Floater uses EpiPen on self without prescription

[wagrxm2000]

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So I got an interesting call from one of my techs today. I guess the floater today had a pretty bad reaction to the take out he ordered. While he does have a pen, he didn't have it on him nor has a script for a refill.

While I could care less and will just get a script tomorrow, do you think that's acceptable and would you do the same thing if a customer came running in asking for one?

 

[pencilandpen]

if a customer comes in with a serious emergency I would not hesitate for 1 second to give him a epipen.
the generic epipen is only $110 for a box, somebodys life is worth more than that.

 

[pencilandpen]

once i was having a really bad asthma attack and didnt have my proair with me i just grabbed one off the shelf and used it

 

[wagrxm2000]

if a customer comes in with a serious emergency I would not hesitate for 1 second to give him a epipen.
the generic epipen is only $110 for a box, somebodys life is worth more than that.

Would you get a script and charge them? If not how do you quantify that with your DM?

once i was having a really bad asthma attack and didnt have my proair with me i just grabbed one off the shelf and used it

I think this is going too far.

 

[owlegrad]

Lol why is epipen ok but proair too far? Just curious.

 

[pencilandpen]

Would you get a script and charge them? If not how do you quantify that with your DM?



I think this is going too far.

If I can identify who it is and get their insurance info i may go and get a script, but even if I dont get a script its just a box of generic epipen. A one time $110 shrink is just a drop in the bucket. As long as I keep my metrics up and my customer surveys good my DM doesnt care lol.

As for the proair I did it once, my DM didnt care either. What would have been the althernative? shut down the store and end up in ER, very likely couldve died from suffocation? Of course after that incident I made sure to carry my proair everywhere with me.

 

[wagrxm2000]

Lol why is epipen ok but proair too far? Just curious.

Where do you say no? If you have a terrible migraine would you grab a sumatriptan off the shelf?

 

[wagrxm2000]

If I can identify who it is and get their insurance info i may go and get a script, but even if I dont get a script its just a box of generic epipen. A one time $110 shrink is just a drop in the bucket. As long as I keep my metrics up and my customer surveys good my DM doesnt care lol.

As for the proair I did it once, my DM didnt care either. What would have been the althernative? shut down the store and end up in ER, very likely couldve died from suffocation? Of course after that incident I made sure to carry my proair everywhere with me.

Sorry not saying you shouldn't have, just seeing what others think.

 

[owlegrad]

Where do you say no? If you have a terrible migraine would you grab a sumatriptan off the shelf?

Personally I might (shhhh! Our secret) but regardless proair and epipen are both life-saving so I don’t see why one would be ok but the other one not.

 

[PA_dud3]

Would there be any legal ramifications if you did do this?

 

[owlegrad]

Would there be any legal ramifications if you did do this?

Could be, but it’s unlikely. Basically someone would have to report you to your BOP or call the cops.

Even ignoring the “praticing medicine” part, it is still theft regardless assuming you didn’t pay for the medication first.

 

[pencilandpen]

Where do you say no? If you have a terrible migraine would you grab a sumatriptan off the shelf?

when its life threatening, as in anaphylaxis, severe asthma attack and opioid over dose.
in the case of migraine I would say that's inappropriate to sumatriptan off the pharmacy stock, I would use ibuprofen and tylenol and suck it up.

in my state pharmacist can dispense emergency medication if in his/her judgment not doing so would be life threatening
I have interned/worked in NJ/PA/MD and I dont think any of these states specifically prohibits emergency dispensing of medication in a life threatening situation, correct me if I am wrong.

 

[pencilandpen]

Could be, but it’s unlikely. Basically someone would have to report you to your BOP or call the cops.

Even ignoring the “praticing medicine” part, it is still theft regardless assuming you didn’t pay for the medication first.

In the states I have worked in its not illegal, or at least as far as I know. As for "theft" I didnt steal it for my own profit....
My store also has a shrink budget, as long as I dont exceed that I am fine, I lose way more money from bad inventory practice than from a one off emergency dispensing of meds

 

[wagrxm2000]

when its life threatening, as in anaphylaxis, severe asthma attack and opioid over dose.
in the case of migraine I would say that's inappropriate to sumatriptan off the pharmacy stock, I would use ibuprofen and tylenol and suck it up.

in my state pharmacist can dispense emergency medication if in his/her judgment not doing so would be life threatening
I have interned/worked in NJ/PA/MD and I dont think any of these states specifically prohibits emergency dispensing of medication in a life threatening situation, correct me if I am wrong.

People get severe migraines making them completely unfunctional. What if you require your entire cocktail: sumatriptan, diphenhydramine, ketoralac, nalbuphine, etc.

 

[PA_dud3]

People get severe migraines making them completely unfunctional. What if you require your entire cocktail: sumatriptan, diphenhydramine, ketoralac, nalbuphine, etc.

Still, a migraine isn't exactly life threatening to the point you would have to take pharmacy stock for it, in my opinion. If it got to the point where you were nonfunctional I think it might be a better idea to contact your manager instead of just popping some imitrex

 

[owlegrad]

In the states I have worked in its not illegal, or at least as far as I know. As for "theft" I didnt steal it for my own profit....
My store also has a shrink budget, as long as I dont exceed that I am fine, I lose way more money from bad inventory practice than from a one off emergency dispensing of meds

How sure are you that you’re lost prevention department would agree with this? Because I’m very nearly 100% certain that it would not. You don’t have to have a profit motive for it to be theft...

 

[pencilandpen]

People get severe migraines making them completely unfunctional. What if you require your entire cocktail: sumatriptan, diphenhydramine, ketoralac, nalbuphine, etc.

it comes down to pharmacist judgement, I would give med for people whos suffocating right in front of me, but for a bad migraine they can go to the ER

 

[owlegrad]

when its life threatening, as in anaphylaxis, severe asthma attack and opioid over dose.
in the case of migraine I would say that's inappropriate to sumatriptan off the pharmacy stock, I would use ibuprofen and tylenol and suck it up.

in my state pharmacist can dispense emergency medication if in his/her judgment not doing so would be life threatening
I have interned/worked in NJ/PA/MD and I dont think any of these states specifically prohibits emergency dispensing of medication in a life threatening situation, correct me if I am wrong.

They don’t have to specifically prohibit it. Pharmacy law is usually inclusive not exclusive. So if they don’t specifically allow it that makes it illegal.

 

[pencilandpen]

How sure are you that you’re lost prevention department would agree with this? Because I’m very nearly 100% certain that it would not. You don’t have to have a profit motive for it to be theft...

i dont know, havent got into any trouble yet doing that. My student loan is paid off, I am willing to move anywhere, I have 12 months of emergency funds in savings account. But I think $110 is not worth the bad publicity.

bottom line is if somebody comes into my pharmacy and is suffocating from asthma or anaphylaxis or dying from any other condition I would not hesitate to help them. I have expressed this opinion to my bosses they agree with it.

if i do get let go then I will go for med school, been thinking about it but hesitating because making good money right now in pharmacy and getting lots of over time.

 

[johnpharm01]

There are three problems with using an epipen without prescription.
1. Theft
2. Possessing a prescription drug without a prescription
3. Administering a prescription as a pharmacist this is not allowed in my state unless anaphylaxis is due to an immunization that the pharmacist gave and an rx must be provided for this epipen.

Pencil and pen your suggestions I find illegal and unethical. I have seen staff get in trouble for simply taking a tablet of tylenol. Walgreens fired a diabetic for taking food off the shelf without paying for it before consuming it to stave off hypoglycemia. AHA BLS does not include training on the use of Epipen and how would you know its anaphylaxis- have you been trained in this area? Even Narcan in my state has to dispensed and PAID for in my state at my employer.

 

[wagrxm2000]

Still, a migraine isn't exactly life threatening to the point you would have to take pharmacy stock for it, in my opinion. If it got to the point where you were nonfunctional I think it might be a better idea to contact your manager instead of just popping some imitrex

I don't get migraines but the stories I get told from some customers that have severe cases is they pretty much are nonfunctional for the rest of the afternoon. I can't imagine what it would be like without all the medication they take.

 

[pencilandpen]

They don’t have to specifically prohibit it. Pharmacy law is usually inclusive not exclusive. So if they don’t specifically allow it that makes it illegal.

yes I think youre right in this statement. But I dont think the board is gonna persecute a pharmacist for saving somebody's life. Of course there is always a risk when doing it. Its a risk I am willing to take

 

[owlegrad]

i dont know, havent got into any trouble yet doing that. My student loan is paid off, I am willing to move anywhere, I have 12 months of emergency funds in savings account. But I think $110 is not worth the bad publicity.

bottom line is if somebody comes into my pharmacy and is suffocating from asthma or anaphylaxis or dying from any other condition I would not hesitate to help them. I have expressed this opinion to my bosses they agree with it.

if i do get let go then I will go for med school, been thinking about it but hesitating because making good money right now in pharmacy and getting lots of over time.

Sorry I think we are talking about two different things. I am talking about using said medications for self-medication, not on a patient.

 

[PA_dud3]

I don't get migraines but the stories I get told from some customers that have severe cases is they pretty much are nonfunctional for the rest of the afternoon. I can't imagine what it would be like without all the medication they take.

One of my relatives has migraines and is, as you said, nonfunctional when they do occur. However even with all the medications she takes (Imitrex, etc) she still is pretty much nonfunctional for the rest of the day, even after taking the medications. It's unfortunate but I don't really hold much stock in the "rescue" migraine medications in terms of their effectiveness.

 

[wagrxm2000]

I think you guys have bigger cojones then me.

Something bad could happen and you're screwed.

 

[wagrxm2000]

One of my relatives has migraines and is, as you said, nonfunctional when they do occur. However even with all the medications she takes (Imitrex, etc) she still is pretty much nonfunctional for the rest of the day, even after taking the medications. It's unfortunate but I don't really hold much stock in the "rescue" migraine medications in terms of their effectiveness.

I'm talking about yourself though, I'm not giving it out anyways. What about migraines that may lead to seizures?

 

[johnpharm01]

The road to hell is paved with good intentions. Call 911 provide care consistent with your training.

 

[pencilandpen]

There are three problems with using an epipen without prescription.
1. Theft
2. Possessing a prescription drug without a prescription
3. Administering a prescription as a pharmacist this is not allowed in my state unless anaphylaxis is due to an immunization that the pharmacist gave and an rx must be provided for this epipen.

Pencil and pen your suggestions I find illegal and unethical. I have seen staff get in trouble for simply taking a tablet of tylenol. Walgreens fired a diabetic for taking food off the shelf without paying for it before consuming it to stave off hypoglycemia. AHA BLS does not include training on the use of Epipen and how would you know its anaphylaxis- have you been trained in this area? Even Narcan in my state has to dispensed and PAID for in my state at my employer.

I am saying that because I have done it once before. In that incidence I gave the epipen but did not administer it. What youre saying it is more ethical that I shouldve withheld the epipen and possibly let them die? What I am trying to say is that somebody's life in an emergency is more important than a technicality.

 

[deleted103644]

Don’t know what your scope of practice is exactly, but this would certainly be against some state laws if not all of them.

EMTs aren’t allowed to administer an Epipen in most states unless it’s the patient’s own, so I can’t imagine pharmacists are allowed to do it either.

If there are loopholes for allergic reactions after vaccination, maybe it could be covered by that, but still think you would be on shaky ground.

 

[pencilandpen]

I think you guys have bigger cojones then me.

Something bad could happen and you're screwed.

theres always a risk. in that incidence i gave the epipen, did not administer it, and called 911. I have been taught how to use epipen, but never actually use one, and honestly if I did have to use one I would be quite nervous

 

[pencilandpen]

Don’t know what your scope of practice is exactly, but this would certainly be against some state laws if not all of them.

EMTs aren’t allowed to administer an Epipen in most states unless it’s the patient’s own, so I can’t imagine pharmacists are allowed to do it either.

If there are loopholes for allergic reactions after vaccination, maybe it could be covered by that, but still think you would be on shaky ground.

yea I DISPENSED epipen once, but did not actually ADMINISTERED it.

 

[PA_dud3]

I'm talking about yourself though, I'm not giving it out anyways. What about migraines that may lead to seizures?

I don't know, to my knowledge I've never had one. If I were a pharmacist, I still would be very hesitant to dispense anything in an emergency. Even in the case of anaphylaxis, I still think it would be best to call 911 and just do basic first aid/monitoring instead of jumping to administer something. If I were personally having a migraine, however I still would probably just take some Ibuprofen and trudge through the rest of the day.

 

[radio frequency]

Maybe give yourself a flu shot after the epi so you can claim it was due to a vaccine reaction? I kid.

Really, I think the float did the right thing in this situation. Maybe not legal, but still ok in my book in this situation. Just get an after the fact script to back the dispense up.

 

[wagrxm2000]

I don't know, to my knowledge I've never had one. If I were a pharmacist, I still would be very hesitant to dispense anything in an emergency. Even in the case of anaphylaxis, I still think it would be best to call 911 and just do basic first aid/monitoring instead of jumping to administer something. If I were personally having a migraine, however I still would probably just take some Ibuprofen and trudge through the rest of the day.

Yeah that's what I would do too.

Maybe give yourself a flu shot after the epi so you can claim it was due to a vaccine reaction? I kid.

Really, I think the float did the right thing in this situation. Maybe not legal, but still ok in my book in this situation. Just get an after the fact script to back the dispense up.

Oh if anyone asks you, tell them we had a script.

 

[RxPreceptor]

Still waiting for the first RPh to take Haloperidol & Ativan off the shelves and forcefully use on an unruly customer

 

[johnpharm01]

I am saying that because I have done it once before. In that incidence I gave the epipen but did not administer it. What youre saying it is more ethical that I shouldve withheld the epipen and possibly let them die? What I am trying to say is that somebody's life in an emergency is more important than a technicality.

Technicality, hardly. Like I said how would you know it was even anaphylaxis? We have all been trained to recognize symptoms but no OJT like drs do. I would encourage you to contact your BOP, your management at the store and get written directions in writing. Good luck.

 

[BMBiology]

So I got an interesting call from one of my techs today. I guess the floater today had a pretty bad reaction to the take out he ordered. While he does have a pen, he didn't have it on him nor has a script for a refill.

While I could care less and will just get a script tomorrow, do you think that's acceptable and would you do the same thing if a customer came running in asking for one?

Of course it is acceptable. Common sense > pharmacy law

 

[CetiAlphaFive]

i dont know, havent got into any trouble yet doing that. My student loan is paid off, I am willing to move anywhere, I have 12 months of emergency funds in savings account. But I think $110 is not worth the bad publicity.

bottom line is if somebody comes into my pharmacy and is suffocating from asthma or anaphylaxis or dying from any other condition I would not hesitate to help them. I have expressed this opinion to my bosses they agree with it.

if i do get let go then I will go for med school, been thinking about it but hesitating because making good money right now in pharmacy and getting lots of over time.

Bro what.

You need to invest

 

[wagrxm2000]

Of course it is acceptable. Common sense > pharmacy law

Well yeah like I said I could care less. Just trying to see where people draw the line.

Like someone mentioned above, theft would be a big issue. I could easily see someone just taking pens and saying they had to use them.

Oh and calling 911 is always an option. I would say get their opinion first, if they don't think they will get there in time, go ahead.

 

[lord999]

Could be, but it’s unlikely. Basically someone would have to report you to your BOP or call the cops.

Even ignoring the “praticing medicine” part, it is still theft regardless assuming you didn’t pay for the medication first.

Not in AZ, MN, TX, NY, or FL at least (I think CA as well). Emergent situations are excusable under extenuating circumstances for legend drugs (insulin to a diabetic, epi-pen in these situations). Just get the documentation done afterward and it's fine. There's no Board issue whatsoever. TX doesn't even require reconciliation with the prescriber under their emergency refill regulation.

I do expect that the pharmacist makes good on it from a cost standpoint afterwards (insurance or cash), but this is trivial to deal with.

 

[BMBiology]

Well yeah like I said I could care less. Just trying to see where people draw the line.

Like someone mentioned above, theft would be a big issue. I could easily see someone just taking pens and saying they had to use them.

Oh and calling 911 is always an option. I would say get their opinion first, if they don't think they will get there in time, go ahead.

If someone going to steal from the pharmacy, they would do it behind your back not come up with an elaborated scheme.


Sent from my iPhone using SDN mobile

 

[wagrxm2000]

If someone going to steal from the pharmacy, they would do it behind your back not come up with an elaborated scheme.


Sent from my iPhone using SDN mobile

Hey you never know.

Maybe your pharmacist really wants to help out with the opioid crisis and takes a box of Narcan everyday and gives it to someone they think needs it.

 

[pencilandpen]

Hey you never know.

Maybe your pharmacist really wants to help out with the opioid crisis and takes a box of Narcan everyday and gives it to someone they think needs it.

actually theres a sign in my pharmacy promoting that it is available with out a prescription under a standing order and most insurances will cover it, so yea I am trying to get as many narcan out there as possible.
more script count for me, more narcan out there to save a life, win win

 

[wagrxm2000]

actually theres a sign in my pharmacy promoting that it is available with out a prescription under a standing order and most insurances will cover it, so yea I am trying to get as many narcan out there as possible.
more script count for me, more narcan out there to save a life, win win

Oh I didn't mean through insurance, straight stealing it and going out to the back alley and giving it to the first person they see.

We give Narcan all the time to customers that ask for it. Every customer that's on an opioid gets asked if they want it.

 

[PA_dud3]

Oh I didn't mean through insurance, straight stealing it and going out to the back alley and giving it to the first person they see.

We give Narcan all the time to customers that ask for it. Every customer that's on an opioid gets asked if they want it.

We had a person that came in asking for Narcan and Disulfiram one day. We can't dispense Narcan without a prescription, but I hate to think what might have been happening at home for them to ask for those two. I don't even know if they make Disulfiram anymore.

 

[Niosh]

once i was having a really bad asthma attack and didnt have my proair with me i just grabbed one off the shelf and used it

My old boss did this and got fired for it. "Dispensing without a license" as she was a tech.

 

[pencilandpen]

My old boss did this and got fired for it. "Dispensing without a license" as she was a tech.

well I did get a prescription and paid for it by the end of the day. but i guess you still need a pharmacist to dispense meds

 

[Deja]

People get severe migraines making them completely unfunctional. What if you require your entire cocktail: sumatriptan, diphenhydramine, ketoralac, nalbuphine, etc.

being nonfunctional is different than life/death

I wonder what the news headline would be if someone actually dies in the pharmacy because the pharmacist didn't give epipen

 

[owlegrad]

being nonfunctional is different than life/death

I wonder what the news headline would be if someone actually dies in the pharmacy because the pharmacist didn't give epipen

Wonder no more! It would look exactly like this: Case against pharmacist who refused EpiPen struck out

 

[Deja]

Wonder no more! It would look exactly like this: Case against pharmacist who refused EpiPen struck out

lol that was fast but this is a little different, seems like the mom just ran to the pharmacy and demanded a pen without giving any details

also it wasn't in US, US news are way more sensationalized lol