Junkie Response Thread

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RX2090

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For entertainment purposes. A light hearted thread, something different. How do you guys respond to obvious junkies who try and fill controlled substances at your pharmacy? Especially the ones who are persistent.

The guy who fills a 473 mL bottle of Prometh-Codeine, 30 mL a day and come every 14 days for an entirely new bottle.

The fellas who have their Oxy 30, take 2 tablets 5x a day, #300

The girl who wants to get her Alprazolam 2 mg, take 3 tablets 3 times a day, #270.

You get the jist. Sometimes you can simply say "I don't have it in stock." But they'll say "order it for me." You can counter with an "I think it's on back order, I've been ordering it for a while." But they sometimes insist on leaving the script with you.

Does anyone actually outright say "I'm not filling this because I don't feel comfortable?" I think that's like asking for a confrontation...

Discuss
 
As an intern (I never worked retail as a pharmacist) my pharmacists almost always said they were out of stock and the patient would leave and go to another pharmacy. If I was uncomfortable I would tell the patient that and would tell them that I could hold the script and call the doctor's office when it opened up. I worked nights and weekends. No one ever waited for me to call the doctor. There were times I thought the patient may get confrontational when I expressed my concerns about the script but thankfully it never got to that point. I know it's common practice but I don't like lying and saying it's not in stock when it really is.
 
I took care of a woman who was on megadoses of valium. Like 10mg q 4 hours round the clock. With additional 10mg PRN doses available up to 2x per day. She had stiff person syndrome, and keeping to that dosing schedule was the only thing that allowed her to be even minimally functional. She said that once when she had been unable to fill her prescription, she had gone into withdrawal and ended up tubed in the ICU secondary to seizures. (No information about why she had been unable to fill the script. I'm not blaming any pharmacists.)

I get that she is the exception, and not what you are talking about at all. I also have had loved ones with addictions to prescription drugs, and I truly appreciate the importance of pharmacists in reining in that scourge. It would just be nice if there were some reliable way to screen for legitimate medical need versus recreational drug seeking. Instead real patients suffer because they are mistaken for junkies.
 
Promethean said:
I took care of a woman who was on megadoses of valium. Like 10mg q 4 hours round the clock. With additional 10mg PRN doses available up to 2x per day. She had stiff person syndrome, and keeping to that dosing schedule was the only thing that allowed her to be even minimally functional. She said that once when she had been unable to fill her prescription, she had gone into withdrawal and ended up tubed in the ICU secondary to seizures. (No information about why she had been unable to fill the script. I'm not blaming any pharmacists.)

I get that she is the exception, and not what you are talking about at all. I also have had loved ones with addictions to prescription drugs, and I truly appreciate the importance of pharmacists in reining in that scourge. It would just be nice if there were some reliable way to screen for legitimate medical need versus recreational drug seeking. Instead real patients suffer because they are mistaken for junkies.
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I think as long as the patient provides a complete picture of their medication history with "one" pharmacy then I don't think there's any issue with any pharmacist filling any controls.

It's the patients who go to different pharmacies, different doctors, always pay cash, always get controls only and nothing else, always wanting to fill controls early... you get the drift.
 
I take a controlled medication (testosterone) because my body doesn't make it. I have gotten serious flack from pharmacists who have treated me as if I presented a rx for heroin because I am a young (looking) man taking testosterone injections. I guess they assume that I am using it for bodybuilding, but one look at my physique ought to disabuse them of that notion.

Until recently, when I found a really pleasant Target pharmacy, getting my prescription filled has always meant a lot of hassle. I've been told that "we don't stock it" when I know very well that they do because I know an older guy who gets his filled there, and "we have to call and confirm this with your doctor," etc. while the techs give me the evil eye. I've gone to different pharmacies because of the way that I was treated at the one before. I have to pay cash because my insurance refuses to cover transgender related health care.

I'm on a relatively low dose, so a 10mL vial can last just over 6 months. One pharmacist refused to fill it for this reason, and told me that I would have to have the doc write for 1 mL vials (Which cost 4x as much.) She also refused to return the prescription to me, tearing it up so that I had to go back to my doctor's office to obtain a new script to take elsewhere. So, my doctor generally trusts me, but she found it so unbelievable that the pharmacist had shredded the script that she still called the pharmacy to confirm my story.

Being treated like a drug seeking junkie can cause some of the behaviors you identify as indicators of being a drug seeking junkie. Especially when it happens every time you step to a pharmacy counter. I actually teared up a little when my current pharmacist didn't put me through the third degree, but just filled my rx. I'm anxious because she is out on maternity leave, and I have to get a new vial.
 
Promethean said:
I take a controlled medication (testosterone) because my body doesn't make it. I have gotten serious flack from pharmacists who have treated me as if I presented a rx for heroin because I am a young (looking) man taking testosterone injections. I guess they assume that I am using it for bodybuilding, but one look at my physique ought to disabuse them of that notion.

Until recently, when I found a really pleasant Target pharmacy, getting my prescription filled has always meant a lot of hassle. I've been told that "we don't stock it" when I know very well that they do because I know an older guy who gets his filled there, and "we have to call and confirm this with your doctor," etc. while the techs give me the evil eye. I've gone to different pharmacies because of the way that I was treated at the one before. I have to pay cash because my insurance refuses to cover transgender related health care.

I'm on a relatively low dose, so a 10mL vial can last just over 6 months. One pharmacist refused to fill it for this reason, and told me that I would have to have the doc write for 1 mL vials (Which cost 4x as much.) She also refused to return the prescription to me, tearing it up so that I had to go back to my doctor's office to obtain a new script to take elsewhere. So, my doctor generally trusts me, but she found it so unbelievable that the pharmacist had shredded the script that she still called the pharmacy to confirm my story.

Being treated like a drug seeking junkie can cause some of the behaviors you identify as indicators of being a drug seeking junkie. Especially when it happens every time you step to a pharmacy counter. I actually teared up a little when my current pharmacist didn't put me through the third degree, but just filled my rx. I'm anxious because she is out on maternity leave, and I have to get a new vial.
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The 1 mL vials should be used at that dosage.

From http://www.cdc.gov/injectionsafety/providers/provider_faqs_multivials.html:

When should multi-dose vials be discarded?
Medication vials should always be discarded whenever sterility is compromised or questionable.
In addition, the United States Pharmacopeia (USP) General Chapter 797 [16] recommends the following for multi-dose vials of sterile pharmaceuticals:
  • If a multi-dose has been opened or accessed (e.g., needle-punctured) the vial should be dated and discarded within 28 days unless the manufacturer specifies a different (shorter or longer) date for that opened vial.
  • If a multi-dose vial has not been opened or accessed (e.g., needle-punctured), it should be discarded according to the manufacturer’s expiration date.
The manufacturer’s expiration date refers to the date after which an unopened multi-dose vial should not be used. The beyond-use-date refers to the date after which an opened multi-dose vial should not be used. The beyond-use-date should never exceed the manufacturer’s original expiration date.
 
But then why does a 10 mL vial exist? Why is that the standard quantity dispensed to every person I know who uses it for this application? No one uses that much in a month, unless they are abusing it.

I don't produce any androgen endogenously and I maintain therapeutically appropriate levels in the middle to high end of the normal range on about 1.7 mLs (280mg) per month, in divided doses.

Also, sterility was not the reasoning used by the pharmacist who destroyed my script, but I'm sure she would have used that excuse if she had thought of it. She tallied up the dosage I was on at that time, determined that the doc had written for 6.25 months worth and destroyed the script on the basis that controls cannot be written for longer than 6 months. That was the second time I had gone to that pharmacy, and the first time she gave me the "we don't stock it, here," excuse and got really irritated when I said that I would be happy to wait for it to be ordered in, as I knew the chain carried it, since I'd filled it before at a different store. I came back in, and she confirmed that they had ordered it, but let's see... oh, I'm going to have to inconvenience you by tearing up your prescription. Thanks for shopping at Rite Aid.

If I had to use 1 mL vials, not only would that be so much more expensive, and all out of pocket, but I would have to endure the harassment and suspicion at the pharmacy counter that much more often. My doctor just changed how she wrote the prescription, so that now, according to the written instructions, I run out every 5 months. But since I'm also supposed to titrate to serum levels, I continue administering my customary dosage.
 
RX2090 said:
Does anyone actually outright say "I'm not filling this because I don't feel comfortable?" I think that's like asking for a confrontation...
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"Maximum regulatory purchases exceeded." Actually true

"It has been too long since this script was written" (for ED scripts regardless of what state law permits. No excuse to hang on to one for 2 months just to "redeem" it)

This is asking for confrontation regardless.

Scripts for 10 mL testosterone vials can be filled at another pharmacy. Liability issues, just asking for a chargeback (waste) when it's completely avoidable if single-use vials are available, etc.
 
Promethean said:
But then why does a 10 mL vial exist? Why is that the standard quantity dispensed to every person I know who uses it for this application? No one uses that much in a month, unless they are abusing it.

I don't produce any androgen endogenously and I maintain therapeutically appropriate levels in the middle to high end of the normal range on about 1.7 mLs (280mg) per month, in divided doses.

Also, sterility was not the reasoning used by the pharmacist who destroyed my script, but I'm sure she would have used that excuse if she had thought of it. She tallied up the dosage I was on at that time, determined that the doc had written for 6.25 months worth and destroyed the script on the basis that controls cannot be written for longer than 6 months. That was the second time I had gone to that pharmacy, and the first time she gave me the "we don't stock it, here," excuse and got really irritated when I said that I would be happy to wait for it to be ordered in, as I knew the chain carried it, since I'd filled it before at a different store. I came back in, and she confirmed that they had ordered it, but let's see... oh, I'm going to have to inconvenience you by tearing up your prescription. Thanks for shopping at Rite Aid.

If I had to use 1 mL vials, not only would that be so much more expensive, and all out of pocket, but I would have to endure the harassment and suspicion at the pharmacy counter that much more often. My doctor just changed how she wrote the prescription, so that now, according to the written instructions, I run out every 5 months. But since I'm also supposed to titrate to serum levels, I continue administering my customary dosage.
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Why do 10mL vials exist? That argument does not hold up. Why do armor piercing cop killer bullets exist if I'm not supposed to shoot at law enforcement officers?

But really, they probably officially exist for institutional and compounding use, and practically exist because people abuse testosterone. Pharma is more concerned with sales than preventing widespread drug misuse epidemics. The makers of OxyContin founded several organizations via shell corporations to advocate for pain relief to be considered a "vital sign" and "patient right" and brainwash doctors into turning as many people into addicts as possible.

Trust me, I feel bad for your situation, but I also don't want you to end up with osteomyelitis. What insurance do you have? We should probably post that to publicly shame them here. They should be paying for this.
 
zelman said:
Trust me, I feel bad for your situation, but I also don't want you to end up with osteomyelitis. What insurance do you have? We should probably post that to publicly shame them here. They should be paying for this.
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The one owned by the hospital system where I worked for years, which also is an insurance company. Which also denied me coverage for blood tests unrelated to transgender healthcare, because transgender. Also, refused to cover routine gyne exams, because transgender.

I have to pay out of pocket for things that other people would have covered, because what if it were related to my gender issues. That would make a CBC and BMP into experimental care rather than routine health care. This isn't actually that unusual. There are a couple of places that have made this kind of discrimination by insurance companies illegal, so that trans related health care has to be covered, but in like 47 states, it is still perfectly legal and is common practice by virtually all companies in those areas.

Don't get me wrong. I am very grateful to have access to healthcare at all. I am far more fortunate than many. I have a sympathetic physician and I can afford to pay more for my care. It is just that when I am doing so, running into more hassle when I try to fill my prescription is salt in the wound.
 
Wow that is crazy. I don't even think it is legal to tare up a prescription. I bet you could report that pharmacist to the BOP if you were so inclined.

I will say there has been many times my pharmacy has been unable to get testosterone in a timely fashion for whatever reason (we hit our ceiling for the month, backstock, w/e). I often wonder if people think I am lying when I say we are having a hard time getting it in. Based on this thread I think it is an obvious "yes", lol.
 
zelman said:
The 1 mL vials should be used at that dosage.

From http://www.cdc.gov/injectionsafety/providers/provider_faqs_multivials.html:

When should multi-dose vials be discarded?
Medication vials should always be discarded whenever sterility is compromised or questionable.
In addition, the United States Pharmacopeia (USP) General Chapter 797 [16] recommends the following for multi-dose vials of sterile pharmaceuticals:
  • If a multi-dose has been opened or accessed (e.g., needle-punctured) the vial should be dated and discarded within 28 days unless the manufacturer specifies a different (shorter or longer) date for that opened vial.
  • If a multi-dose vial has not been opened or accessed (e.g., needle-punctured), it should be discarded according to the manufacturer’s expiration date.
The manufacturer’s expiration date refers to the date after which an unopened multi-dose vial should not be used. The beyond-use-date refers to the date after which an opened multi-dose vial should not be used. The beyond-use-date should never exceed the manufacturer’s original expiration date.
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Even at 200mg q week, you're not using it all in 28 days, and most aren't taking that high of a dose. NY law even carves out the ability to dispense 6 months of testosterone instead of the usual 3 month max, likely because most patients won't use up the vial in 3 months. I'll have to check the PI if they have a longer BUD.
 
owlegrad said:
I often wonder if people think I am lying when I say we are having a hard time getting it in. Based on this thread I think it is an obvious "yes", lol.
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Attitude counts for a lot. I get that it isn't a statin or SSRI, that everyone and their cousin is on. So, when someone is decent to me and seems genuinely apologetic, I believe them.

The pharmacist in question is very clearly of a particular conservative religious group (which one is irrelevant) and disagrees with my "lifestyle." I'm not just speculating about that. It wasn't my first run-in with her, though it was my last. So, she manufactured a reason not to fill the script. It certainly wasn't about my best interests as a patient.

Huh. I just assumed that she was within her professional rights to destroy a rx that she determined to be illegal / excessive. Didn't even question the legality of her action, just the common decency of it. Even if she did overstep, I am not so vindictive as to chase her down 3-4 years after the fact to try to pursue a grievance at this point. Just keep moving right along, letting karma clean up messes like her.

She has to live in that hateful mind her whole life, after all. That is a worse punishment than any I would or could inflict.
 
Ackj said:
Even at 200mg q week, you're not using it all in 28 days, and most aren't taking that high of a dose. NY law even carves out the ability to dispense 6 months of testosterone instead of the usual 3 month max, likely because most patients won't use up the vial in 3 months. I'll have to check the PI if they have a longer BUD.
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I would be so grateful for that information. I googled a little and couldn't find anything readily available online, and I don't have the inserts for any old vials laying around.

I'm curious if being an oil based suspension makes it more or less likely to become contaminated. I'd expect less, since I can't imagine there are a lot of human pathogens that thrive in sesame oil, but that is just conjecture. Regarding this matter, I'm just a patient, so what do I know?
 
zelman said:
The 1 mL vials should be used at that dosage.

From http://www.cdc.gov/injectionsafety/providers/provider_faqs_multivials.html:

When should multi-dose vials be discarded?
Medication vials should always be discarded whenever sterility is compromised or questionable.
In addition, the United States Pharmacopeia (USP) General Chapter 797 [16] recommends the following for multi-dose vials of sterile pharmaceuticals:
  • If a multi-dose has been opened or accessed (e.g., needle-punctured) the vial should be dated and discarded within 28 days unless the manufacturer specifies a different (shorter or longer) date for that opened vial.
  • If a multi-dose vial has not been opened or accessed (e.g., needle-punctured), it should be discarded according to the manufacturer’s expiration date.
The manufacturer’s expiration date refers to the date after which an unopened multi-dose vial should not be used. The beyond-use-date refers to the date after which an opened multi-dose vial should not be used. The beyond-use-date should never exceed the manufacturer’s original expiration date.
Click to expand...

You would have to contact the manufacturer. The guidelines listed above are for health care facilities and doctors offices. This may not apply to patients. Unless the package insert says so, I would think it would be fine to use it past 28 days.
 
WVUPharm2007 said:
Yes. Grow a spine and put your foot down. I do it at least once a week, sometimes every night.
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This. Actually we tell them we won't fill them for X reason and they don't even argue it.
 
RX2090 said:
You get the jist. Sometimes you can simply say "I don't have it in stock." But they'll say "order it for me." You can counter with an "I think it's on back order, I've been ordering it for a while." But they sometimes insist on leaving the script with you.
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If they insist on leaving the script, I would answer with: I will keep a photocopy and try to order, if the med comes in, I will call you so you can bring in the original paper. In the mean time, take the original with you and try other pharmacies.


RX2090 said:
Does anyone actually outright say "I'm not filling this because I don't feel comfortable?" I think that's like asking for a confrontation...
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Depending on how in pain the patient is. The keyword of comfortable can trigger an attack from patient.
You: I'm not filling this because I don't feel comfortable.
Patient in pain: Comfortable? Do you even know the meaning of comfortable? I am un-confortable here. I am in pain. Every hour, every minute. That's why I get this script to relieve my pain. Don't you dare to tell me about comfortable because I haven't had any for the past 10 years......I can NOT sleep, I can NOT work. I am not comfortable. I am a burden to everyone. I try to get the med myself and I get mistreated everywhere. I tried to not take med and I went into withdrawal and ended up in emergency room.....Do you feel comfortable after car accident? Because I don't. Did I ask for car accident? No I didn't.
Put yourself in my shoe and feel the pain.....

Having family member with cancer, I feel the pain. So, please be on your best human behaviors please folks.

There are patients truly in pain.
 
"I'm not comfortable filling this prescription" is usually all it takes.

If they want to argue it you can offer a few explanations:
-You are not comfortable with the dosage
-"After reviewing the patient profile I'm just not comfortable filling this"
-If it's someone who has never used your pharmacy you can say you don't have it in stock, but I'd try to avoid this one and only use it on people who haven't filled there before otherwise they will want you to order it
-If the patient lives out of town you could say you are not comfortable filling controlled substances from out of town

Some people just leave as if this is expected (probably just got denied at the previous 3 pharmacies) and some will throw a fit, saying "call my doctor" blah blah blah. "I'm not questioning the authenticity of the prescription, I am just not comfortable filling it"... then brace yourself for the explosion.

Obviously some people are in pain, but what people don't seem to understand that the pharmacist has no obligation to fill anything that he/she is not comfortable with as far as controlled substances goes and the patient is welcome to use any other pharmacy. No need to play "victim"

Fibromyalgia and lower back pain are not a good reason to be on high doses of oxycontin and dilaudid
 
If they argue excessively I'd kick them out. I'v seen pharmacists kick plenty of people out of the store, one floater even told a guy to take his Lortab and blow it up his ass. The guy got a CVS gift card out of it but still no Lortab 🙂
 
If you just tell them no they will stand at the counter and either stare at you until you continue talking or flip out. I like to just stare back until they leave.
 
Then you tell them to leave or you are calling the cops because they are trespassing. They try it because it makes cowardly pharmacists to cave or use some bogus lie

all chains have a policy that mandates you not fill if it's not for a valid medical reason. That is a 100% concrete way out of filling anything. If something needs a doctor call write "validate" on it before you talk to the patient. They will either leave it with you or never come back since they hate you for writing on the rx

its amazing how much seakers leave you alone once you stop playing around with them and take a firm line
 
SClENCE said:
If they argue excessively I'd kick them out. I'v seen pharmacists kick plenty of people out of the store, one floater even told a guy to take his Lortab and blow it up his ass. The guy got a CVS gift card out of it but still no Lortab 🙂
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It really isn't a good idea to suggest that alternate route of administration to a drug seeker. Given the greater bio-availability / avoidance of first pass, he will likely experience considerably greater effect, should he take your advice literally. 😀
 
Ackj said:
Even at 200mg q week, you're not using it all in 28 days, and most aren't taking that high of a dose. NY law even carves out the ability to dispense 6 months of testosterone instead of the usual 3 month max, likely because most patients won't use up the vial in 3 months. I'll have to check the PI if they have a longer BUD.
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Hubbs is on testo IM due to cancer/rad treatments and Im a PharmD so naturally got quite involved in the testo expiration debate.

I called 2 manufacturers and could not get any testing beyong the 28 day BUD of multidose vials. So thats the max day supply a 10ml vial can be supplied for. Hubbs also had extra medication I would throw away every month due to the unavailability of the 1ml vials in the 2011-2013 years. I bet the bodybuilding guys would have loved to get at my sharps container. We usually did mail order (Caremark) but when we couldnt/had availability issues and had to go to local stores it was a PAIN.

Publix got hit with a insurance chargeback due to giving the 10ml vials 28 days expiration (insurance said they should have given actually supply ie 90 days) when I was a lowly 4PD and when I pointed out to the Pharmacy manager this was not correct she was quite surprised the issue wasnt discovered on a corporate level.

Anyway nowadays hes a guinea pig on Aveed for more consistent levels so its a non issue for us.
 
Though I don't think that insurance companies should pay for gender changes I don't personally support it the pharmacist has no right to tear up a prescription and it is illegal.
 
sakigt said:
Hubbs is on testo IM due to cancer/rad treatments and Im a PharmD so naturally got quite involved in the testo expiration debate.

I called 2 manufacturers and could not get any testing beyong the 28 day BUD of multidose vials. So thats the max day supply a 10ml vial can be supplied for. Hubbs also had extra medication I would throw away every month due to the unavailability of the 1ml vials in the 2011-2013 years. I bet the bodybuilding guys would have loved to get at my sharps container. We usually did mail order (Caremark) but when we couldnt/had availability issues and had to go to local stores it was a PAIN.

Publix got hit with a insurance chargeback due to giving the 10ml vials 28 days expiration (insurance said they should have given actually supply ie 90 days) when I was a lowly 4PD and when I pointed out to the Pharmacy manager this was not correct she was quite surprised the issue wasnt discovered on a corporate level.

Anyway nowadays hes a guinea pig on Aveed for more consistent levels so its a non issue for us.
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Thank you for sharing your research into this matter.

I plan to continue use of the 10mL vials, for longer than 28 days, as I believe that recommendation to be excessively conservative for a single patient using the drug at home (with fastidious aseptic technique, might I add.) I think that it takes into consideration the breaches of sterility that can occur in an institutional setting, where the person handling the vial can change shift to shift, and where a vial may be accessed much more frequently than once per week. But it is good to at least know where the lines are drawn.
 
SClENCE said:
Though I don't think that insurance companies should pay for gender changes I don't personally support it the pharmacist has no right to tear up a prescription and it is illegal.
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I'm not going to argue with your opinion, however shortsighted I believe it to be. I want to reiterate that insurance companies have used the fact that they don't pay for transgender related care to define all my healthcare as transgender related. Insurance companies want to avoid paying for anything that they possibly can, and I have even had their representatives lie to me to get me to pay bills that should have been covered. Routine care that had nothing whatsoever to do with my gender. That might also be illegal, but individuals have a hard road to having their legal rights enforced.

It is easy to for you to say what you think about someone else's access to healthcare (that they are paying for, by the way.) I genuinely hope that you never have to know what it is like to face real, pervasive discrimination and barriers to care, even though I think that would change your mind pretty quickly.
 
RX2090 said:
Does anyone actually outright say "I'm not filling this because I don't feel comfortable?" I think that's like asking for a confrontation...
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I was taught in pharmacy school way back in the dark ages to be straight foward and not to lie. I have always been honest....I will say "I'm not filling this because you are 2 weeks early and I will have to talk to your doctor first." (they will then say, I'm going on vacation, my doctor told me take more, my med was stolen, etc. and I will reiterate that regardless of the reason I will need to speak with their doctor.) or if this is an on-going problem with a pill-mill doctor I will say "I'm not filling this because you have been 2 weeks early for the past 6 months. Yes, I have talked to your doctor, I still can not fill your prescription." If appropriate, I might say "you are 2 weeks early, I can not fill your prescription until April 25, call back then and your prescription will be filled on that date."

If there is a dangerous level of overuse, I will be straightward and tell them about the health concerns (liver damage with Norco, etc.) with their overuse and encourage them to talk to their doctor about more appropriate pain treatments. I will tell them that I can not fill their prescription because of those health concerns.

Sure, some people get mad, but as long as you are professional and refuse to budge they will leave (and probably come back the next shift to try a different pharmacist.) I've never been threatened, if I were, I would immediately call the police. I have had some people call or come back repeatedly ever hour hoping I would change my mind (I didn't.) They, of course, always have the option to take their prescription to another pharmacy.

You aren't doing the addict any favors by making up stories to avoid confrontation (that sounds like co-dependency to me.) Just be honest about your reasons for not filling their prescription, be non-emotional, and regardless of the reasons they give stick to your original line of "I will have to talk to your doctor first." or "I can not fill your prescription." Once you get a reputation, you will be less likely to be bothered by patients who know they aren't going to get you to change your mind.
 
Promethean said:
I'm on a relatively low dose, so a 10mL vial can last just over 6 months. One pharmacist refused to fill it for this reason, and told me that I would have to have the doc write for 1 mL vials (Which cost 4x as much.)
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The amount that can be dispensed varies by state law. If insurance is paying, then the patient may very well be limited to 1ml vials for a 30 or 90 day supply. You indicate you pay cash and your prescription lasts over 6 months. In IL, this could not be legally dispensed to you, as the maximum for a CIV that can be dispensed at any time is 6 months or less. If 10 mls puts you even 1 day over 6 months, then the pharmacy must legally dispense a smaller amount of 1 ml vials. I know the cost difference sucks, but the law is the law. I suspect that your state has a similar law, and while you may have gotten "lucky" with some pharmacists who ignored the law, you can't blame the pharmacist who was actually following the law for not giving you a 10ml vial.

As for the sterility issue, I counsel patients on what is recommended. Reality is, because of cost, patients will use vials longer than is recommended (especially insulin vials.) Practically speaking, if the patient is using good sanitary practices (clean needle each time, alcohol swab, etc. the risk is small, not negligible, but small.)

She also refused to return the prescription to me, tearing it up so that I had to go back to my doctor's office to obtain a new script to take elsewhere. So, my doctor generally trusts me, but she found it so unbelievable that the pharmacist had shredded the script that she still called the pharmacy to confirm my story.
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This is illegal (I assume this was a prescription the doctor gave you, and not a phone-in or e-rx prescription) I guess I can't speak for every state, but I'm fairly confident that in almost every state, if not every state, the prescription belongs to the patient and must be returned to the patient if the patient asks for it. (The exception is if the pharmacist has verified with the doctor that the script was written on a stolen script pad or something similar and was not actually authorized by the doctor, in that case the pharmacist can legally keep it.)
As your experience happened 3 - 4 years ago, it isn't worth making a big deal about it now, but you should know this for yourself in the future (and for your future patients.)
 
Now for the next step. How many of you have had the balls to say no even when a (sketchy) physicians tries to give you a reason why their patient needs their meds early?

Those are always fun. "Oh, you're going to call the board? And what? Complain that I wouldn't fill a narcotic 8 days early for reasons that appeared dubious to me? You go right ahead."

I piss drug seekers off royally. I mean, they HATE me. 4+ years of this **** has made me a bitter, war hardened dubious narc prescription denier.
 
BidingMyTime said:
This is illegal (I assume this was a prescription the doctor gave you, and not a phone-in or e-rx prescription) I guess I can't speak for every state, but I'm fairly confident that in almost every state, if not every state, the prescription belongs to the patient and must be returned to the patient if the patient asks for it. (The exception is if the pharmacist has verified with the doctor that the script was written on a stolen script pad or something similar and was not actually authorized by the doctor, in that case the pharmacist can legally keep it.)
As your experience happened 3 - 4 years ago, it isn't worth making a big deal about it now, but you should know this for yourself in the future (and for your future patients.)
Click to expand...


I was under the impression that NYS official prescriptions belonged to the state of NY.
 
I don't understand why you guys waste time saying "i'm not comfortable" or "I can't fill this because". It is a waste of time and in some cases will end up in a 10 minute conversation that is a huge waste of time. I have no problem lying to junkies and telling them I don't have it in stock It saves me time and makes my life easier. While I give them the scripts back I tell them I don't have it in stock and we will have it in stock in 5 days. Then I walk away. I have never had a junkie ever say anything back. They always take their scripts and leave. When I used to work overnight at first I would I have a line out the door at 12:01 every night. After a couple months of me working there we had none. Most junkies aren't ******ed, some probably know im lying. But who cares they are a bunch of junkies. Your choice is tell them out of stock and they leave, or use that i'm not comfortable blah blah blah line and end up having a 10 min back and forth conversation.
 
npage148 said:
That just makes you a coward. Telling them you are not filling because it's not legit takes the same amount of time. "I'm not filling it and if you have no other business I ask that you leave the store"
Click to expand...

Oh....So you have oxycodone 30 mg but you're not going to fill it for me? Good to know. See you later when the time is right....
 
I've been called a ****** (rhymes with rabbit), bitch, chink, what have you for denying scripts outright (I don't use the "out of stock" excuse). Come at me bro lol
 
CUpharmD2013 said:
Oh....So you have oxycodone 30 mg but you're not going to fill it for me? Good to know. See you later when the time is right....
Click to expand...

That's a stupid position to take. It's obvious we are loaded with narcotics all the time so would one upset guy rattle you? If you're worried some junky making idle threats your should find new job. If you think the threat is credible, you call the cops and make a report, if not move on.
 
npage148 said:
That's a stupid position to take. It's obvious we are loaded with narcotics all the time so would one upset guy rattle you? If you're worried some junky making idle threats your should find new job. If you think the threat is credible, you call the cops and make a report, if not move on.
Click to expand...

Why is it so OBVIOUS that we are loaded with narcotics? I have the big guns in stock for a select few patients who I know can be trusted. From how you're talking, I'm guessing you don't work in a low income/high crime area. What will calling the cops and making a report do if we don't know when they'll return to rob us? The cops aren't going to provide us with 24/7 monitoring and what am I going to tell them? Mr. Junkie with a script for his grandma who looks like every other junkie may or may not have made a valid threat on our pharmacy.
 
If you work at a low volume setting like the overnight shift it's easier to spend time telling the junkies no. But when it's a busy day shift easier to sometimes say out of stock
 
Just repeat after me: "I can't help you with this." That's all. "I can't help you with this." They get the message.
 
npage148 said:
That just makes you a coward. Telling them you are not filling because it's not legit takes the same amount of time. "I'm not filling it and if you have no other business I ask that you leave the store"
Click to expand...

Have you ever worked in retail??? I guarantee you telling them your not filling it because it is not legit DOES NOT take the same amount of time. They will engage you in an useless back and forth conversation. Just tell them you don't have it in stock and keep it movin.
 
The easiest way to permanently get rid of them is by saying you are not comfortable with the dosage and to try another pharmacy. If they argue just say the DEA is cracking down and you won't be able to fill it. Period.

Half the time you say you are out of stock they will tell you that you are irresponsible for not having the medication that they so desperately need, ask when you will be getting it, and leave the script.
 
From what I've seen, the "we don't have x in stock" excuse worked way better than "I am not comfortable filling this/I will not fill this because (insert reason)." 99% of the time the person doesn't make a big deal about it and if he/she asks if they can order it for us tell them that we can try, but can't make any guarantees on if/when it comes in.

Then again, I work in an area where there aren't very many junkies at all and they're surprisingly calm about being rejected. I guess I'm just lucky.
 
owlegrad said:
I never let anyone leave a script with me I won't fill. I also won't let them leave it with me if I am out of stock on a C2. What if I misplace it? I give them the script back every time.
Click to expand...

I was just making the point that using OOS as an excuse to not fill something is a bad idea considering many drug seekers will try to leave the script and tell you to call them when it's in... therefore wasting more of your time when you have to explain to them that you won't take a script on OOS narcotics.

Weather or not you want to put narcotics in pending and file the script (on scripts that you intend to fill) has nothing to do with the point I'm making, though I personally agree that it's better not to take them even on scripts that I would otherwise fill.
 
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My boss (the owner) just tells them its on back order lol
 
naseuy said:
I was under the impression that NYS official prescriptions belonged to the state of NY.
Click to expand...

Ah, that is why I said "most states." NY is definitely a state all to its own.

Sugoi Travis said:
Then again, I work in an area where there aren't very many junkies at all and they're surprisingly calm about being rejected. I guess I'm just lucky.
Click to expand...

If they are calm, than they are probably dealers, not junkies.
 
Some of my sickle cell patients have told me how difficult it can be to get their medications filled and that they often feel judged. It's also not always easy for them to venture far out of their neighborhoods to find a pharmacy willing to fill their multiple opioid scripts.
 
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