Pain management: the 24 hour OxyContin wait
Disclaimer: none of the stores I've worked in have ever been held up. I've never had anyone shove any weapons into my face and demand XYZ controlled substance. Those of you who have experienced this may think differently.
All of the pharmacies I work in, save my home store, have mandatory 24 hour OxyContin waiting periods. I used to be envious of these stores, but the more I learn think about it, and about pain management in general, the more I think maybe it's a stupid rule. Why was I envious of those other stores at first?
Well people that bring in scripts for CIIs — especially OxyContin — seem to bring in 2 or 3 at a time. And they usually come in packs of 2-3 people at a time. Almost like they're all friends or something. ("Hey guys let's hang out and take some Oxies tonight!" "Yeah, OK!") I have no idea why. Maybe it's just my area. Anyway, that means you've got anywhere between 6 and 9 OxyContin scripts to fill. These people often choose to wait. Filling 9 prescriptions for CIIs really gums up the works. Most retail pharmacies keep their CIIs in a safe, and only a pharmacist has access to them for theft reasons. This means that the pharmacist is tied up for about 15-20 minutes doing nothing but working on these prescriptions. That's a royal pain in the ass for everyone else. Those of you familiar with retail pharmacy understand that ours is an interrupt-driven business. You just don't have time to concentrate exclusively on one task for 15 or 20 minutes to the exlusion of all else. The rest of the place falls apart because the pharmacist is the bottleneck through which all prescriptions must pass.
It's easier if there are two pharmacists on, because one can pick up the slack, but at most smaller retail pharmacies, there is no pharmacist overlap.
Anyway, as I said, my attitudes have changed. While I don't think it's often necessary for these people who wait for their Oxy scripts to do so, I do think retail pharmacies should re-think the "mandatory" 24 hour wait period so that (ostensibly) we can order OxyContin for the next day.
Random aside: Ordering OxyContin for the next day is complete and utter BS anyway, as you pharmacists will know. It takes at least two days for the requisite 222 form to make it to the supplier. In fact, there's just one pharmacist per pharmacy allowed to sign off on a CII order, and s/he doesn't work 7 days a week, usually. So next-day ordering is out most of the time. The idea is that this policy will trick people into thinking that your retail store doesn't actually have any OxyContin on the premises for safety reasons.
Back on topic: people who are on maintenance doses of OxyContin don't usually need to wait. In stores where there's a 24-hour wait policy, these people happily drop off their prescriptions and pick them up the next day.
Last night we had a person who had been in a serious accident involving a tractor trailer get released from the hospital. She had 3 prescriptions, one of which was for OxyContin. I had to turn her away — which made me mad because we had it in stock, and I sent her up the street to my home store where we don't have any waiting rules — for what amounted to no reason. I guess this "rule" is in place for "safety" reasons. Though any criminal is going to know — not guess — that this rule is complete BS, which isn't going to prevent him from holding you up in the first place.
If you're at one of these 24-hour wait stores, are you really going to try to convince some dude sticking a .44 magnum in your face that you really don't have any OxyContin in the safe? Somehow I doubt it. It's just not worth the risk.
So we've created a rule that merely offers the illusion of protection. It keeps the honest opioid users honest, won't deter those bent on breaking the law, and prevents those who may legitimately need a prescription for OxyContin today (first-time fillers) from getting their medication.
What a wonderful, pointless system we've created. I think it would be more effective if we simply advertised the fact that we keep less than 100 tablets of OxyContin in the store at all times. That, at least, sounds somewhat believable.
While this post was more introspective and rant-ish, I have lots more to say about the clinical aspects of pain management in the near future, especially about the castigation of opioid users by pharmacy staff, and the backwards attitudes of (usually older) pharmacists when it comes to pain management.
[tags]Medicine, pharmacy, OxyContin[/tags]
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Well, I'm an old pharmacist who believes that opiates are, first and foremost, medicines for the relief of pain,that people in chronic pain have had a right to relief long before there ever was a DEA,a BNDD, or a board of pharmacy, and that their dependence upon opiates is therapeutic.
Comment by The Ole' Apothecary — August 19, 2007 @ 4:31 am
Pain relief is necessary, except for those who become addicted from abusing drugs. Then medicinal therpy is not appropriate, due to the fact that the addiction becomes a more serious issue than the pain itself.
Comment by Dan — June 1, 2008 @ 10:06 pm
Dan – you are right on. And that's exactly what we currently have; is a prescription addiction crisis/epidemic in this country. And why? Money. Billions. That's why. One only need look at the number of patients expected to require pain medication and the yearly revenues these drugs produce. It's OBSCENE. Certainly not representative of a legal demand and supply. The producers of these drugs know full well that there is a surplus of product out there that is NOT going to legitimate pain patients. They have internal systems, which tell them this. Yet they continue to manufacture these drugs, supplying in numbers for the pain patients, AS WELL AS the illegal trade.
There are thousands of legitimate pain patients, who have now become "drug addicts". 75 year olds are ending up in detox centers after a life of exemplary citizenship. Why's that? Because the same manufacturers campaingned in the early 90's for "the right to pain relief", and fraudulently offered studies that today are considered "junk science". They cleverly orchestrated an atmosphere for the fear of undertreatment of pain and the threat of lawsuits (based on ONE California case).
President Bush says that drug money supplies the “terrorists” and their weapons. As far as I'm concerned, that drug money includes the pharmaceutical product/revenue. OxyContin comes from the same poppy fields, the same plant, that cocaine and heroin come from. The only difference is that it is a “legal” drug. A legal medical drug, which for the first in history, has become the cause of deaths over the "illegal" drugs.
The person who posted this complains of multiple OxyContin prescriptions being presented at the same time. Aren't there laws that if you (a pharmacist) suspect something wrong, you have not only the right, but duty to check into this? Is this what a pharmisist does about a potential problem? Writes a complaining comment on the internet? I thought you were supposed to help to protect that these pills only get into the right hands? When you filled those 3 "inconvenient" customers, did you stop to think that the pills were most probably going to end up in some teenagers stomach, possibly ending in death?
I am disappointed in the whole system. The pharmaceutical company's should not be producing product for illegal traffic and trade. The FDA should not allow "junk science" to be used in the process of market approval. Doctors should be trained well enough in this area to make sure that only the appropriate candidate of these drugs gets a prescription. At the very least, they should be doing thier own homework; not blindly accepting reports from the money-based manufactureer. Pharmacists should be diligent in assuring the prescription is legitimate and initiates from a legitimate doctor for a legitimate patient. Patients should begin to question EVERYTHING about thier health. The day of "professional integrity" is over. I feel qualified to make these statements, as I am a victim of this system, a 55 year old chronic pain patient prescription addict with an unwanted detox history. I only wish I had known what OxyContin really represented. I'd have taken the pain over it any day.
Annie
Comment by Annie Ilene — June 4, 2008 @ 2:15 pm
I suppose this rule would apply to hospice patients as well? We only use one pharmacy exclusively (non-box retailer) and I am not aware they do that to our patients.
Comment by HospiceDoc — June 5, 2008 @ 6:48 pm
HospiceDoc, we don't discriminate who it applies to. Judging on a case-by-case basis opens up a whole can of worms that we would rather not.
Generally, because this practice is so common in Massachusetts, prescribers will write the scripts 1-3 days ahead of time (if it's for OxyContin) because they know about the wait, and the patient or a family member drops it off and picks it up later.
Comment by RJS — June 6, 2008 @ 11:23 am