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]

So it looks like at the end of next week, we’re going to run out of generic Plavix. I’ve not followed the business drama of Big Pharma in a little while because I find it dull, so I have no commentary on the outcome of the lawsuit, which I presume has been settled in S-A and BMS’s favor. Apotex had a good run while it lasted. I mentioned in September that we were warned that this might happen.

In any event, it looks like it’s for real. As far as I know, this is the only time in recent history where a generic has been withdrawn. I think I recall similar things happening for Lanoxin (digoxin) and Synthroid (levothyroxine), but generics for those drugs were withdrawn because of problems with bioequivalence rather than as a result of litigation.

It’s going to suck explaining the reasons why clopidogrel is temporarily going the way of the Dodo. People don’t take too kindly to the idea of their copayments doubling (or more). I’m thinking I should write a little handout for people explaining what happened so we don’t have to have the same conversation 500 times. After telling something a dozen or so times, you’ve heard all the wisecracks and complaints that such a topic engenders, and it just gets redundant and tiresome.

I also think the idea of jerking patients/consumers around like this is ethically wrong, patents and the justice system be damned. But then morality is entirely dependent on one’s point of view, now isn’t it?

[tags]Medicine, pharmacy, big pharma, plavix, clopidogrel, ethics[/tags]