opioid dispensing

[sosoo]

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You need to look at the fentanyl dose. Fentanyl is much stronger than oxycodone, but the doses used are much smaller.

You also should take a look at the oxycodone dose that is being used. Four times daily is a frequency not a dose, so it may or may not result in a high dose of oxycodone. I have seen some patients with low tolerance to opioids treated with 1/2 Percocet 5mg tablet four times daily as needed (not in combination with fentanyl obviously). Even though it's being taken up to four times daily, that's not a very high dose.

of all the things u look at, do u even consider the "increasing" abuse? increasing hospitalization and fatality?

 

[Abby Atwood]

of all the things u look at, do u even consider the "increasing" abuse? increasing hospitalization and fatality?

Always; we all do.

 

[CetiAlphaFive]

please read the express scripts article, and watch some tv news.

Are you quoting Trump, or do you really lack any professional knowledge on the subject other than your opinion of "Me no likey!" ???

 

[sosoo]

Are you quoting Trump, or do you really lack any professional knowledge on the subject other than your opinion of "Me no likey!" ???

just the stuff they talk about on the news. drug abuse, hospitalizations, etc.... professional knowledge only relates to proper use of the medications, not abuse.. u know that right?

 

[RxPreceptor]

Yeah, we all know what level of evidence tv news and express scripts fall under...(hint sarcasm).

Just ask yourself, what is the difference between addiction and dependency? (knowing the difference is often in many NAPLEX questions). The first fill limit is to deter people from becoming dependent on what should be short term opioid use as well as cut down the supply of people selling unused drug.

 

[CetiAlphaFive]

just the stuff they talk about on the news. drug abuse, hospitalizations, etc.... professional knowledge only relates to proper use of the medications, not abuse.. u know that right?

What gave you that idea? If a pharmacist understands how a drug works therapeutically, they absolutely should understand its illicit use.

Here are two papers stating that the majority of fentanyl deaths are due to street fentanyl (produced in China and sent to the US illegally, as I posted earlier), and not prescription fentanyl.

Furthermore, I sure hope you don't dispense tramaadol, as it's seen a similar rise in mortality.

Gladden RM, Martinez P, Seth P. Fentanyl law enforcement submissions and increases in synthetic opioid-Involved overdose deaths - 27 states, 2013-2014. Morb Mortal Wkly Rep. 2016;65(33):837-43

Peterson AB, Gladden RM, Delcher C, Spies E, Garcia-Williams A, Wang Y, et al. Increases in fentanyl-related overdose deaths - Florida and Ohio, 2013-2015. Morb Mortal Wkly Rep. 2016;65(33):844-9

 

[owlegrad]

Tramadol May once again be spoken on sdn.

 

[deleted820760]

Tramadol May once again be spoken on sdn.

LOL. Nice work. (*Electronically pats Owlegrad on the back)

 

[CetiAlphaFive]

Tramadol May once again be spoken on sdn.

Ultram is also banned, FYI

EDIT: Guess not. LOL

 

[Charcoales]

Tramadol.

 

[panicatthepharmacy]

just the stuff they talk about on the news. drug abuse, hospitalizations, etc.... professional knowledge only relates to proper use of the medications, not abuse.. u know that right?

I would love to know where you come up with some of this stuff.

 

[sosoo]

I would love to know where you come up with some of this stuff.

i follow the news daily. to keep up to date with crazy things ppl do. by the time u wait for stats, its already years late. also this district where im at is C2 heaven. vs where im from C2 dispensing was more controlled.

 

[Vandalia]

Against my better judgement, I will jump in and provide a perspective from emergency medicine. We are where we are at in part due to two fallacies:

1) People with legitimate pain do not get addicted to opiates.
2) The second is actually far worse: People who abuse prescriptions will only abuse prescriptions. Therefore if we simply cut them off they will be fine. The end result is them ending up with "heroin" laced with who knows what.

If anyone tells you a solution to the problem that is only a couple of sentences long, stop listening. They are an idiot. The obvious initial step is that people who are never exposed to opiates will never become addicted to opiates. That we have some control over. Those who have been on oxy for a decade, I have no clue. So far this year I have seen a number of those overdoses and we have been able to keep them alive. I have seen an equal number who ended up with "heroin" and those have a far, far, worse outcome.

The one thing I am absolutely convinced of is that the next "solution" will only make things far worse.

 

[Dr. Nico]

Its insane, and Trump supposedly called it a national emergency informally.

And what happens when the pharmacy stresses you to fill more while you dont want to risk your pharmacy license....

 

[sosoo]

And what happens when the pharmacy stresses you to fill more while you dont want to risk your pharmacy license....

this is where im at the moment. almost every pharmacy i go to the tech accept every single narcotics, combo, high dose, large quantity. and the supervisor will give a call and lecture (hint: verbal warning) if u don't fill them.... yesterday, i came across a "second" cvs in this district with unreconciled hydrocodone 10/325 missing 1,000+ pills unaccounted for..

 

[CetiAlphaFive]

Against my better judgement, I will jump in and provide a perspective from emergency medicine. We are where we are at in part due to two fallacies:

1) People with legitimate pain do not get addicted to opiates.
2) The second is actually far worse: People who abuse prescriptions will only abuse prescriptions. Therefore if we simply cut them off they will be fine. The end result is them ending up with "heroin" laced with who knows what.

If anyone tells you a solution to the problem that is only a couple of sentences long, stop listening. They are an idiot. The obvious initial step is that people who are never exposed to opiates will never become addicted to opiates. That we have some control over. Those who have been on oxy for a decade, I have no clue. So far this year I have seen a number of those overdoses and we have been able to keep them alive. I have seen an equal number who ended up with "heroin" and those have a far, far, worse outcome.

The one thing I am absolutely convinced of is that the next "solution" will only make things far worse.

Thank you for articulating what most of us have been trying to explain to sosoo.
There is no easy answer to this question, and to parade yourself as some sort of self-righteous opioid gate-keeper is irresponsible and naive.
The true professional acts as an advocate for their patient.
Give the doctors grief when they try to increase the patient's MME. Ask what caused the patient's pain level to increase.

Blanket refusal is stupid, dangerous, and counter productive.

Saying it's only OK for hospice patients is intellectually bankrupt. It's stupid to justify this as being OK, "because hospice people are going to die anyway."