I choose pharmacy as a profession because I wanted to serve those who did not have access to healthcare, those for whom a pharmacist is the only means to medical care and advice. What I hadn't anticipated, when I took that oath, was that I'd be in the business of enabling drug abusers and junkies. In my naivety, I thought that pharmacy would involve counseling geriatrics on compliance with their blood pressure medication and the treatment of other chronic illnesses. But all too often, instead of focusing on a patient's drug regimen, I am being deterred by an oxycodone seeker, an addict calling pharmacy after pharmacy in search of a specific brand of oxycodone, "because it works better."
Generally speaking, it’s not the illicit drug users whoI have problems with, it’s the people who abuse prescription medications, those who employ doctors, nurses, and pharmacists as vehicles in their lousy schemes. The seeker will use any means available to entrench his or her subjects in their web of lies and to make their story believable.
I once had the unusual circumstance of having to tell an elderly man in his 70s--wearing a World War II veteran’s hat--that I'd discovered his treacherous little secret. He had gone into the emergency room with a chief complaint of, "having back pain from shoveling snow," and the doctor on duty gave him a prescription for 20 counts of vicodin, which he brought to me. "Could you fill this real quick,” he asked. “I can't wait very long, I am in too much pain; oh, and don't run that under my insurance, I will pay out of pocket." Red flags immediately began flying with those words: don't run it under my insurance. I wanted so desperately to be wrong about him, to just be a paranoid pharmacist who misjudged this elderly and pained man. But, on the advice of the technician I was working with that day, I ran a report on the prescription monitoring program and discovered that he was being seen by two different doctors each month who were both supplying him 80 counts of vicodin, with only one being billed to his insurance. Each prescription was being filled at a different pharmacy, and neither doctor was aware that the other was also supplying this man with narcotics as well. But this particular month, even 160 tablets would not suffice for our "retired navy sailor."
When I ultimately returned his prescription to him letting him know that I wouldn't be filling it, I made an attempt to give him my health professional opinion. "Sir,” I said, “if your pain is not being treated properly, and you're not getting enough relief from your medication, you need to be seen by a pain management clinic." I then went on to explain to him that I had to call the two physicians who were each in the dark about the other. As a pharmacist and a human being I still wanted to help him, thinking that he was in pain and just needed to know that there are other options. Enraged and frustrated, he snatched the prescription out of my hand and stomped out of the store. I was left demoralized and he, utterly humiliated. He exploited not only my emotions and trust, but a crew of other health professionals as well who'd been serving him for an entire year, all to attain his set objective. I remember thinking to myself he couldn't be an abuser, he's a retired military geriatric, who's clearly in pain. But we all know that a veteran's hat can be acquired just about anywhere.
The most deceitful act I've seen so far involved the use of a child. A woman who had stolen a physician's prescription pad attempted to fill a prescription for xanax. She was carrying a fussy infant, and looked frazzled and tired, like any new mom would. She played the part of an overwhelmed new mom who just needed an anxiolytic to help her calm down and relax. But, as it turns out, she and the group of people who she was involved with were going from pharmacy to pharmacy, all over town, using alias names and filling controlled substance medications which they would then turn around and sell. It’s possible that the fussy and upset baby merely a prop, and was not even hers.
It saddens me, but experiences like these have shaken my faith in those whom I serve, sometimes at the cost of the honest patients. I am no longer persuaded easily by their stories; I'm not as trusting as I once was. I've learned that addicts and drug abusers come in all shapes and sizes: young and old, they carry infants and wear the clothes of a veteran. They are convincing. They look just like you and me.
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