A Pained Life: Distrust and Don’t Verify

A Pained Life: Distrust and Don’t Verify

A video was recently posted in a chronic pain support group of which I am a member.

“Red Flags” was produced by the National Association of Boards of Pharmacy and the Anti-Diversion Industry Working Group, a coalition of pharmaceutical manufacturers and distributors, as an educational video for pharmacists to help them identify the warning signs of prescription drug abuse and diversion.

Warning signs for pharmacists seems like a good idea. Just like when diagnosing a physical illness, it is good to have a list of symptoms to work with.

But sadly this video was more interested in stereotypes and putting the blame on patients.

Some of the “flags” make sense. Patients coming into a pharmacy in groups, all having opioid scripts from the same prescriber, and for the same medication, appears to be suspicious on its face.

But if someone uses “street slang” it should not be an automatic warning sign – not as long as the prescription is from a legitimate doctor for a legitimate drug with an appropriate dosage and amount.

The same is true if a pharmacy customer has constricted pupils or other physical signs of being medicated. If I am on a narcotic drug given by my doctor, I may well have signs of having taken that medication. On the other hand, if I am glancing all around, acting very nervous and leery, I may be trying to scam.

It is always better if prescriptions come from one doctor, but often those of us in pain require more than one specialist. Often each doctor will give prescriptions on their own.

The same is true if we have multiple pain disorders, or other conditions that have pain as a component. More than one doctor will most probably be writing our prescriptions. And those may be for pain medication.

I have no problem with the pharmacist making sure the prescription has a legitimate purpose, if he has a good reason to ask.

But I do wonder, why does the customer have to prove it? The video makes the patient the bad guy, suggesting they have to prove the legitimacy of their prescription and the need for it.

A doctor prescribes for reasons only he may know. He decides which drug is appropriate, not the patient. He can explain his reasons; the patient often cannot. The disorder and how it is treated may not be one the pharmacist is familiar with.

In the video, I did not hear the announcer say, “If you, the pharmacist, have questions about a customer, their prescription, or the reason for the prescription, call the doctor and verify.”

But the doctor is the one who can verify, who can explain, who can confirm a patient’s identity and if the prescription is real.

We have enough to deal with — merely getting through our days with pain.

We should not also be put in a position of having to defend what our doctors do to help us.

Carol Levy

Carol Levy

Carol Jay Levy has lived with trigeminal neuralgia, a chronic facial pain disorder, for over 30 years. She is the author of “A Pained Life, A Chronic Pain Journey.”  Carol was accredited to the United Nations Convention on the Rights of Persons with Disabilities, where she helped get chronic pain recognized as a disease.

Carol is the founder of the Facebook support group “Women in Pain Awareness”. Her blog “The Pained Life” can be found here.

The information in this column is not intended to be considered as professional medical advice, diagnosis or treatment. Only your doctor can do that!  It is for informational purposes only and represents the author’s personal experiences and opinions alone. It does not inherently or expressly reflect the views, opinions and/or positions of National Pain Report or Microcast Media.

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Authored by: Carol Levy, Columnist

There are 10 comments for this article
  1. MichaelG at 9:06 am

    These pharmacists have too much power! They have, personally, ruined doctors, like me, because they were too ignorant to understand the proper treatment of chronic pain patients. One call to the medical board and your livelihood could be gone! Now, I live in poverty and in chronic pain from a spinal cord injury! If there is , truly, karma, these people are going to have a lot to handle! Maybe they will get chronic pain. But, alas, pharmacists “know” doctors and can get whatever they want without being questioned!

  2. Minuett at 7:15 am

    THANK YOU, a Carol. Perfectly written. Those were my concerns with that very skewed video as well.
    Denying a valid patient’s medication can cause the patient to go into shock, and can cause death.
    Terrifying that pharmacists would rather risk killing legitimate patients than risk a single dose getting into the wrong hands, as pharmacist steve puts it.

  3. Johnna Stahl at 10:26 pm

    And speaking of red flags (at Marci’s post)…

    A copy of Walgreens “Good Faith Dispensing Program” checklist, requirements, and restrictions, kindly posted by Pharmacist Steve:

    http://www.pharmaciststeve.com/wp-content/uploads/2014/10/Walgreens-Opioid-GFDdocuments.pdf

    So, If you’re wondering what may trigger the denial of your prescription (and a call to your doctor for more information), these are a few from the checklist:

    *Third party is being billed (cash or a cash discount card is a red flag).
    *Quantity is 120 units or less; or 60 units or less if paid by cash or cash discount card.
    *Patient has been on this same medication strength and dose for less than 6 months.

    I’ve read that Walgreens forwards the names (and personal health information) of patients who are red-flagged to the DEA. Pretty soon, the DEA will have a file on every single American (if it doesn’t already).

  4. Johnna Stahl at 10:20 pm

    Marci said: “This type of scrutiny doesn’t happen to customers picking up antibiotics, insulin or beta-blockers. Just pain patients.”

    And yet, there are incidents of kids overdosing on drugs like insulin, beta-blockers, and ADHD drugs too. (Along with incidents of poisoning from household products, and things like toys.)

    And the scrutiny is a little like having a tattoo on your forehead that says “addict,” just because you’ve been prescribed something for pain. (Perhaps pain patients should all start wearing prison orange so we are instantly recognizable.) I can almost — almost — feel what it would be like to have a different color skin than white. (As I already know how it feels to be discriminated against for being a woman.)

    “I would like to see the training videos on how to spot ‘legitimate’ pain patients.”

    I would like to see a drug store’s training videos on how to catch criminals, so I can compare the two and see if there are any differences.

  5. Johnna Stahl at 10:03 pm

    kellix said: “There are some doctors that think crohns isn’t painful. Yes it is.”

    I think it’s interesting that your doctor thinks Crohn’s isn’t painful, when it is one of the few qualifying conditions for the Medical Cannabis Program here in New Mexico (along with Ulcerative Colitis).

    “why isn’t this patient getting better… he said there are some people that are not going to get better”

    Recent changes to forms for the Medical Cannabis Program include language that says the doctor must certify that the patient is improving on the treatment. (And how is that the business of the state’s Department of Health? Talk about coming between the doctor/patient relationship… In fact, I don’t think there’s much left in the doctor/patient relationship.)

    I’m not sure how I would define “improvement” for constant pain that never goes away. Anyway, I’m not seeking to improve my condition through treatment — I’m just trying to remain stable.

  6. Reena at 7:34 am

    Also, it is very dangerous and painful to be suddenly off of pain meds. Ths is bad medical that harms. Where is the pharmacist responsibility of that, as well as Ada violations of access, discrimination and accommodation. As it is civil rights violations; no govt agency or even the federal/state funded disability rights groups are not helping us for these violations or the many other types of violations by medical, even thoough the Medicare scandal has been mentioned in alternative media.

  7. Marci at 6:15 pm

    I would like to see the training videos on how to spot ‘legitimate’ pain patients. There seems to be only one side of this story being reported. Never any training on how to delve deeper in a positive, helpful manner with customers or taught to look further at the past script records a chronic pain patient would have picked up that might assist a pharmacist to form some helpful conclusions if they were genuinely interested in providing personalized support to a patient’s healthcare and not just restricting medication based on the type of drugs they see written on the script. This type of scrutiny doesn’t happen to customers picking up antibiotics, insulin or beta-blockers. Just pain patients. Yes, pharmacists should be trained to look for red flags, but not to look at EVERY customer with a script for pain medication as suspect.

  8. kellix at 10:38 am

    Great article, but that’s the way life is getting. 4 years ago when I got my fusion, my doctor could call in a prescription, no problem. Now you have to go to the doctor and get the prescription on special paper that like money. Also I have chronic pain from my back, legs and having crohns disease. There are some doctors that think crohns isn’t painful. Yes it is. Also I have looked at it from my PMs pint of view, hes told me things, that I know he shouldn’t have but the fact, that doctors are being audited so badly that they are scared to death to do their job, and end up undertreating the patient. Who cares nobody, because they are afraid their license will get pulled. I hate whatever happened in Florida and all the other places that started all this, because the people that have true chronic pain, its made our lives a living hell. Where you have to jump thru hoops to stay. My doctor said it perfectly he has had govt types ask him, why isn’t this patient getting better one. I think its illegal from hippa looking at our records, and 2 he said there are some people that are not going to get better, he’s seen it for 20 years, they just will not, so your trying to make their quality of life bearable. I wish they would interview the doctors instead of the pinhead admin doctors who haven’t been in the trenches for years. The ones in the trenches see the real pain, and they also see the ones they bounce because they are obviously faking it for meds. Which if any of them had to go thru what I went thru would never take a med again. I would love to be off of them. But till the pain changes or something happens. Keep trudging along.

  9. Pharmacist Steve at 9:08 pm

    The DEA has taken the stance that Pharmacists are responsible to determine if the pt has a medical necessity for the Rx just presented them. This places the Pharmacist in the position of being a diagnostician .. even though they have little/no training in this area and be able to do it without access to the pt’s medical records. Within the DEA statue.. there is the phrase corresponding responsibility… and the DEA has decided that even though the Rx was written by legally licensed prescriber that has a valid DEA license to prescribe controls the Rx may not be “legal” because of questionable medical necessity. All too many Pharmacists have taken the position that they would rather deny legit pts their meds than take the risk of the first dose getting in the wrong hands.

  10. Cozette Davis at 4:48 pm

    Thank you Carol for continuing to be vocal and a watch person for chronic pain suffers. It is sad that the patient has to justify what a physician wrote. With the number of people developing chronic pain disorders rising, I wait anticipating the response of many physicians and pharmacists.