’s with dots over them with some letters.  They don’t care about the IR/ER/XL/OMFG  dosage form, they want the drug on the prescription and they wanted it filled before they handed you the Rx.  Short of yelling at the doctor for omitting probably the second-most important piece of information on the Rx (yeah, that’ll teach him! *sigh*), all we can do is just bend over and accept the 30 min phone-call and hateful glares from ungrateful patients.

Par, generic Toprol XL, and getting even.

Unless you live in a box, you all are well aware that we are in a nationwide Metoprolol Succinate (Toprol XL) shortage.  This is caused by Ethex getting spanked by the FDA and not allowing to sell drugs in the US.

Now what makes me angry about this, is that the only other manufacturer of generic Toprol XL is Par.  Par, upon Ethex biting the big one, decided to jack up the price about 75-100% THEN back-order us to kingdom come.  You know, Fuck you Par.  It would be one thing if you would of kept the price the same and been back-ordered, that’s understandable.  However you totally screwed us over both price-wise (since most insurance companies were reimbursing based on the OLD MAC price) AND you cannot supply!  I’m not sure if this shortage is intentional so they can squeeze some extra bucks out of us (if so, go fuck yourself), or why they would need to raise the price as high as they did (other than “because they can”).

So here is a big TAP fuck-you to you Par.  Since you can’t supply to us, I’m getting everyone switched over to another product, and when your shitty product does come back in stock, I’m not going to switch them back.

DTC Advertising

DTC Advertising – Direct to Consumer Advertising.  Everyone has seen the “Ask your doctor about whocares, a new drug to help you sleep/screw/be-happy” commercials on the TV.  These are the steaming turd in the diaper of medicine.

Lets take a stereotypical patient.  While he/she is sitting around leeching on the taxpayer dollar watching Judge Judy and Maury (“You are NOT THE FATHER”), he sees a commercial for a new drug.  The commercial is happy, wonderful, and promises a new life (in very vague terms) if you take this drug.  “ASK YOUR DOCTOR ABOUT THIS”.  So the idiot does.

Idiot goes to his doctors office, and after signing his name with drug-branded pens on a drug branded clipboard and gets seated in a drug-branded chair while looking at drug-branded posters on the walls, he sees the doctor (who has a drug-branded clipboard and a drug-branded stethoscope).  He asks the doctor for the drug which he saw on the TV.

Now here is where I have the issue.  You see, in a perfect world the patient wouldn’t have advertisements bombarding him that he SHOULD be on this, because in a perfect world someone with medical knowledge would make the judgment call on what medications the patient should be on due to the symptoms presented.  The patient should have zero say in what he/she should be on, because he/she really doesn’t know enough to get the “whole picture”.  The patient shouldn’t say “I WANT TO BE ON THIS BECAUSE THE TV SAYS SO” but “I am experiencing symptom X, what do you think”.

Its now NOT the doctor making the decisions on what drugs a patient should be on, but the patient and the TV.  If the doctor says no, the patient will find another doctor who will say yes.  Now I’m not one to turn down business, but there is a huge problem with most modern trade-name drugs:

  1. Insurance companies (if they pay for it) reimburse $2.50 on that $200 Rx.  Its not even worth my time to even carry it.
  2. Most of the new trade-name only drugs are just “Me-Too” knock-offs because patents are expiring left and right.  I really don’t give a rats ass that a once-daily drug is coming out with a new XR formulation that is…. ONCE DAILY.  Seriously, who cares?
  3. All of the new and novel trade-name drugs aren’t the ones that are advertised on TV, only the shit patent-expiring crap.
  4. What the fuck is wrong with the generics that save the patient AND an overstressed health care system money?  Oh, not advertised on TV.

If the generic drug companies didn’t have their heads up their asses, they would advertise on TV.  “Watson Pharma! Bringing you quality generic Vicodin and Soma!”.  However I really wish they would just shitcan all of the DTC marketing crap and leave the selection of drugs to the people with the education to do so.