Tighter Control on Vicodin?

A widely prescribed painkiller


So, before reading this blog post, take a peek at this article:  http://www.latimes.com/news/local/la-me-0126-vicodin-20130126,0,4066484.story

I’m not going to comment on whether or not this is a good move because, truthfully, there’s a lot to be said for both sides of the coin. There would be patients–legitimate pain patients–who would suffer from this being approved. But, there would also be a lot less abuse (or so we would hope). Regardless, I’m not going to comment on whether this is good or bad. I can tell you one thing, though:  this would make life in a big chain retail pharmacy a nightmare. Can you imagine having to be the only one allowed to count out every hydrocodone-based prescription? I don’t know where we would store it all to be honest. But, I digress.

The real thing that should be focused on here is how we, as a health care community, look at “chronic pain”. There are so many chronic pain sufferers out there, and each is different. My thoughts are that instead of reclassifying the most commonly prescribed medication in the US, we should reclassify how it is prescribed. No primary care physician should be the main person writing for a chronic pain medication. Chronic pain patients should be going to a pain specialist. This should be required. This is not only to insure the prescribing is done correctly, but to help the patients find the best possible relief. Now, I’m not saying there aren’t pain doctors out there that give out narcs like candy, but they are better equipped to be writing for these patients. I feel like writing for chronic heavy duty narcotics is out of a primary care physician’s realm of practice. Primary doctors are too quick to write a chronic lower back pain patient a script for Percocet many times. Shouldn’t they be trying out other options, such as Cymbalta or gabapentin first before going to a potent opioid medication? I think people should exhaust all other options first before starting with meds like that, including things like acupuncture and physical therapy. It’s very difficult to get off opioids once you’ve been taking them for a while. You can always go forward if it’s not working, but it’s hard to go back.

The other thing that makes the world of opioids so tough is the lack of communication between physicians, sometimes due to the patient not telling the whole truth. We had a patient who is taking both Suboxone and Percocet on a daily basis. She stopped coming to our pharmacy because we questioned why she was on both and asked if we could contact her physicians about therapy modification. There is no reason she should be on both. I wonder if her two doctors know that she is on both medications. How it ever went through her insurance is beyond me. Usually, that kind of interaction requires a prior authorization, so either one of the doctors did the prior authorization without thinking or the insurance let a major drug interaction slip by. Whichever it is, it truly points to a problem with the way this nation treats chronic pain and opioid dependence/addiction.

It really saddens me. I wish that the FDA would focus on where pain killer abuse starts instead of where it ends. We need to be proactive about health care, not reactive. If we can prevent opioid misuse by better regulating how and by whom the medications are prescribed, then we won’t need to restrict them in the pharmacy as much. But, that’s just me, a lowly pharmacist who receives multiple 7 to 10 day early fill authorizations from the same primary doctors every few weeks. Who am I to argue?


Image courtesy of http://www.latimes.com/news/local/la-me-0126-vicodin-20130126,0,4066484.story





Today was a wonderful day at the pharmacy, as a whole. It went smoothly, and people were in a good mood. It made the day pass quickly and made me smile. As usual, there was one story that stuck out in my mind.

The picture above is an example of a syringe that is normally used for insulin injections. We usually only sell them as prescriptions for diabetic patients. But, in some states (like mine), they are available for sale without a prescription. We see people come in and get insulin and syringes for their dogs every now and then, but most of the time, we don’t know the exact reason for the purchase of a pack of syringes. Many times, we assume it is because they are using them for injection of illicit drugs like heroin or methamphetamine. The focus of allowing the sale of needles without a prescription is to provide clean needles in order to prevent the transmission of infections like HIV and Hepatitis C.

Well, in walks a man asking for a pack of syringes. When the technician ringing him out him asked what size he was looking for, the man answered back he didn’t know. My tech tried to explain that we couldn’t sell any if he didn’t know what he was looking for, and the man started to become angry. I decided to intervene and diffuse the situation. Upon my coming over, the man blurts out that his brother is a junkie that has attempted to sober up and has relapsed several times. He told me his family doesn’t give him any money to fund his addiction, but they do come into the pharmacy with his money to buy needles for him. They don’t want him to contract anything from needle sharing, which I cannot say I blame them for.

After some more history of his brother’s struggle with addiction, I was able to help figure out what type of syringes the man had been sent to obtain. I suggested a program that handles needles for people openly struggling with addiction to him, but he said his brother is currently refusing to try any programs. I then told him to keep lines of communication open with his brother and always try to talk to him about coming clean because he may reach a point where he wants to try to sober up again and will need a support network. The man nodded, purchased the syringes, and left.

I felt awful for that family after talking to him. Not only does addiction ruin the lives of the ones who are addicted, but they ruin the family ties and friendships of the addicted person as well. It was heartbreaking to hear that the man had tried and failed multiple times to sober up and stay clean. Normally, we only see the people we assume are addicted coming into the pharmacy for syringes. They tend to act nervous and appear physically worn down. This was the first time I had seen a family member of an addicted person come in for them. What a different perspective it gave me.


Image courtesy of http://i810.photobucket.com/albums/zz25/rampanthers/InsuLinSyringeUnOpen.jpg