I posted about S's experience with the stigma against people who take narcotics on a regular basis when he went to the emergency room.
Today, we ran into it again at the pharmacy. The pharmacists refused to fill his valid prescription, written by a reputable doctor, on the grounds that he is taking too much. My question is "Since when did pharmacists become doctors or DEA agents?"
This is a common problem when on a long term narcotic prescription. Many of the people interviewed for Arthur Rosenfeld's book The Truth about Chronic Pain: Patients and Professionals on How to Face It, Understand It, Overcome It complain about their pharmacists refusing to fill narcotic prescriptions.
In S's case, he was prescribed a higher dose of his breakthrough medication because we were going on vacation. His doctor tried to estimate how much more he would need, but the estimation was off and S needed to take more than was prescribed. Before he left, his doctor told him, "come back when you run out, I will refill it."
S went back to the doctor when we returned and explained what happened. The doctor had no problem with this and wrote another prescription to make up the difference. He knows that S is in constant pain, and any additional activity is excruciating. He also knows that S does not abuse his prescription. If he is not in pain, he doesn't take them. This was the first time that he ever asked for an additional prescription. It was not a problem.
We knew the insurance company would not pay for the second prescription and that is fine. If you take any medication outside of the prescribed amount, the insurance company will not pay for the additional prescription. We told the pharmacist what had happened, she called the doctor's office to verify and filled the prescription.
Today's script was his regular monthly dose. Because we live in a rural area, the pharmacies do not typically stock this medication. We almost always call around to find out who has it in stock. Our regular pharmacy is part of a chain and the local store did not have enough. We called the next closest store in the same chain and they did have it in stock. However, the pharmacist refused to fill it --without even seeing the prescription or talking to the prescribing doctor. I ended up driving an hour to get the prescription filled at a different chain pharmacy.
Correct me if I'm wrong, but I feel it is not the pharmacists job to determine whether or not an individual needs a medication. I can see refusing to fill it if there was a drug interaction or if S was allergic to it. But, simply because the pharmacist felt he was taking too much, I don't think that's right.
It is the doctor's job to determine the medication needs of his or her patient. S's doctor understood the circumstances, knew it was not going to be an ongoing problem and wrote the script. If he felt there was something underhanded or not quite right, he would have refused to write the script.
Needless to say, the pharmacy in question has lost our business. I am willing to drive an hour for our prescriptions if it solves the problem. S has fought long and hard to get the correct pain management. He is going to live with this pain for the rest of his life. He will become tolerant to the dosage he is on and it will need to be increased. These are the facts of chronic pain and narcotic use. I refuse to work with a pharmacy that does not understand or accept these facts.
Showing posts with label drug stigma. Show all posts
Showing posts with label drug stigma. Show all posts
Wednesday, August 10, 2011
Monday, July 4, 2011
The Drug Stigma
According to the Institute of Medicine (IOM), approximately 116 million people in the United States suffers from chronic pain. The report acknowledges that, "For many people, however, pain prevention, assessment, and treatment are inadequate." This is a subject S and I are intimately familiar with.
Because of the stimga attached to narcotics, it is virtually impossible for some people to get access to the pain relief that they desperately need. S uses a narcotic pain patch and oral narcotics for breakthrough pain. Due to medication interactions and his bipolar disorder, narcotics are the only effective pain medication he can take without a risk of extreme mania.
However, whenever he sees a new doctor or takes a trip to the emergency, he is almost seen as a drug seeker. Even if he is there for something other than the pain and never once asks for his medication.
Case in point, I recently had to take S to the emergency room. He was "falling asleep" without warning, no matter what he was doing. It came on suddenly and scared both of us rather badly. We called his insurance company's nurse line and the nurse suggested that it might be extremely low blood pressure. We tried most of the day to raise his blood pressure, but the episodes continued. It was a Friday afternoon and there was no way we were going to be able to see his regular doctor and I was frightened that his blood pressure would drop low enough to due permanent damage or kill him.
To their credit, the ER doctors actually did do every test that they could to rule out a stroke, heart or lung problems or an infection. But, I could hear the doctors and nurses talking and they automatically assumed drug addiction. As test after test came back negative, there was more and more talk of addiction and rehab at the nurses station.
After 4 hours, I asked that he be given his regular medication dose because I had left in a hurry and forgot to bring a dose from home. My request was outright denied. He was even denied his psychiatric drugs, even though it was well past his time to take them. He was forced to lie there in excruciating pain for another four hours.
Once, while S was passed out, the doctor came to suggest taking him off all of his medication, including his psychiatric drugs. I just kind of looked at him like he was insane and said "no, thank you. He is on these medications for a reason."
After 8 hours, S was released with the helpful answer of "reduce the levels of your pain medication." By that time I wanted to punch the doctor in the face, but I managed to smile, nod and get S dressed and out the door without any yelling or violence. I was pretty darn proud of myself!
Fast forward a couple of days to S's regularly scheduled therapy session. He told his psychologist what was going on, and she knew exactly what happened. The stress from fighting with his disability insurance company combined with his barely managed pain levels were causing him to experience blackouts. He wasn't falling asleep. His blood pressure was not low. His body was just shutting down.
Had the doctor taken him off his medications, he would have probably experienced them more frequently. Not to mention the fact that his bipolar disorder would be completely unmanaged and he would not be able to walk or function on his own due to extreme pain.
I have been reading The Truth About Chronic Pain: Patients And Professionals On How To Face It, Understand It, Overcome It
by Arthur Rosenfeld which discusses in detail, the stigma of narcotics and the problems people have with getting adequate pain relief. Over the next couple of days, I will share my thoughts and feelings about this book. I recommend it to anyone living with a chronic pain condition.
Because of the stimga attached to narcotics, it is virtually impossible for some people to get access to the pain relief that they desperately need. S uses a narcotic pain patch and oral narcotics for breakthrough pain. Due to medication interactions and his bipolar disorder, narcotics are the only effective pain medication he can take without a risk of extreme mania.
However, whenever he sees a new doctor or takes a trip to the emergency, he is almost seen as a drug seeker. Even if he is there for something other than the pain and never once asks for his medication.
Case in point, I recently had to take S to the emergency room. He was "falling asleep" without warning, no matter what he was doing. It came on suddenly and scared both of us rather badly. We called his insurance company's nurse line and the nurse suggested that it might be extremely low blood pressure. We tried most of the day to raise his blood pressure, but the episodes continued. It was a Friday afternoon and there was no way we were going to be able to see his regular doctor and I was frightened that his blood pressure would drop low enough to due permanent damage or kill him.
To their credit, the ER doctors actually did do every test that they could to rule out a stroke, heart or lung problems or an infection. But, I could hear the doctors and nurses talking and they automatically assumed drug addiction. As test after test came back negative, there was more and more talk of addiction and rehab at the nurses station.
After 4 hours, I asked that he be given his regular medication dose because I had left in a hurry and forgot to bring a dose from home. My request was outright denied. He was even denied his psychiatric drugs, even though it was well past his time to take them. He was forced to lie there in excruciating pain for another four hours.
Once, while S was passed out, the doctor came to suggest taking him off all of his medication, including his psychiatric drugs. I just kind of looked at him like he was insane and said "no, thank you. He is on these medications for a reason."
After 8 hours, S was released with the helpful answer of "reduce the levels of your pain medication." By that time I wanted to punch the doctor in the face, but I managed to smile, nod and get S dressed and out the door without any yelling or violence. I was pretty darn proud of myself!
Fast forward a couple of days to S's regularly scheduled therapy session. He told his psychologist what was going on, and she knew exactly what happened. The stress from fighting with his disability insurance company combined with his barely managed pain levels were causing him to experience blackouts. He wasn't falling asleep. His blood pressure was not low. His body was just shutting down.
Had the doctor taken him off his medications, he would have probably experienced them more frequently. Not to mention the fact that his bipolar disorder would be completely unmanaged and he would not be able to walk or function on his own due to extreme pain.
I have been reading The Truth About Chronic Pain: Patients And Professionals On How To Face It, Understand It, Overcome It
by Arthur Rosenfeld which discusses in detail, the stigma of narcotics and the problems people have with getting adequate pain relief. Over the next couple of days, I will share my thoughts and feelings about this book. I recommend it to anyone living with a chronic pain condition.
Subscribe to:
Posts (Atom)