We all rely on our doctors to check us out, keep tabs on chronic health or pain situations, and treat us accordingly, often with pain medications or other prescriptions. A majority of doctors are excellent -- that's why they make the big bucks -- and often know your name and medical history without even opening your chart. Your doctor knows you, and is the only person (other than yourself) qualified to make decisions about your health and prescription choices. Period.
So why in many states, most recently California, has the ultimate choice of whether to fill a prescription --particularly for controversial or easily abused medications like Plan B, Viagra, Xanax, and opioid medications like morphine and OxyContin-- now fallen into the less-educated hands of pharmacists who, with all due respect, have not been to medical school and know nothing about individual patients and their care?
Originally enacted in the wake of Roe v. Wade to protect religious doctors from being forced to perform abortions against their will, laws across the country have now grown to include any medication that the pharmacist deems "medically unnecessary or extreme," as though they are in any position to make these kind of decisions for someone whom they barely know.
Today, the laws are most commonly used to prevent young women from obtaining Plan B emergency contraceptives, which have been at the center of a smear campaign touting it as "the abortion pill" which, to be clear, is an entirely different thing altogether.
But it isn't just reproductive-aged women who are being hurt by these new policies. I have a close male friend named Brandon who, because of back-to-back sports injuries and a wild car crash, has severe pain in his lower back and left leg, which frequently goes numb and causes him to lose balance, for which he uses a snazzy cane, like House as a young adult. He has been seeing the same doctor for years -- no "doctor shopping" for this guy -- and his excellent doc seems to understand the level of pain that Brandon experiences without treating him like some sort of junkie. Relying on years of medical school as well as decades of experience in the field, this doctor knows what he is doing. When it comes Brandon's medical treatment, I hope his doctor never retires.
Not only do pharmacists (and, even more importantly, pharmacy techs) have only a small percentage of the medical diagnostic experience of a real doctor, they have absolutely no access to a patient's medical history or have even an inkling, especially in my friend's case, of what his medical problems may be.
They just see a healthy-looking twentysomething who takes some hardcore painkillers. They don't notice the cane without which he cannot walk. They are not kept awake all night because of never-ending spasms. They don't know that he has lost 60 unnecessary pounds from his 6'2" frame, leaving him markedly underweight because his health problems prevent him from keeping most of his food down.
My friend's doctor has never treated him with anything but respect, but I have lost count of the times when a pharmacist or a pharmacy tech gave him an attitude after looking at the medications he takes. The reactions have been anything from perfectly normal and kind (rarely) to cold indifference and nitpicking of his prescription to make sure he wasn't "pulling a fast one on them," all the way to complete refusal to fill a prescription, even though it was a new, completely valid one and not a refill (some abusers get early refills as they burn through their meds too quickly).
This particular pharmacist (at a major pharmacy chain) told my friend and his mother that there was no way anyone his age could need that much medication and basically alluded to the idea that my friend's doctor was either negligent or easily tricked. His doctor is neither. A quick trip to another pharmacy remedied the situation, but for folks who live in rural areas where there may only be one pharmacy within 100 miles, situations like this could be devastating.
Of course there are people misusing the system and taking pain medications to get high. Kids will do anything for a high -- weirdoes are drinking hand sanitizer now to get a buzz for God's sake. But as many irresponsible pill-poppers as there are, there are also people like my friend, who are careful to follow the rules and truly need the medication.
And just like there are both trustworthy and addicted pill poppers, there are also both quality and substandard pharmacists and techs. One pharmacist friend of mine (who is excellent) will attest that while she was in school there were a noticeable amount of (mainly men) who could not wait to start working so that (for whatever reason, probably because they didn't feel powerful enough growing up) they could make life harder for people who are unfortunate enough to require strong narcotic analgesic pain medications. Clearly these guys are reacting to the stigma that surrounds the treatment of chronic pain, and when I think about the number of people who have been treated like my friend it is sickening.
My friend's prescriptions are literally saving his life. But the pharmacy doesn't NEED to know all of that, either. All the pharmacy needs to know is that he is ill enough to require two forms of very strong morphine just to function, and that his doctor, who has been my friend’s doctor since my friend was a child and now has logged 30 years of experience in family practice, feels that his medication level is just fine. Let's keep medical decisions in the hands of the doctors.
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Monday, 11 June 2012