Is it just me

[Old]

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Is it just me that notices people who go to Dr. Feelgood come in barely able to speak or make eye contact whenever their appointment day and they get new rx's? They seem completely out of it on appointment day. They seem perfectly fine the rest of the month. You don't think they are actually are saving a few out to take before their blood test to check for blood levels of the narcotics do you? Why arent they incoherent the rest of the month?

I had another one yesterday that brought in a handful of narc scripts, told the tech he doesnt take morpine anymore , yet brings in a new script for it, told another tech that he is offered 35.00 a piece for them. Could barely understand him. today he is fine. Has an adderall script wants a particular brand because the other ones don't tast good. I always thought you were supposed to take them with water and swallow them. But I am old, what do I know.

While I am ranting did they recall tylenol, ibuprofen and all otc pain meds. why the h*** is everyone on norco, oxy's and if every other thing anymore.

Just wondering?? rant over, back to counting pills with a little tin knife.

 

[All4MyDaughter]

If someone was really that incoherent, why would you dispense a narcotic? Sounds like the patient needs medical assistance and shouldn't be driving.

As far as your other example, no way would I dispense narcs to someone who admits that they aren't taking it and plans to sell it.

 

[KidPharmD]

Under no circumstances would I dispense to either of these situations. You have one group that comes in looking impaired, that means they get no controlleds from me, and another who implies (admits) to the intent to sell - Him I would never dispense to again. That is a liability in case of a DEA investigation.

 

[Gombrich12]

How incoherent are we talking here? It seems like a quarter of the people I see on this stuff at least show some signs of impairment. Usually it's the slurred druggy voice. I always wanted a motorcycle until I worked in a pharmacy. I can't believe how many people are driving around impaired from drugs and age.

 

[Old]

How incoherent are we talking here? It seems like a quarter of the people I see on this stuff at least show some signs of impairment. Usually it's the slurred druggy voice. I always wanted a motorcycle until I worked in a pharmacy. I can't believe how many people are driving around impaired from drugs and age.

 

[Old]

1. I didn't fill the narcs for him. But, my partner will with no question. Every day, any day.

2. Groggy, not speaking well, seemed out of it. ALWAYS, appears that way on appointment day but no other day of the month. Him and several others that come in. Why would that be?

3. Said he is offered 35.00 a piece for morphine but didnt say he sold them. I am sure he would never do that. None of the people who go to the Dr. Feelgoods of the world ever sell their meds or use them illegally. That belief is just a myth.

Sometimes you just get tired of the narcotic game that occurs daily. You can't fill them with a clear conscience in my opinion anyway. Just get tired of the game somedays.

 

[BidingMyTime]

The older I get, the more I've become aware of the tremendous problems with chronic pain & its undertreatment, the more I give people the benefit of the doubt. Even if they are/were a junkie, it doesn't mean they don't have chronic pain. Still, the 2 situations you describe are quite troubling & outside of expected behavior of people being treated with chronic pain. Still, its not our job to provide drugs for those who have no medical need for them.

With the 1st situation, I think your guess that they are just taking their medicine on appointment day could be correct. 1st step, I would call the doctor and make him aware of what you've observed. 2nd and even more concerning, if the person drove themselves & is obviously impaired, I would call the police, you could literally be saving people's lives. (I called the police once on a woman who went through our drive through with a car full of little children who had no seatbelts or car seats.) Whether or not I decided to fill the prescription would depend on how the talk with the doctor went. If I did fill it, I would document everything, and if the same thing happened at that month, I would refuse to fill it. If the doctor completely blew off my concerns, I would refuse to fill it. What I would want from the doctor is a reasonable explanation of why he would be impaired (maybe he is getting a therapy or procedure done and the doctor gave him a shot of versed or something? Obviously he shouldn't be driving.....), or if the doctor promised to address my concerns, say by calling in the patient for an unannounced drug test mid-month.

2nd situation, I can't imagine why that guy would say that. Most legitimate pain treatment patients aren't discussing their medications with anyone outside close friends/family, so who is this guy talking about his medicines with that is offering him cash for his drug? And if the guy really is selling drugs, why would he be dumb enough to tell that to a pharmacy employee? I'd almost take that as a covert cry for help, that he wants to be caught. Or maybe he really just dumb. Again, my first step would be to call the doctor & discuss the situation with him. Maybe the doctor was going to try to wean him off the morphine or switch him to another medicine, but his pain increased. so he was restarted on the morphine?

I think your partner is setting himself up for big trouble by filling these prescriptions without asking questions.

 

[ancienbon]

That is good thread. The store I float most of the time has a good number of patients, if not most of them, who abuse their pain medications. Those patients have been on soma, and Percocet for a very long time, and don't see a pain specialist. They see a primary care physician who over prescribe Percocet. I refused one a few days ago, and the patient asked when the Rx manager was going to be , and I am sure he will fill it for him. I once was able to help one of our customer , a very nice one, get off Percocet. When I explained her the danger of taking Percocet for so long, she admitted that she does not feel good when she does not take it. I think she talked to her doctor about it.... She has not filled it for a few months now. Most of the patients who have been on theses drugs for a long time are not really on pain but they are just addicted.

 

[Old]

That is good thread. The store I float most of the time has a good number of patients, if not most of them, who abuse their pain medications. Those patients have been on soma, and Percocet for a very long time, and don't see a pain specialist. They see a primary care physician who over prescribe Percocet. I refused one a few days ago, and the patient asked when the Rx manager was going to be , and I am sure he will fill it for him. I once was able to help one of our customer , a very nice one, get off Percocet. When I explained her the danger of taking Percocet for so long, she admitted that she does not feel good when she does not take it. I think she talked to her doctor about it.... She has not filled it for a few months now. Most of the patients who have been on theses drugs for a long time are not really on pain but they are just addicted.

It is sometimes hard to tell the good from the bad which is an unfortunate situation. We have a "pain specialist" that is responsible for more drug addicts in my area than anyone. Is currently under investigation again. Is a DO and I think went to a weekend seminar and viola-a pain specialist. "She has not filled her Percocet for a few months now"- at your store I bet. Recently refused someone getting large quantities of Norco, morphine, percocet etc from several docs and phamacies. The guy looks gray/yellow. Cant fill stuff for people like that. Enough other stuff to worry about.

"Most of the patients who have been on theses drugs for a long time are not really on pain but they are just addicted"--- I agree completely. Sometimes starts innocently enough but then ends bad. Many others are bad from the start and are selling the stuff for cash. Speaking of cash-Don't you love the people who come in with multiple c2's , not your patient, say they have an insurance card but want to pay cash. Yea, okay. Not on my watch. Come back when the other guy is here-it will be all good.