Narcotic customers

[PharmGirl31]

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So I remember a Pharmacist once ask me when I was an intern "what kind of customers always give you problem"? I guess with "elders??" lol, but it turn out he say it's patients who want their pain med. Which makes perfect sense!!
So I would like to know what kind of situation that can arise with these kind of patients who want their narcotic and how should I deal with them? I reason I ask is because I am a new grad pharmacist and am very nervous about starting work.

 

[owlegrad]

"We are out" is the most common line if you do not want to fill a prescription for a narcotic. Or you could be honest I guess.

Your techs will know what to say if you are not going to fill a script, I bet.

 

[BrightLight]

Pt on medical and it's refill too soon or plan limit exceeded so we were forced to do a TAR. Pt calls >3 times a day to ask why it is not approved yet. Each call lasts forever because pt would go round and round hoping that she would wear us out and we would magically get the med ready for her. If that fails she threatens to talk to the manager

 

[rxlea]

How do you tell the difference between an addict and a patient in pain?

 

[firi808]

How do you tell the difference between an addict and a patient in pain?

They can both be in pain. With experience you pick up on clues which differentiate addicts.

 

[PharmGirl31]

may I ask what's a TAR?

 

[PharmGirl31]

SO i was reading on AngryPharmacist on a situation where a pts brought in a bunch of scripts from the hospital, which include antibiotics and pain med, and they only want to fill their pain med because apparently they don't have $ for antibiotics (yeh rite). What would be the best way to deal with that? just fill the pain med?

 

[All4MyDaughter]

They can both be in pain. With experience you pick up on clues which differentiate addicts.

So an "addict" with legit pain should not be treated? Or do you mean someone who is dependent on the med?

 

[owlegrad]

may I ask what's a TAR?

I am curious as well.

 

[Ackj]

So an "addict" with legit pain should not be treated? Or do you mean someone who is dependent on the med?

 

[rxlea]

SO i was reading on AngryPharmacist on a situation where a pts brought in a bunch of scripts from the hospital, which include antibiotics and pain med, and they only want to fill their pain med because apparently they don't have $ for antibiotics (yeh rite). What would be the best way to deal with that? just fill the pain med?

Some antibiotics are very expensive without insurance. Even a generic Z pak is 20 something bucks. Clinda, levo, and doxy are pretty pricey too... And then there's linezolid..

 

[Bkobe7]

may I ask what's a TAR?

It stands for Treatment Authorization Request and is basically a prior authorization (PA) request for California Medicaid patients. It couldn't be called a PA because that just wouldn't be the California way... 🙄

 

[crossurfingers]

SO i was reading on AngryPharmacist on a situation where a pts brought in a bunch of scripts from the hospital, which include antibiotics and pain med, and they only want to fill their pain med because apparently they don't have $ for antibiotics (yeh rite). What would be the best way to deal with that? just fill the pain med?

There are a few hospitals here that put on the prescription that the patient must fill both or none at all and they tell the patients that up front as well. I would check the state narcotic registry to see their history. If they seem fishy I would contact the doctor.

The most common problems I have re: narcotic pain meds is patients seeing multiple doctors or early fills. For early fills I refuse to fill early without approval from their doctor. I always tell them that they need to talk to their doctor if the dosage written is not adequately controlling their pain since there is a maximum amount they can take safely and there are other pain medications available. I tell them that some people die from taking too much pain medication and that for safety reasons they cannot take more than what the doctor wrote for without discussing it with the doctor and the doctor needs to change the prescription (for legal purposes). For the multiple doctor issue I tell them we have to verify that this doctor is aware of what medications the other doctor is giving before we dispense because it can be dangerous to combine too many pain medications.

 

[PharmDstudent]

SO i was reading on AngryPharmacist on a situation where a pts brought in a bunch of scripts from the hospital, which include antibiotics and pain med, and they only want to fill their pain med because apparently they don't have $ for antibiotics (yeh rite). What would be the best way to deal with that? just fill the pain med?

I don't do it. You get both or go elsewhere. If an antibiotic, NSAID, etc. is prescribed, then the doctor wants them to have both - which I verify. If the doctor approves just dispensing the pain medication, then I will.

Pain medication is not a treatment. It alleviates pain, but does not treat anything.

 

[owlegrad]

I don't do it. You get both or go elsewhere. If an antibiotic, NSAID, etc. is prescribed, then the doctor wants them to have both - which I verify. If the doctor approves just dispensing the pain medication, then I will.

Pain medication is not a treatment. It alleviates pain, but does not treat anything.

Well, NSAID's "treat" inflammation.

 

[PharmDstudent]

Well, NSAID's "treat" inflammation.

NSAIDs are non-narcotic 😉

 

[VA Hopeful Dr]

So an "addict" with legit pain should not be treated? Or do you mean someone who is dependent on the med?

They said addict, so they obviously didn't mean dependent.

Some antibiotics are very expensive without insurance. Even a generic Z pak is 20 something bucks. Clinda, levo, and doxy are pretty pricey too... And then there's linezolid..

Clinda and doxy are on a $4 list down here, and $20 isn't asking too much if you are actually sick.

 

[xiphoid2010]

Both or nothing is the way to go for hospital scripts, especially coming from the ER. The last thing we need is more addicts wasting tax dollars on ER visits for a weekend fix. Exercise that pharmacist's right to not dispense once in a while.

 

[taken2]

we don't fill any thing more than 30 at a time. if a rx says dispense #60, we tell them we don't have it.

 

[spacecowgirl]

I require both the abx and pain med. It's almost always clinda or something cheap so I have had no problems with that and the patients don't argue with me.

I don't understand telling people that you are out when you're not. How does that help anything?

 

[rxlea]

They said addict, so they obviously didn't mean dependent.



Clinda and doxy are on a $4 list down here, and $20 isn't asking too much if you are actually sick.

I stand corrected. I haven't worked retail since 2006 so clearly I am out of touch...

But for a poor person, 20 bucks is a lot.

 

[owlegrad]

I require both the abx and pain med. It's almost always clinda or something cheap so I have had no problems with that and the patients don't argue with me.

I don't understand telling people that you are out when you're not. How does that help anything?

It is an easy way to not fill a prescription, rather than going through all the trouble of being honest.

I stand corrected. I haven't worked retail since 2006 so clearly I am out of touch...

But for a poor person, 20 bucks is a lot.

Agreed.

 

[PharmGirl31]

"We are out" is the most common line if you do not want to fill a prescription for a narcotic. Or you could be honest I guess.

What if after you say you're out, the patient request that we order it, wouldn't it be the same?

 

[owlegrad]

What if after you say you're out, the patient request that we order it, wouldn't it be the same?

Won't be in until next week, manufacturer back-order, etc.

 

[All4MyDaughter]

They said addict, so they obviously didn't mean dependent.

Actually, it's not obvious. People use the two terms as if they mean the same thing, but they don't.

 

[All4MyDaughter]

we don't fill any thing more than 30 at a time. if a rx says dispense #60, we tell them we don't have it.

I think this is questionable patient care. After I had surgery, I got generic Percocet and the sig was 1 to 2 tabs Q 4 to 6 hours PRN pain. So #30 would be less than a three day supply. What right does the pharmacist have to truncate the duration of therapy in situations like that?

 

[Sparda29]

I think this is questionable patient care. After I had surgery, I got generic Percocet and the sig was 1 to 2 tabs Q 4 to 6 hours PRN pain. So #30 would be less than a three day supply. What right does the pharmacist have to truncate the duration of therapy in situations like that?

Agreed. Unless the poster meant to say days supply.

 

[VA Hopeful Dr]

I stand corrected. I haven't worked retail since 2006 so clearly I am out of touch...

But for a poor person, 20 bucks is a lot.

I would agree, except they always find the money for pain meds.

 

[ucrx]

Agreed. Unless the poster meant to say days supply.

I hope so. My patients would all be in trouble- oxycontin/ms contin bid-tid, plus high dose frequent prn meds. Some are overly doped, but they're on a palliative care/approaching hospice track. Others are addicts (who often have risk factors for cancer such as cigarette smoking) and now have cancer and legitimate pain. Should these people's pain be ignored?

I come from retail originally, so I understand how frustrating it can be when it seems like everyone getting narcotics is overusing and addicted or selling their pills. But in retail, you don't see them before they get appropriately treated and you can completely miss their very real pain. Especially when things like chemo are almost entirely done at a clinic/hospital/hospital outpatient pharmacy.

 

[DASicari]

One of my colleagues brought up an interesting idea regarding ER C2s: Make an expiration date of maybe 72 hours or so on C2s brought from the ER. I can't count how many times we have had a patient throw a fit because there is an issue with an ER script that they were given 3 weeks ago.

Not to derail the thread, but any thoughts on this?

 

[Dr Wario]

One of my colleagues brought up an interesting idea regarding ER C2s: Make an expiration date of maybe 72 hours or so on C2s brought from the ER. I can't count how many times we have had a patient throw a fit because there is an issue with an ER script that they were given 3 weeks ago.

Not to derail the thread, but any thoughts on this?

At my store we could make an expiration date of 72 minutes and we still would never have to turn anyone away. I can always still feel the heat from the printers on those scripts.

 

[Sparda29]

I require both the abx and pain med. It's almost always clinda or something cheap so I have had no problems with that and the patients don't argue with me.

I don't understand telling people that you are out when you're not. How does that help anything?

Check out this story.

http://abcnews.go.com/Health/insurance-24-year-dies-toothache/story?id=14438171

Guy is a 24 year old with a tooth infection. He goes to the dentist in Mid-August with a toothache and is told they need to pull it. He decides not to since he doesn't have insurance.

He goes to the ER a bit later when his face starts swelling and he gets a script for abx and pain meds. Can't afford both so he picks the pain meds.

Tooth infection spreads and causes his brain to swell. He died on Tuesday.

 

[joetrisman]

Check out this story.

http://abcnews.go.com/Health/insurance-24-year-dies-toothache/story?id=14438171

Guy is a 24 year old with a tooth infection. He goes to the dentist in Mid-August with a toothache and is told they need to pull it. He decides not to since he doesn't have insurance.

He goes to the ER a bit later when his face starts swelling and he gets a script for abx and pain meds. Can't afford both so he picks the pain meds.

Tooth infection spreads and causes his brain to swell. He died on Tuesday.

Saw this early today as well. At my store, its both, the abx only, or nothing. I explain to the patient that they won't die of pain but they have a potential to die from their infection. If they honestly seem like they can't afford it, I refer them to Meijer as they have like 8 or so free abxs. During my rotation there, 7 out of 10 scripts were free Abxs