The Pharmacy Chick

Flying the coup in retail

An early goodbye to 2016 please

Filed under: Uncategorized — pharmacychick at 7:30 pm on Monday, November 14, 2016

I suppose some years rack up as better than some, but this year wasn’t the best for the Pharmacy Chick.  As a whole I’m ready for 2016 to enter the record books and go away.  I get asked via email if I have given up writing and the answer is no, but I can’t think of great things to write. But I thought id share just a bit of my personal side as to why I am stressed and distressed.

In January Mr Chick had a stomach ache, which I wrote about turned into emergency appendix removal.  Having met his deductible in 2015 it was very untimely to start meeting 2016 deductible so early!  He still was struggling with his back nearly a year after surgery 1.

Apri 1 brought the death of one of my dogs, 6 months after the death of my other dog.  Missing them both and down to 2 dogs one of which has outlived all the others so far.  she lives on borrowed time I know.

June we had some more tests on Mr Chicks Back and tried the equivalent of Snake Oil, some stem cell injections, none of which was covered under insurance.  $4k good bye and it didn’t work. $11k in out of pocket expenses so far…

We started process for 2nd surgery.

Sept was the 2nd surgery,  successful by surgery standards but 2 months later same symptoms persist. Doc says nerve damage could take yet another year to heal.  More waiting.

The back brace he work for 5 weeks aggravated the inguinal hernia he has had for many years.  He has to have a hernia repair done before years end. More time off work. More Bills. At least deductible is paid. Fix all you can before years end.

Add that to the 3 skin cancers he had taken off his face last week, that is 5 procedures he has had/or will have before the expiration of this year.  He has missed 10 weeks of work so far ( thank you FMLA and sick pay) and we still have to manage the hernia surgery.

I had an abnormal mammogram and had a second which was inconclusive so we are gonna check again in 6 months.  I care less about me than Mr Chick, so that is a 6 month wait I don’t care about.

One car had a head light out in October.. ” replace the bulb” I asked.  apparently newer model cars don’t ” replace bulbs” $1300 dollars later….yes you apparently replace ” assemblies” when you need a new head light bulb.  God help you if you have a LED..those I am told are $3k. There are advantages to having an old beater.  you can actually replace parts and not entire assemblies!

2 days later I got a broken crown.  Temp crown and $1100 OOP later I am better, but my company has really crappy dental insurance I have discovered.  Insurance is great…when you don’t use it. LOL I am grateful that I do have money in the bank to pay for this kind of financial stress. But bleeding cash isn’t a lot of fun, and we have bled a lot of it so far.

Work has been stressful with the retirement of my immediate superior and the take over by a person I cannot seem to communicate with. He is from a culture that doesn’t speak ” my language” and I don’t mean English.  He sounds like a robot. We had over 2300 flu shots to process in a 6 week period in a time where a tech I had a lot of problems with finally left, and we were 1 full time person short. I have been coming into work at 530 am working to 9 pm some nights to keep the work load from burying me. I praise the end of October and the downward slide of flu shots. Still havent replaced missing tech and most days the office has no staff to cover.

The company I work for has started a major shift in policies and procedures and nearly every day something new has come down the pipe requiring a change in how i do things. Questions are not allowed and explanations are not forthcoming. WE get random auditors showing up every 4-6 weeks for hours at a time. Tell me thats not stressful.

I sleep maybe 4-5 hours a night. And never all  those hours in a row.

Yup, 2016 can just blow.

No excuses

Filed under: Uncategorized — pharmacychick at 4:09 pm on Monday, October 24, 2016

Pharmacy Chick has started at least a dozen posts in recent days and most of them have fallen by the wayside for lack of interest or a decent conclusion. I want to write well, on subjects that matter enough to me to share.  I’ve received email from readers wondering if I have quit or moved on, and no, Ive done neither but I have seemed to have covered most of the subjects that interest me and to rehash them constantly is kind of a waste of time.

I do have a presence on Facebook, not as Pharmacy Chick, but as the real me.  Recently I made a post that garnished a lot of comments and interest and because it had a relationship to work, I decided that indeed, I have a subject worth writing about.

It started Saturday afternoon.  My tech went to lunch ( a mandatory function within our company…you cannot NOT take a lunch when you are a tech).  All was well until a certain time when it seemed all of Chickville descended on the pharmacy.  2 phones were ringing and at both windows (drop off and pick up) I had at least 2 people in line.  Thats about 6+ individuals that wanted my attention.  I was working thru one end of the windows when this Neanderthal of a man, with a teenage boy accompanying him, came up and spoke over everyone else ” Isn’t there anyone else around here?  I want some help”. I said ” no, I am the only staff member here at the  moment, Ill take care of you as soon as I can”.  It would seem that it would be pretty obvious that I wasn’t sitting around reading magazines and ignoring the lines. but that wasn’t acceptable, he had to go on. “There are other people down here too and we are waiting”. His tone of voice was abusive and inflammatory.  No shit sherlock, I’m not blind but I am also not able to be in two places at one time. ” Ill be there as soon as I can, I have to finish here”.  Bearing witness to all of this was our store manager who asked if he could help me so I had him help a nice lady find something on an aisle.  Finishing up I went down to the drop off and took care of a clearly embarrassed-f0r-me lady who dropped off her rx and said ” ill be back later and I promise I won’t yell at you”.  Neanderthal wasn’t to be found anymore.

Later my manager said ” you can call me anytime you need some extra help”.  He is a peach of a guy, someone with a heart of gold and I’d take a bullet for. I said ” thanks Rick, I got this, I just don’t need or appreciate being yelled at by jerks”.  And my boss said “Well we never know their circumstances”….

I thought about that for a while and I burned…not for pity but for resentment because that statement right there has taken our country from one of politeness and appropriate behavior to one of rudeness, violence, get-what-you-want-at-all-costs, take no prisoners.  I refused to accept that and I respectfully disagree with my boss.

Later that night I made a generic post about the incident explaining that circumstances are no excuse for rudeness and inappropriate behavior in social settings.  We need to exhibit self control, and mind our manners regardless of the crap we have in our lives.  if we can’t, we are showing others that we are petulant toddlers instead of civilized humans.

I got a lot of comments, mostly positive and in agreement.  One commenter was a mother of a special needs person who for the most part agreed, but said ” I am occasionally rude and I am not sorry for that  because I have a special needs child”.

Sorry, my friend, that is utter CRAP.  Let me expound on this

EVERYBODY has circumstances. Nobody is exempt.  You may have a special needs child.  The lady next you may have an abusive husband.  The man at the counter may have just lost his job.  The lady standing  next to you in line may have lost her son to a heroin addiction,  and the guy  next to you in traffic just lost his wife to cancer , and the person waiting on you at the  restaurant may have had a miscarriage 2 days ago…   WHOSE circumstances  trump anyone else’s?

NOBODY’S.. Everybody has crap in their lives we have to deal with.  That is just a fact of life. If you are reading this and you can say ” I have no crap”  consider yourself lucky, because someday you will. we all do.  Life is tough.

That does  not justify ruining someone else’s day because your day sucks.  Why am I telling you this?  Why does this matter?  Because I have seen an increase in in appropriate behavior exploding over the last several years. If you work in a service industry or with the public you’ll agree… We see it on you tube, filmed by cell phone cameras.  We see it captured on video surveillance in stores.  Its disgusting frankly, so see people descend into behavior that is frankly,  embarrassing to watch and probably worse to witness.

Circumstances are not an excuse for being rude to people you come in contact with.

Circumstances are not a justification for taking out your frustrations on others

Circumstances are not a reason for abusing other people, your own children or animals

Circumstances are just that…Circumstances.  WE all have them.  We all have our baggage that life has given us to carry. So the next time you want to lash out, pack it away.  Be nice. Be polite, Be proper.  Its not your right to be nasty, rude or inappropriate.

And if you are?  Why don’t you man up and apologize.


And the the rest of the story?  My tech came back and the first thing she said was ” Man, I sure feel sorry for Reba in the Deli, this guy was yelling at her about something wrong with his sandwich”  I asked  Did he have a teenage boy with him?  ” why yes he did..”

What you think that teen was learning…..


Be an encourager, a Coke and a smile!

Filed under: Uncategorized — pharmacychick at 5:00 pm on Tuesday, June 7, 2016

In that grand old world out there, being a retail pharmacist is akin to being a punching bag in a white coat.  That being said I also state that many professions are in the same boat.  I speak for flight attendants, wait-staff, checkers, etc…and the common thread to all of us, is that we  are cursed  um… blessed to deal with the public on a daily basis.

It takes a lot of fortitude to spend one’s career dealing with the public.  I don’t need to go into examples because most of my readers are either pharmacists or patients.  If you are a patient and are still reading me after all these years I am going to assume that you are a good patient.  If you aren’t then you have most likely  decided you hate me and don’t read me anymore anyway…or read me only to throw caustic comments my way.

I am going to add another profession to the list of the abused:  Golf professional.  I say that because I have developed a special friendship with the  head professional at the club that I am a member at.  For that, he has let me into the life of a golf professional, an eye opening experience to say the least.   Thankfully he doesn’t mind sharing what its like to be a professional all the way down to the cellular level in the day to day activities.  I have developed a great appreciation of the work that he does but more so, what he has to put up with.  Who’d have thought that in a place where one pursues a pleasure activity that there would be so much angst.  Its not an easy job.  He’s dealing with the “public” too, albeit they are referred to as ” members”.   He has a tough skin but he takes a lot of the criticism personally.

A lot of us do that however…  I can have accolades all day but if I get one person who berates me, It pretty much ruins my day.  Same for my friend.  He is a great human being, a gifted teacher, a compassionate individual, soft spoken yet eloquent. He “makes” time for everyone despite the fact that his weeks are often 60-70 hours.  I don’t confess to work that many hours. I can’t do it anymore. When I am on shift I am performing at top speed for every moment. Its exhausting both physically but mostly mentally.  Some days, as I approach that 13th hour on the clock, my brain is starting to break.

He breaks too. So I decided to be his encourager.  Someone to be in his corner, when nobody else may be on any given day.  Ive actually adopted the idea of being an encourager at work too,  to  offset the self loathing I suffer from.  The fact is, I may do amazing things ( well not really) but inside I feel at a loss of importance and value. So I encourage others so that they don’t feel the same way I do. Nearly every day at work, I will make an effort to make a positive remark to dozens of people.  Most of the time its a comment about what they are wearing ” boy you look great in blue”, ‘ Love that jacket!”  I think people need to be uplifted to off set the rigors of the day that beat us up. I have an encourager too.  He is a man that brings me a coke whenever he is in the store.  He simply stops by, tells me Hello, and hands me a coke.  Makes my day EVERY.SINGLE.TIME.

For my professional, I want to walk into his office every day I play and greet him with the best smile ( and a COKE)  he will see all day, not because I have to, but because I happen to LIKE HIM as a person and a valued friend.  I want to elevate him to a place that will hopefully sustain him during the attacks on his psyche that will occur all day long. In return… well..thats the kicker I need no return!

Well, maybe I can hope for  ONE return, a continuing friendship that blesses my life with this special person and his family. Over the 28 years that I have lived in my community, I have learned the value of a friend.  I have no family in the city I live in. My nearest relative is 500 miles away…except Mr Chick of course.  Making friends is hard for me. Making acquaintances is easy.  I have a zillion of those, but FRIENDS..that takes effort…and time..and trust.  Introverts don’t make friends easily, but they make excellent friends.  We don’t require a lot of maintenance because its exhausting for the introvert to spend TOO Much time with him or her.

I wish I could do more.  He has a personality type much like mine, self depreciating sense of humor ( its almost a contest who can self insult the most…).  He is good for me tho,  he is my gifted teacher and motivates me to keep trying when I really want to give up on the game I love so much but gives me great grief.  I want to be better, I demand to get better. I will get better.

But mostly I want to love on him like he deserves. To show my friend ( which is better than can be so mean to each other) that there are some people out there who knows he is awesome and amazing and doing a fantastic job doing what he loves to do, thru much effort and time and energy.

who can you be an encourager to? Or who has been your encourager?


Everyone is talking bathrooms

Filed under: Uncategorized — pharmacychick at 7:43 am on Sunday, May 22, 2016

The newsiest news lately is bathrooms….and change rooms too if you want to lump them all together.  Everybody is in a tither about bathrooms. Im just gonna make a short post about how I feel about the matter and let the comments decide for themselves how they feel.

In my workplace we have 2 Trans.  Both are male that have identified themselves as female. One has made the outward transition to female by wearing ladies clothes etc. and the other, while taking meds to make the change, still outwardly seems to identify as a male by physical appearance, clothing  etc.. Ive seen both frequently in the store.  1 uses the ladies room and the other still uses the mens.

I don’t care.  There ya go. There are things about this overall situation, as a conservative Christian, that would be worthy of a theological discussion but this isn’t the post for it.

If you have to go to the bathroom, and you look and dress like a lady, then use the ladies room, or a family style room where you can lock yourself in privately and not worry about who might see you and be offended. I mean, whats gonna freak people out more? a person who appears to be a woman walking in to a women’s restroom? or a mans?   I understand that mens rooms often don’t have “stalls” but  perhaps its time for all bathrooms to have them. I dunno…

Lockerooms are a little dicey for me at this time.  Thats when the gloves come off…and the shorts, and the bras and the makeup for all to see.  I still feel that in THIS case,  whats under your clothes might matter when thats what is about to be exposed in a public shower in a lockeroom.

Perhaps the future lies in construction…where buildings have bathrooms…just a line of single-holers with locked doors.  no labels, no freaking out…but what is your opinion??

Sick of crap.

Filed under: Uncategorized — pharmacychick at 9:21 am on Wednesday, May 11, 2016

It used to be that if you wanted the best of something you didn’t have to look hard to find it.  Often times it was “made in America” and other times it was the iconic name of a company that offered the best and you just knew that if you bought that product or service you would get the best…or nearly the best.  ( I can’t always afford “the best”)

Recently I think that we as a nation, and possibly the world, has settled for mediocre in just about everything….or worse yet, settled for crap.  Let me cite some recent examples.

  1. Cell service.   Cell phones, or “mobile devices” as they are referred to know have moved from luxury item to nearly necessity.  We all pay a pretty penny for such services but who among us can say with any certainty that our service is awesome?  Not me.  I allegedly have the best provider in the US, and yet I still get dropped calls….texts that don’t send or receive…
  2. similarly when I am at work I pretty much can tell immediately if a caller that is on the phone with ME is on a cell phone.  The clarity sucks and often is so bad that I will tell the caller ” I cannot hear you ,please call back when you are in a place where your connection is better”.  Is this our future?  Is this progress as we know it? to have phone service reminiscent of the days of party lines and operators?
  3. Internet.  Between TV internet and phone, the Chick family pays a pretty penny..we like our technology, but almost once a week I have to “recycle” the modem upstairs because it seems to “forget” who it is.  And according to comcast…aka Xfinity, this is perfectly normal and acceptable.  I disagree.  If I forgot who I was on a weekly basis, I’d probably be in assisted care with a dribble bib around my neck. I would certainly not be in  a high profile pharmacy job. I also have satellite TV that occasionally needs the same kind of service…or we will record a show that will stop in mid viewing because the connection was lost.  Can I deduct a certain amount from my bill because I didn’t get what I paid for?  not likely…
  4. clothes.  I can’t list the amount of clothing that I have spend decent amounts of money on that after 1 washing barely resemble the item that went into the washer.  I ve had articles of clothing that have buttons barely sewn on, hems that weren’t done properly, arms of different length, seems splitting, etc AND I buy clothes that are known for quality. I don’t shop for clothes at Target…I choose high end because I want to wear them for a long time.  I find it disappointing that a high quality name such as Nike, Nordstrom, Columbia Sports, Adidas etc, make something that costs a great deal of money that ends up pilling, shrinking, pulling, fading and buttons falling off after only a few wearings.  I recently bought a pair of pants from one of these listed above, ..they were the zip off shorts kind with new tech seams where they are glued on.  I wasn’t all that sure about trying glued together seams but I thought I’d try it.  Mistake.  before the first washing the seams around the zipper were raising.  I had to IRON the glue back into place or the whole “seam” would come off in short haste. Now I carefully look at each leg before I wear to see if I have to iron glue my seams back together.
  5. My dryer.   a couple of years ago my old washer dryer was fading fast.  We went to Sears and bought a top of the line Whirlpool Cabriolet washer dryer combo.  I spent as much on that pair as I did for a car when I was in college…maybe more so.  And right out of the chute the dryer has a spot that grabs clothes by the lint catch..I emailed the company but got a pretty lame reply..” its been reported but very rare” and offered nothing in the form of a solution.  So about once a week Ill pull something out from the dryer and its attached to that spot and has been spun into a twisted mess.
  6. Eating out.  We like to eat out.  with just the two of us, its something we just enjoy..having a good meal out somewhere in a pleasant environment.  Well, thats also getting harder to find.  If you look at most menu’s now, its a big deal to eat out. you can expect to drop close to 40 bucks for a meal for 2 and an AVERAGE priced restaurant.  I believe they think that if they offer you a massive QUANTITY of mediocre food you will overlook the QUALITY>  What I see in most places is heavily sauced, heavily salted, and covered in cheese. I also encounter loud music too distracting to hear my husband, or the current trend of having TV’s mounted everywhere.  If I wanted to watch tv while I ate, I ‘d do it at home.
  7. consumer goods: the incredible shrinking package.  Who hasn’t noticed this?  the only thing not shrinking is the cost of the package and my bills.  We’d all like more for less but what we really get is less for more.
  8. We run a small home based business. We sell  a skin care product that we are pretty proud of.  I opened our most recent case of product that came from our lab and send off some to one of our best customers. She contacted us and wondered why it was half empty. ” are you changing your packaging?” she asked.  Of course not.  We went and looked carefully at this new case was absolutely horrified to see that  most of the containers were either only partially filled  and when put on the scale, did not contain the advertised amount of product.  We have over a thousand bucks of inventory ( at cost) that is worthless because  the QA of the lab didn’t fill the jars to its stated ( and agreed upon) size.  We  of course replaced all of HER inventory with proper product but I am left pretty pissed and the crap they sent us
  9. I went to the gym last week and was looking at the medicine balls that they had on the shelf.  Most were broken or split an I asked the gym manager why they looked that way…they were relatively new.  He said,  they get damaged when people throw the against the wall during an exercise routine.  ” aren’t they supposed to be able to sustain that kind of use?”  Well, yes he said, but they don’t..”  More crap.

I believe that we have been slowly led to believe that poorly made, poorly constructed and poorly executed products is acceptable and the norm now.  I don’t agree.But I don’t have an answer either.  What is your “crap” story??

RIP Old man

Filed under: Uncategorized — pharmacychick at 6:57 am on Saturday, April 2, 2016

Saying goodbye to your dog is never easy and no matter how many times you have done it, the process sucks just as much.  Old man decided on April Fools, to make no joke about it and said goodbye.  He enjoyed his breakfast, spent the day with his buddies in the yard, and when Mr chick came home from work, he slowly lumbered into the house and laid down…and made it clear it was enough.

A heart can only last so long, especially when its so tired and inefficient.  Mr Chick took him to the same caring loving vet that had performed the miracle spleen surgery on him a few years ago. He remembered him immediately…called him a miracle dog.  I made it after work just in time to hold the boy and say goodbye.

I can hardly see the screen to write..Goodbye Old Man, you were loved


An old dog, another goodbye on the horizon

Filed under: Uncategorized — pharmacychick at 5:23 pm on Monday, March 28, 2016

The hardest thing I have to do in my current existence is say goodbye to a dog.  It causes my heart to break into hundred pieces and I can feel the cracking starting already.  I have old dogs.  I have written about my favorite girl who died from  Hepatocutaneous syndrome 2 years ago.  It still aches my heart to know she was too young when she died and there wasn’t anything I could do.

My current pack is 3.  Love them all for each of their own special characteristics.  I have a blind dog that I took in as a “temporary” foster…2 years ago. He was tied to a pole outside and left to sleep in a barrel.   I took in an old dog, nearly deaf as a “temporary” foster 4 years ago.   He was dumped at a kill shelter when his owner died.  They are mine now 🙂 Seems Temporary has a new definition in the Pharmacy Chick household.  My third dog I raised from a pup. She will be 13 later this year, and she is my little old lady.  2 boys and a girl and something tells me that my trio will be a duo or even a single before years end.   My ” old man” as I call him is of unknown age.  When he arrived 4 years ago, we were told he was already 12 or 13.  That was obviously wrong because my breed of dog barely makes it to 13 let along 17 which he might be now.  By his appearance ill guess he is about 13 NOW.   He had a massive tumor removed from his spleen shortly after we got him.He has suffered from a chronic cough from the day we took him in.

Old Man is going to the vet tomorrow again, hopefully not for the last time.  He has been on my mind and heart a lot lately.  He has a myriad of health issues that seemingly defy diagnoses.  But I think we have one…Idiopathic Laryngeal paralysis.  He fits all the criteria and he also has a highly significant heart murmur that impedes his blood flow.  His back legs have atrophied from possible progressive nerve damage and he exhausts himself from the coughing that comes from both the ILP and the murmur. Poor thing, the only time he is at rest is when he sleeps, which is alway in short bursts and for too short of time.   WE have had to sleep with ear plugs in not to be awakened 15 times a night from the coughing. Its tough for us to watch but tougher on him too endure I suppose.   He could have surgery ..again, but his advanced age makes it a challenge for anesthesia. He struggles up and down stairs some days and other days he does well.  The last two days have been hellish on the Old Man.

Decisions decisions….Oh How I hate these days…

The refill box..extinct or not?

Filed under: Uncategorized — pharmacychick at 4:53 pm on Monday, March 28, 2016

ONE , if not THE most frustrating chore of each and every day in the pharmacy is the infamous refill box…that alphabetical list of pages…each of which represents unfinished work….prescriptions with ZERO refills that have been sent to the Dr’s office for approval.  Its always a work in progress.  Every request 1 page goes in….every approval, one page comes back out and into the trash.  Never in 30 years of practicing pharmacy have I ever had an empty box.

Every evening near the end of the day we go thru the box, pulling pages that we may have forgotten to pull earlier and refaxing everything that has been there for 48 hours.  I prefer to refax every 24 hours but I get too many crabby Dr offices sending me nasty notes demanding 72 hours for refill authorizations.  Well ,I don’t get 72 hours to fill a prescription, why do YOU need 72 hours to authorize one?    It takes my techs 30 min or more to comb thru the box, clean it out and fax the remaining content.  Thats a significant amount of time devoted daily….MON-FRI.  Sat and sunday get a pass because we fax on friday night for all things left over on the weekend.

A while back..quite awhile… I had dinner with a pharmacist friend of mine who stated he had dumped his refill box entirely.  He said he decided his and his staff’s time was too valuable to be messing around with the refill box.  One night he tossed the whole thing in the trash.   I asked how he managed to pull that off.  He said ” simple”. “Once its FAXED or E-SCRIPTED, its in the dr.’s office. Im done with it.  I don’t care what happens after that, its THEIR responsibility to ok it or the patients responsibility to ask the dr why its NOT”. He said he made an effort to educate his patients that he no longer took the refill box, and if they wanted to inquire why an rx is not ready, he would verify it went to the office  and refer patients there.  He said it took about 3 months before everyone was aware and on board of the process and with a few bumps and painful moments it has finally managed to take hold.

He said,  “I don’t have 3+ hours a week to devote to the small percentage of  prescriptions I gain by hounding the drs to ok them. I don’t feel its cost effective to use that labor.”

It made sense but I haven’t had the guts to make the dump yet.  It may come sooner than later.  We have been told that we are getting a new computer system.  reading the guidelines and procedure manual I see that the procedures do not include a refill box.  It states. ” Once the refill has been verified as “sent”  it should be discarded.”   WHOA…

There is something I hold on to when I have the knowledge that I have sent a refill– I have the date and time in front of me–and my notes as to 2nd or even 3rd fax. Throwing that to the 4 winds makes me nervous.  No more second faxes..NO more tracking.  Just send and pitch.  Sounds great..until Joe Customer gets pissy when his rx was never okayed…and blames me for not “doing my job and following up” Fact of the matter is I can ASK a dr for an ok, but I cannot demand it.

I think for now Ill keep my box until I get the gut enough to say goodbye to it.

The United States of Oxy

Filed under: Uncategorized — pharmacychick at 4:20 pm on Monday, March 14, 2016

A recent publication in the Wall Street Journal (very timely) illustrates the blog post I wrote about recently about our rampant abuse and misuse of opiates in the United States.  The title of this blog is merely a quote from Senator Edward Markey ” we have become the United States of Oxy”.

Overdose deaths due to Opiates have tripled from 2000 to 2014. The most recent data is 28647 deaths due to opiates.  61% of all overdoses were related to opiates alone.   This factoid however wasn’t the one that concerned ( or shocked) me the most.  This one did:  ( and I am going to Bold face it to emphasize it).  “Americans consume 80% of the global opiate supply despite making up less than 5% of the world’s population” 

Does that shock you?  It should.  It should also sicken you.

We ( Americans) have a drug problem.  We do not have a pain management problem.  We do not have an illness problem. WE HAVE A DRUG PROBLEM  Do you think for that 95 percent of the worlds population do not have back, neck, shoulder, WHATEVER injuries or pain??   What makes us unique to consuming 80% of the  worlds opiates when we are only 5% of the population?

I don’t have the answer.  But I do believe wholeheartedly that we certainly do NOT need to be consuming 80% of all global opiates.  We have too many people wanting opiates to avoid withdrawal, using opiates for inappropriate uses, using opiates in excess and for recreational uses.

Its a bit of an embarrassment to lead the world in this kind of statistic.  The legislation recently passed in the Senate hopes to curb such abuse but its a losing battle when its done on that end.  It needs to start at the Dr’s office.   If you want to read the article you can possibly look online under the Wall street Journal, but most of the time you have to be a subscriber to read it.



Misuse and Abuse. A growing issue

Filed under: Uncategorized — pharmacychick at 5:29 pm on Tuesday, February 16, 2016

Misuse and Abuse..Dur (drug utilization reviews for the TLA deficient), CMR, Fraud Waste and abuse..All of these are hot terms in pharmacy right now.  Between Boards of Pharmacy, CMS and PBM’s we are attacked on all sides by agencies trying to monitor what we dispense, who we dispense to, how much we dispense and how often we dispense it. More often than not it focuses on controlled substances and expensive drugs…they can levy hefty fines and chargebacks on these.

What that means is that pharmacists now get to don the hat of compliance officer and policeman. It used to be that Overuse was the only thing that we would get harassed about by agencies, but any type of misuse or abuse is monitored  by our overlords.

Misuse is not only over use of a medication. Its any deviation from the directions provided by the prescriber.  This also includes under utilization, or use for any condition for which it wasn’t prescribed.( off label use)

Everyone has misused a drug at some time or another.  I had a bad cough 2 months ago and my doc was being a real pill and wanted an appointment to be seen and it was nearly a week away… IN the mean time Im hacking my guts out.  I had some old vicodin from a shoulder injury so I used it for my cough.  Technically misuse but it worked like a charm.  I occasionally forget to take my cholesterol med, thats technically misuse also.

Recently we received notification that all controlled substances WILL ( not should) but WILL be monitored for misuse and abuse. Days supply will be checked and monitored and days between refills will be reviewed and monitored for accuracy.  What this means is that someone is watching our dispensing of controlled substances.  Opiate abuse is rampant in the United states and the pharmacist is the infantryman trying to do battle from both sides. Customers who need ( or want) their pain meds for genuine need or abuse..and doctors who feel compelled to keep writing scripts despite admonitions from agencies  who ask them to refrain or reduce prescriptions.

Personally, the only reason I care about this subject is a piece of paper on the wall called my license.  I value that license because it pays my bills each and every month.  without it, I cannot come into the pharmacy and make a living.  If I dispense narcotics or any controlled substances  outside proper procedures I can lose that license.   I wrote a piece a long time ago called” Cash is not Carte Blanche” and to this very day I get people ripping me a new a$$hole because they think I am a judgmental whore for not giving narcotics to everyone who claims to need them.   Read the entire post and substitute Zestril for Norco in it and see if you have the same reaction.  All early refills need justification and just because he wanted to pay cash doesn’t mean he gets the refill….and it doesn’t matter the drug except for the fact the 1 is controlled and the other is not. Nevertheless, the actual content of the post got completely lost by commenters getting pissed, all of whom I am guessing take opiates. Why else would you if you didn’t?

let me share some some factoids: cut and pasted from the American Society of Addiction Medicine Opiate addiction 2016 facts and figures


Opioid Addiction

  •   Opioids are a class of drugs that include the illicit drug heroin as well as the licit prescription pain relievers oxycodone, hydrocodone, codeine, morphine, fentanyl and others.
  •   Opioids are chemically related and interact with opioid receptors on nerve cells in the brain and nervous system to produce pleasurable effects and relieve pain.
  •   Addiction is a primary, chronic and relapsing brain disease characterized by an individual pathologically pursuing reward and/or relief by substance use and other behaviors.
  •   Of the 21.5 million Americans 12 or older that had a substance use disorder in 2014, 1.9 million had a substance use disorder involving prescription pain relievers and 586,000 had a substance use disorder involving heroin.
  •   It is estimated that 23% of individuals who use heroin develop opioid addictio.4 National Opioid Overdose Epidemic
  •   Drug overdose is the leading cause of accidental death in the US, with 47,055 lethal drug overdoses in 2014. Opioid addiction is driving this epidemic, with 18,893 overdose deaths related to prescription pain relievers, and 10,574 overdose deaths related to heroin in 2014
  •   From 1999 to 2008, overdose death rates, sales and substance use disorder treatment admissions related to prescription pain relievers increased in parallel. The overdose death rate in 2008 was nearly four times the 1999 rate.  In 2012, 259 million prescriptions were written for opioids, which is more than enough to give every American adult their own bottle of pills.  Four in five new heroin users started out misusing prescription painkillers. As a consequence,the rate of heroin overdose deaths nearly quadrupled from 2000 to 2013. During this 14-year period, the rate of heroin overdose showed an average increase of 6% per year from 2000 to 2010, followed by a larger average increase of 37% per year from 2010 to 2013.
    •   94% of respondents in a 2014 survey of people in treatment for opioid addiction said they chose to use heroin because prescription opioids were “far more expensive and harder to obtain.”Impact on Special PopulationsAdolescents (12 to 17 years old)
      •   In 2014, 467,000 adolescents were current nonmedical users of pain reliever, with 168,000 having an addiction to prescription pain relievers.
      •   In 2014, an estimated 28,000 adolescents had used heroin in the past year, and an estimated 16,000 were current heroin users. Additionally, an estimated 18,000 adolescents had heroin a heroin use disorder in 2014.
      •   People often share their unused pain relievers, unaware of the dangers of nonmedical opioid use. Most adolescents who misuse prescription pain relievers are given them for free by a friend or relative.
      •   The prescribing rates for prescription opioids among adolescents and young adults nearly doubled from 1994 to 2007

     Women are more likely to have chronic pain, be prescribed prescription pain relievers, be given higher doses, and use them for longer time periods than men. Women may become dependent on prescription pain relievers more quickly than men.


    Ive come to the realization that most of the people who get hot and bothered over this subject come across as narcissistic  soap boxers who might just as well wear a shirt that says ” narcotic takers lives matter”..since they seem to get all puffed up anytime this subject is broached. They seem to believe that 1) we are the judge and jury in the pharmacy  and 2) we look all day for opportunities to deny people their meds. Of course if the said person were to OD and die as 18893 people did in 2014, I am sure I would be first to be sued by some family  member wanting blood for the death of their “loved” one because I filled their med early/too often/inappropriately.

Lets look at those two assumptions:  Judge and Jury:  In my pharmacy I have 2 rather large documents: the first is the policy and procedure manual of my business…a rotund tome of over 300 pages.  I also have the Federal and State laws governing pharmacy printed in a enormous binder.  It looks somewhat like a printed version of the US TAX CODE in its size and complexity.  THESE two documents are my judge and jury.   They detail what I do, how I do it and the penalties for doing what I am not supposed to do and NOT doing what I am supposed to do.    And tho I do not have physical copies of these in my pharmacy I am also subject to rules of CMS ( center for Medicare/Medicaid Services)  and nearly every insurance company that we do business with.   Deciding ON my own when to refill a prescription is pretty low on this list.   Using ” good judgement” is pretty much pre-decided often by a governing agency, the insurer or the prescriber him/herself.

Assumption 2: we look all day for opportunities to deny meds:  HAHAHAHAHA.  As if I don’t have enough on my plate.  The goal for every rx I have is simple.  Fill it to completion without a hassle and get YOU out of my pharmacy ASAP with all the necessary tools and information required by law.  Discovering a rx is too early is one of those hassles I didn’t need and didn’t ask for.  No pharmacist goes home at night revelling in the joy of rx’s turned away.  We also don’t spend much time mourning over the plight of all our patients any more than YOU as a patient are concerned about the working conditions/mood/heath/life of the pharmacist you handed your rx to. Its a JOB….a Vocation we have to make money and supply a life for our family.  Its not our passion or obsession …at least not for any pharmacist I have met who have practiced for a few years. To think that we have some kind of vested interest or enjoyment in keeping meds OUT of the hands of the people who should have them is another narcissistic tendency.

For anyone who has bothered to read this far I applaud you.  type ” I read it all” in the comments line to prove it LOL

In summary, its rather are the rules of engagement for  Opiates/benzodiazepines and any other controlled substance we dispense to keep us all on the right size of compliance officers and the law:

  1. WE, the courts and the govt use the hard copy directions as a legal document and we are all are bound to that document. If 90 tabs are given to a patient as a 30 days supply then its  to last 30 days . If a patient comes in 8 days early for a refill or ask for a new rx from the doc then he/she best be able to produce 8 days worth of meds to show the doc if he were to ask or have new directions to support that change.  Ive got several docs in my area now who will refuse to even  issue the next rx till 30 days have passed. Most will put a fill date on these rx’s. They aren’t all idiots just because some behave that way
  2. regulatory agencies are narrowing in on overprescribing and inappropriate prescribing of all controlled drugs.  We have to watch our backs, and if that means telling a patient that we aren’t going to fill a controlled substance early then so be it.
  3. As a patient, do not engage in behavior that would lead your physician /pharmacist/nurse/insurer to assume that you are abusing or misusing a drug.  This includes but not exclusive to: a) taking more medication that is currently prescribed on the label you have on the bottle  b) finding creative ways to get more ” oh I fell last night”  ” I turned my ankle” ” I slipped on the wet floor” excuses have a way of adding up. c) losing meds more than once ” they were stolen on the bus” ” they dropped down the sink” .  Treat your meds like cash.  Would you be careful if you had a handful of 20 dollar bills? and d) going to multiple places and urgent care looking for pain treatments.
  4. if your health deteriorates where you feel you need to increase your doses, you must do it with the permission and cooperation of your prescriber.  You are not autonomous in deciding what is right for your body when it comes to pain management.  Its a team effort and adding more medication may not be the right solution.
  5. Don’t use verbal threats or become argumentative with any of your health care professionals. Thats pretty  much a guarantee that you aren’t going to get any cooperation from any of us.  There are certain red flag behaviors we have been taught to look for and defensive and argumentative behavior is one of those items.
  6. Physicians: use your states Prescription Drug monitoring program if you have one. Any patient presenting “pain” that isn’t obviously quantified with a trauma should be looked up and examined for controlled substances. Any patient who receives regular opiates should also use other modalities to treat and monitor pain. “Just take one more” is not an appropriate modality. Don’t overprescribe opiates.  For instance. Mr Chick received 90 oxycodone for his back surgery and 30 percocet for his appendix removal. Both physicians said ” you shouldnt have too much pain, but here is a prescription.  REALLY was that necessary?  He took 8 oxycodone over first 3 days and that was all he needed.
  7. Pharmacists, its simple math, not an ethics dilemma.  If the patient is supposed to have meds to last 30 days and they are coming in any more than 1-2 days early, then its reasonable to assume that they should have at least 1-2 days left. IF they ask for an  early fill, its more than acceptable to ask the doctor for permission or a reason to document for legal. Leave emotion out of it.  If the patient claims they are out then its really not your problem. Again, its simple math. Now it becomes an issue for the dr and the patient to work out as to why what was given to the patient “ran out”.  90 tabs  at 1 tab 3 times daily will never be anything but 30 days.  its just math. Thats the great thing about math, its not subjective….
  8. lastly, understand that it IS ALL health care professionals “business” to know why patients take their medication.  I get really tired of being insulted by patients and some clinics when I am forced to question a prescription and be told ” This is between me an the patient” or ” Its none of your business”.  Well yes it is…its is very  much my business. And if you question that statement, let me have the DEA , the Board of Pharmacy, your insurer  or the families of the 18,893 people who died of opiate overdose in 2014 explain it to you.
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