Annoying oxy situation

[christy101]

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So long story short, had a patient who came in to fill an oxy in 2 different strengths. I was able to fill one since it was due but the other had problems so I couldn't fill it, it was a bit early and the insurance had some limit, but basically it had a problem and I can't fill it, it wouldn't go through and I didn't want to fill it until I get the situation solved. Patient get really pissed and when I didn't want to give it the pt threatens me that if anything happen to them , I will be held responsible and he will make sure of that. I don't how bad can it be if you don't have one of your oxy, I'm new so yea I am afraid but didn't want to go against what I feel is right and just going by the rules.I'm sure everyone came across this kind of situation at some point. What's your intakes?

 

[M0df]

I wouldn't think twice about it. They got the script back and can go somewhere else? He should be happy you filled one of them. I might not even fill any of them, depending on quantities/strengths/directions. Worst case they call corporate/your supervisor, who may or may not bring it up to you.

 

[rxsurf23]

I'd say you made a good call. It's your license to lose, and if there was an issue with the prescription you made the right call, especially if it was too early to be filled.

 

[Unchained]

You did the right thing. These oxyzombies will relentlessly attack. We have enough support from higher ups now which we didn't have a few years ago. Even a non pharmacist entrenched in a corporate office 100 miles away is familiar with the fines the DEA is bringing down on account of this drug.

 

[WVUPharm2007]

You have no reason to worry.

 

[BidingMyTime]

I will be held responsible and he will make sure of that. I don't how bad can it be if you don't have one of your oxy, I'm new so yea I am afraid but didn't want to go against what I feel is right and just going by the rules.I'm sure everyone came across this kind of situation at some point. What's your intakes?

The patient is responsible for their own health. You have NO legal obligation to fill a prescription when there are unanswered questions about it. In fact, if you filled it early, and the patient overdose because of taking too many, you could be held legally responsible for that.
If the patient doesn't like your judgment call, they are free to go to another pharmacy. And if their health were truly threatened because of not getting a drug, then they should be going to the ER.

 

[s_man]

Don't worry! What health problem could arise from not taking oxy beside suffering from pain? If they suffering from addition, that is a reason you must not fill it if you know. Besides, the medication is early, so he should still have the med and it's not your problem that he is running out of it early. Always be firm and he will never do that again to you, or he could go else where.

 

[BidingMyTime]

Don't worry! What health problem could arise from not taking oxy beside suffering from pain?

Um, withdrawal, esp if the patient has been taking higher doses than prescribed. Unlikely, but possibly could be severe enough to be fatal. Still, the pharmacist can't legally diagnose and dispense early for this reason. If withdrawal is a concern, the patients to be calling their doctor, or going to an ER.


edited to fix quoting

 

[Carboxide]

BidingMyTime: Why don't you do some research on whether opioid withdrawal can kill someone? We'll be right here waiting.

 

[BidingMyTime]

BidingMyTime: Why don't you do some research on whether opioid withdrawal can kill someone? We'll be right here waiting.

I said possibly, can you really think of no situations where it could possibly kill someone? Seriously? I agree its rare, but its no impossible. Here is one plausible scenario, someone who was already in bad health because of their opiate addiction, quits cold-turkey, pukes for 3 days straight, and ends up having a heart attack from their potassium being off because they are so dehydrated from puking. I can think of others, but why don't you go do some research on that yourself.

Or perhaps you want to quibble and say the death was from the dehydration or heart attack, not directly from the withdrawal. My point that someone may require immediate medical help because of withdrawal still stands.

 

[zelman]

I said possibly, can you really think of no situations where it could possibly kill someone? Seriously? I agree its rare, but its no impossible. Here is one plausible scenario, someone who was already in bad health because of their opiate addiction, quits cold-turkey, pukes for 3 days straight, and ends up having a heart attack from their potassium being off because they are so dehydrated from puking. I can think of others, but why don't you go do some research on that yourself.

Or perhaps you want to quibble and say the death was from the dehydration or heart attack, not directly from the withdrawal. My point that someone may require immediate medical help because of withdrawal still stands.

Needing to eat a banana is not "requiring immediate medical help."

Opiate withdrawal is non-fatal. As much as it may suck, it will not kill you.

Seasonal rhinitis could lead to a death because someone driving sneezes and their eyes shut thus causing them to miss a stop sign leading to a car crash. However, ragweed allergies should not be considered fatal.

 

[Carboxide]

I said possibly, can you really think of no situations where it could possibly kill someone? Seriously? I agree its rare, but its no impossible. Here is one plausible scenario, someone who was already in bad health because of their opiate addiction, quits cold-turkey, pukes for 3 days straight, and ends up having a heart attack from their potassium being off because they are so dehydrated from puking. I can think of others, but why don't you go do some research on that yourself.

Or perhaps you want to quibble and say the death was from the dehydration or heart attack, not directly from the withdrawal. My point that someone may require immediate medical help because of withdrawal still stands.

Requiring 3 straight days to cause a situation that could possibly lead to death is hardly consistent with 'requiring immediate medical help.' What does the word 'immediate' mean to you?

Zelman: couldn't have put it better. Nice work.

 

[farmadiazepine]

Nobody can die from opioid withdrawal.

 

[BidingMyTime]

Needing to eat a banana is not "requiring immediate medical help."

If one can't stop puking, then eating a banana won't help.

Requiring 3 straight days to cause a situation that could possibly lead to death is hardly consistent with 'requiring immediate medical help.' What does the word 'immediate' mean to you?

Context. The immediate need for medical help is after the 3 days of straight puking. Not the point that they are at the pharmacist wanting their Oxy to prevent withdrawal.

To say its impossible for someone to die from Oxy withdrawal is irresponsible. Seriously, lets take a situation where a patient has decided to take themselves off their opiates, their SO calls you after 3 days and tells you the patient has puked up everything they eat or drank for the past 3 days. Would you A) tell them that there are problems with withdrawal form opiods and to just hang in there or B) tell them they need to call their doctor immediately or go to the ER? Something being extremely rare, doesn't mean its impossible or never happens.

 

[zelman]

If one can't stop puking, then eating a banana won't help.



Context. The immediate need for medical help is after the 3 days of straight puking. Not the point that they are at the pharmacist wanting their Oxy to prevent withdrawal.

To say its impossible for someone to die from Oxy withdrawal is irresponsible. Seriously, lets take a situation where a patient has decided to take themselves off their opiates, their SO calls you after 3 days and tells you the patient has puked up everything they eat or drank for the past 3 days. Would you A) tell them that there are problems with withdrawal form opiods and to just hang in there or B) tell them they need to call their doctor immediately or go to the ER? Something being extremely rare, doesn't mean its impossible or never happens.

If opioid withdrawal has a one in a billion chance of causing death, I've got about 999,990,000 more prescriptions to deny before I'm going to worry about it.

 

[KidPharmD]

Having seen several opiate withdrawals in the ER before, I would think that sole vomiting would be a very rare withdrawal. Quitting cold turkey usually comes with severe diarrhea, sweating, tremors, and even myoclonus. I think most people would end up in the ER long before they vomited themselves into an arrhythmia (probably wouldn't be a heart attack).

I also don't think that is without reason to warn patients about the potential issues of stopping their meds cold turkey. However, in the original scenario, the patient had two Rxs and he was able to fill one of them.