PHARMACIST STEVE

I routinely get phone calls and I just never know who is going to be on the other line.. other than those who wish to help me lower my credit card interest rate.. of which I don’t have any outstanding balances on them 🙂  And then there are the ones from the “IRS” that is going to come out in 24 hrs if I don’t call them back because of some unpaid tax debt… surprisingly.. I have hung up on every one of those and I am still a “free man”.. they have never showed up at by door to arrest me..

Yesterday I got a call from a person on the west coast, a mid-aged male… who had did something stupid in his teens or 20’s and ended up with intractable chronic pain in his back…

For THIRTY YEARS, he had been patronizing a CVS store near where he lived, but recently he and his wife had moved about 75 miles to a more affordable housing area..  He kept seeing the pain management prescriber that he had been seeing for 10 + yrs and he took a prescription to the local CVS near where he now lives…

So he now takes a new C-II prescription for Fentanyl to a CVS store near his new home.  He described that the pharmacist on duty at this CVS was a YOUNG FEMALE FLOATER…

This pharmacist apparently didn’t bother to check the CVS computer system … apparently she started down the path of looking for a reason not to fill this Fentanyl prescription… she first stated that the date on the prescription appeared to be in a “slightly different shade of ink” than the signature on the prescription..

Of course the pt didn’t know that the only thing that the physician has to physically do to a C-II prescription is sign it in indelible pencil or with a pen that is “liquid ink”… they can’t use rubber stamps or be signed by office nurse/agent… however the office nurse/agent can fill out the entire prescription – including the date – according to federal statue.

The directions on the prescription was for the pt to swap out a patch every 2-3 days.. .but.. the pharmacist stated that the FDA guidelines was for EVERY 3 DAYS… of course… apparently this YOUNG PHARMACIST did not learn out of her academic books that those requires – clinical trials – were done before we knew much about CYP-450 enzyme system and how these 50 odd liver enzymes can affect opiate metabolism and that some pts are slow, some are normal, some are fast and some or ultra fast metabolizers.. and those who metabolize opiate faster with Fentanyl patches can often start going into withdrawal around 60 hrs of having the patch on..

That brings up one of my favorite sayings… “…knowledge is knowing the rules… experience is knowing the exception to the rules ”  It would seem to be that this pharmacist falls under the first part of that saying … and you can guess where I fall ?

End of this story… this pt had to do without his Fentanyl for THREE DAYS… because of this pharmacist’s apparent starting looking for a reason not to fill this particular pt’s C-II Rxs… if for no other reason than he was new pt to this particular store and she was not interested in looking into the pt’s prescription history in CVS’ computer system.

And while on the phone with this pt… he look on my website and found http://www.ncpanet.org/home/find-your-local-pharmacy and had found a INDEPENDENT PHARMACY near him that he was going to reach out to.  This pt also indicated that he has some law background and indicated that he could file charges against this particular pharmacist on his own…

I hope that this pt can get the attention of this particular “by the book & by the numbers” pharmacist…” Maybe he can change some of her “book smarts” … into “knowing about the exceptions to the rules”  Time will tell…  but one thing that this pt can count on… he has my cell number and I am on his side 100% and more than happy to draw him a “road map” to show this pharmacist as to the path that she should be taking with chronic pain pts.

 

 

Filed under: General Problems