The more you talk, the less I believe you

Something I’ve noticed for years: the more a patient talks at you, the more likely they are to be lying. They talk and talk and talk, and nothing of substance comes out. It’s a smokescreen for something else they want. They tell you their life story, and then ask for an early fill on their Vicodin as though the two are somehow related.

Do they think I’m stupid? I can’t count the number of times I’ve put the phone down with the person still talking at me (without having said more than “May I help you?”) done something, and then come back with them still blowing hot air.

The more words someone uses, the greater the chances are that they’re full of shit.

This is in contrast to someone with a legitimate issue who will tell you their story in as few words as possible, and then ask what they need to do. Even people who typically blow smoke talk less when they’re actually telling the truth and they have, for instance, a police report to back it up.

Every retail pharmacist in the world knows exactly what I’m talking about, and I’m sure most ED types do too. Remarkable that the bottom-feeders on the planet haven’t figured out that if they just kept their mouths shut, I’d be 2-3x more likely to believe them. I would have thought such a skill would be accidentally uncovered and remembered. But perhaps idle chatter is the verbal form of a nervous twitch, and many of these folks are halfway decent candidates for the Darwin Awards anyway, so I shouldn’t be surprised that they haven’t learned from past successes.

In any event, they’d all be shitty poker players.

10 thoughts on “The more you talk, the less I believe you

  1. I’m really interested in your blog. I am an Rx pain pill user. I have a broken/repaired spine. I’ve encountered nothing but lip from the pharmacy that I go to. A new chain opened up nearby recently. I went over there to see if things were cheaper and more polite. My scripts were quad the price of the other pharmacy.. the service was better but not better enough to justify paying so much.

    Because this is a controlled substance, I had to get my refill with the “new pharmacy”. After that ran out, I went back to my old pharmacy with the next months script. Well…. don’t I get treated like crap and told by “evil pharmy” that she KNEW I had my last script filled at the other pharmacy and that I would have to wait another day for the new one. When I asked why, she told me that I was either selling them or abusing them and that by law, she did not have to fill my script a day early.

    So…. now what? This woman made me feel horrible. Does she think that I’m making money off of these god awful things? Or worse… abusing them? And why is she privvy to the information about where I go for my scripts? She knows that I don’t have insurance at present!! I feel so violated by this pharmacist that I don’t ever want to go back there again! Are there HIPAA laws against this?

    I know you aren’t a legal guru, but google found you under pharmacist hipaa violations…. so, here I am. I am terribly disgusted. I do have a modicum of intelligence and do know that what I am taking has street value. I’ve had them stolen from me when I was still part of the mainstream workforce. I’ve had to lock them up and count them daily to make certain that I wasn’t being robbed, etc. But good god! Why do some pharmacists assume that all patients are pill guzzlers?

    (I will give you the history of my pain pill use: I was born with a deformity in my spine. I’d been seeing orthopedic/spinal doctors/surgeons since I was in elementary school. I never accepted a script for pain meds until I was in my early 20’s.

    First I was prescribed hydrocodone 5/500. I took those for a few years while steadfast about not having surgery. They then increased my dose to 7.5/500 of same. More time elapsed with refusal of surgery. I have children and worked full time as an aircraft mechanic. I had to do what I had to do to raise my kids.

    Breaking my back was one of those things. Eventually and at present I am prescribed 10/325 norco. I have been on the same dose and qty for 5 years (2 of those years being post op). I am finally back to work, but self employed = no insurance for me. The kids are covered by my ex’s policy.. mentioned so you don’t think that I wouldn’t have my children covered.

    Sorry this is so long… and no, it does not fall under “the more you talk, the less I believe you”…. but it is being posted here because this is where I left off after reading your blog posts. I am amazed at the crap people do in order to get these things! If the “powers that be” were smart, they would take the addictive qualities out of these things so that the rest of us could benefit and the others wouldn’t have a motivation to get their greedy hands on them…. and finally, the pharmacists wouldn’t be so tired of filling these and treat the real pain sufferers with some respect!

  2. Yes, indeed! All the retail pharmacists out there know what you are talking about. I too am a pharmacist, but I haven’t worked in an area that has as much of this kind of stuff going on. The other problem I had when I was at such a pharmacy was all the Value Options (psych insurance) people. They almost always had problems! If their insurance didn’t just start today, it just closed today. Fun!

  3. I’m in a unique position, I think, in that I can see both sides of the equation.

    In 2003 I had a head on collision with a semi (nobody got ticketed, it was an accident) that resulted in, among other things, fracturing L4 and L5 and herniating the discs between L4, L5 and S1 (I also had huge blunt force trauma thoracic injuries including cardiac tamponade and a pneumothorax that nearly killed me). I had to have a fusion and reconstruction to stabilize my spine and I ended up with permanent neuropathy that caused constant, intolerable pain and got started on gabapentin, elavil, duragesic patches – later replaced with morphine pills – and percocet. I went through hell getting those prescriptions filled, despite doing everything my pharmacist suggested I do: always using the same pharmacy for ALL prescriptions, calling ahead of time to let them know to order the meds I was prescribed so I wouldn’t run out and being totally honest with them about what I was taking and why.
    I still got treated like, to be blunt, shit almost every month. It culminated with my asking the tech and on duty pharmacist if they’d like me to drop my pants in the store so they could see my scars and feel the fusion and metal in my back. Oddly enough, they declined. Can’t imagine why. I got sick of it, and I decided to try and do something about it.

    After 5 months of weaning, I am now narcotic free. I had 2 revision surgeries and a radio frequency ablation procedure that makes my pain tolerable on most days (note I didn’t say ‘pain free’, just tolerable) and I’m feeling great most of the time. I’ve gone back to school and am now an EMT. It’s not easy, but it IS worth it.

    Because of my career choice, I see people who feel that their hangnails deserve copious amounts of dilaudid and that ANY pain is vicodin worthy. With fibromyalgia being en vogue, everyone seems to think that they shouldn’t ever have to feel ANY pain, EVER – and those WITHOUT real pain think that they too should have their ‘pain’ medicated. I end up sharing my story with the majority of my patients who fall into those categories, and whilst I don’t know if it’s had a lasting effect on anyone I do know that it acts as a reality check on some folks and stops them in their tracks. I make sure to tell them that I KNOW what pain is like and how it makes you act, see. It’s sometimes quite comical to see people going through all of their repetoire in an attempt to see if they can nail the subconcious physical actions and symptoms of a person with true pain.

    To those people who fake symptoms in order to get pain meds, I say this: fuck you. You’re sick, yeah, but not in the way you think. Let me give you some of the pain I tolerate daily and see how you REALLY like it.

    To those people who really DO have pain but who are histrionic and melodramatic: grow the fuck up and get over yourselves.

    To those people who DO have pain and who try, every month to do the right thing but who get treated like crap by cynical and jaded pharmacy staff: I’m sorry, and I really do feel your pain. There IS life after narcs, you know, and it’s really very cool.

    To aforementioned cynical and jaded pharmacy staff who treat everyone with a narc rx like some drug seeking scum: fuck you too. YOU more than anyone should be ashamed of yourselves. Let me ask you this: why’d you decide to pursue a career as a pharmacy tech, anyway? I’m sure it wasn’t for the money, and you don’t do enough of the pharmacological or chemistry aspect to say that that was your reason. I’ll bet it was, in part at least, because you wanted to help people….right? And do you REALLY think you’re helping people when you tar everyone with a percocet rx with the drug seeking brush? I’ll answer that for you: No, you do not.
    So, take a deep breath and check your attitude from time to time. Your patients will thank you for it.

  4. Victoria,

    I’m sorry you have trouble at your pharmacy. There are a whole bunch of reasons that people get treated like crap when they bring Rxs for schedule II substances.

    1) CII scripts are harder to fill than non-CII scripts. The drugs are usually kept in the safe, and can only be filled by the pharmacist. Given the script volume per pharmacist, this usually adds up.

    2) Rarely does someone with a pain script tell the staff that they’ll come back later. Everyone with a pain Rx wants to wait in the store while it’s filled. Corporate pressure from above mandates that scripts for people waiting should be filled in 15 minutes or less, regardless of how busy it is. Couple this with point #1, and it makes it quite frustrating, particularly if it’s a busy day. Compare this with ADHD meds, which are also schedule II — many, if not most, of those people come back later. Not so with pain Rxs. It takes a huge burden off the staff at the pharmacy when you tell them you’ll come back in a few hours.

    I try *really* hard to be nice to people with 2-4 CII pain Rxs, but some days it’s bloody hard because we’re so busy, and they invariably want to wait. Timewise, I would say it takes nearly double the amount of time to fill a CII as it does a regular script. It’s not as simple as printing a label and counting some pills. In fact, that is the least time-consuming part of the process.

    3) It’s the pharmacist’s perogative to know where you last had your scripts filled, at what dose, and how many you got. It is *their* license. Their livelihood. We’re rather lenient on filling scripts early. If they go through the insurance, then you can have it. If it doesn’t, you can’t. (Unless there has been a dosage increase or something like that.) And it might boggle your mind, but that’s not a HIPAA violation at all.

    4) You get *really* jaded about pain Rxs. I can tell you honestly that *most* of the CII pain Rxs that we will in our store are for human waste products. People who are melodramatic, abusive, and just outright disgusting wastes of space who leer at and abuse staff both in person and on the phone. Particularly the women I work with. They’re always trying to do something underhanded and try to get something out of the pharmacy while they’re there. They “lose” their prescriptions on a regular basis, and it’s always the pharmacy’s job to get them new meds. (Notice that none of their non-pain meds ever get lost.)

    Legitimate folks with chronic pain often get lost when you view the world through such a jaded lens. And there are one or two people — God bless their souls — who ALWAYS come back the next day instead of waiting in the store.

    I hope that answers some of your questions, even if you do not care for the answers.

  5. I understand that it is frustrating working with people with drug addiction, but if you regard them as “bottom-feeders” and “human waste products” from the get-go, as is apparent in this posting, you are not trying *really* hard to be nice to them. Your bias is going to cloud the way you initially interact with them. You have a much better chance of getting respected as a human if you do the same.

  6. Thea: How much experience do you actually have working with drug seeking fibromyalgia and migriane faking scum, and do you understand just how difficult it is to be ‘nice’ to someone who is inhernently rude, onboxious and who is a pathological liar who won’t tell the truth about anything?

    Yes, there are people who have genuine pain and who are treated at legitimate pain clinics. Those are the folks who DON’T solely rely on narcotics and/or the Junkie’s Trinity for their ‘pain’ relief, and they’re the people who are so fucking paranoid about NOT being seen as an abuser that they’ll go to great lengths to work with the pharmacist – such as bringing their prior month’s bottles in so that, if necessary, it can be verified that they have the appropriate amount left. People who fake it usually are out of medications in a pretty short space of time and don’t think anything of calling in with some bullshite excuse as to what happened to their drugs and asking for more – one of my favorites has always been ‘the dog got into it’. Really? How many were in there? A full bottle, huh? How big was your dog? ‘Cause unless it was the size of a small elephant, that mofo should be dead. As a doornail. Oh, he’s a toy poodle? And he’s out in the car? Wow. Can I see him? I’ve never actually wintnessed immortality before.

    Sorry for being facecious, but if you saw what I’ve seen and deal with what these pharmacists and staff deal with on a daily basis, I think you’d be slightly jaded too.

  7. Ari: For the last five years I have worked at a drug treatment facility where the majority of our clients, including the pill-abusing opioid addicts, have been convicted of drug-related charges and mandated to treatment by the court. People who are forced into treatment are not very pleasant to say the least, especially when they are still using and you’re the one who has to tell their parole officer. Of course you’re going to get jaded, but that needs to be balanced with compassion and understanding. Addicts are not intrinsically bad people. They have a sickness that has hijacked their brain; that does not mean they deserve to be treated like garbage. Once you’re hooked its nearly impossible to stop, many of our opioid pill addicts were using the drugs for legitimate medical problems (at least by common perception; as you mentioned, painkillers are often over-prescribed) when they lost control. When withdrawal hits, they feel severe pain, nausea, agitation, and desperation. Be it genetic disposition, comorbid psychological disorder, or environmental factors, some people are especially vulnerable to addiction and find themselves in this position rather quickly. I feel if retail pharmacy staff cannot be understanding of this, perhaps they should work in research pharmacies or someplace where interaction with the public is limited.
    My clients frustrate me often; they lie, they steal things from my office, and they say mean things. However, by comparison, when I was an undergrad I worked at a toy store during the holiday rush. If you want to see obnoxious, dishonest, or just plain hostile, try dealing telling a weary parent that there won’t be any more remote-control airplanes until January. I’ve caught frazzled moms shoplifting because “they couldn’t deal with the long line.” I’ve had desperate dads try to finagle me into giving them other people toy’s from behind the giftwrapping counter by telling me their wives were in the hospital, only to see them with their (healthy) wives in the food court an hour later. My point is there are jerks everywhere, in every population, and all of them are easier to deal with if you try to understand their situation. Classifying and treating addicts as sub-human does nothing but reinforce mental healthcare inequity.

  8. Thea: I’ve been physically addicted to narcotics. I KNOW how withdrawl is.

    Is it difficult to maintain your posture on that pedestal you’re standing on?

  9. Ah all points taken… and yes, actually, those were the answers I wanted to hear. I *am* a pain pill customer who drops off and picks up a day or two later… I’ve only asked to wait once.. and prior to the incident, they were always more than pleasant with me there. I was floored that she knew I had my script filled at the other pharmacy…and at how angry she was… but now that I know why she needed to know, it doesn’t sting so bad. I had never thought of her license. I thought (incorrectly) that she was just being a meathead. I’m over it now.

    Thanks to all who replied to this.. and my post. I appreciate it. The last script I had filled had an extra pill in it (yes I count them so I can put them away for each week). I went back and returned the pill (and because of this blog, I got to make a joke of it) I told “evil pharmy” that I bet she never had anyone return a pill. She looked stunned while I had a good chuckle over it… she finally freakin’ cracked a smile!

    She said that she did have to dispose of it, but thanked me for being honest about it. I think we’re okay now.

    Thanks again. -Victoria

  10. Wow, Ari can’t even be civil to people who aren’t “drug seeking fibromyalgia and migriane [sic] faking scum.”

    What’s your excuse for loosing your temper with people who simply disagree with you? Get jaded having to deal with alternate viewpoints?

    Thea isn’t on a pedestal, it just looks that way from where you have your head stuffed.

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