Are Pharmacists Getting a Bad Rap?

Are Pharmacists Getting a Bad Rap?

Over the past month, ever since Steve Ariens wrote this reply to a reader in his “Ask the Pharmacist” column, I’ve been wondering something:

Are pharmacists getting a bad rap for refusing to fill prescriptions for pain medication?

I’ll say that Ariens’ reply was a bit on the intemperate side, but the overall point he suggested was that if a pharmacy delays in filling out a prescription, then the patient should consider reporting the pharmacy or even taking legal action against it.

A provocative response to be sure — but something patients should know if they believe they are being denied something. The article caused a firestorm of response from patients and pharmacists alike (which at National Pain Report we think is a healthy thing).

Drugs SignMany of the pharmacists who left comments have been loath to use their names. Understandable, but it would be better if they did.

I was drawn to a comment by a reader who called himself “The Actual Pharmacist” who wrote:

“Pharmacists are caught between the DEA, MDs that overprescribe narcotics, abusers of narcotics, and legitimate patients that are suffering through pain. Establish a relationship with your pharmacist and respect his authority.”

That last comment resonated with me. As someone who has suffered from pain, (intermittent, not chronic, it should be said), I have never had any problem or incident with my pharmacy when I’ve had prescriptions filled. I’ve taken the time to get to know the folks at the pharmacy and have pretty good conversations with them about prescriptions.

In fact, at a CVS pharmacy in Northridge, California over the holidays, I approached one of the pharmacists about helping me pick the right over-the-counter product for a severe cold, which she did willingly and helpfully.

One future pharmacist who did leave his name to a comment is Eugene Vivelo IV, who is a student at Butler University. In a thoughtful email and a subsequent interview with National Pain Report, Vivelo said, “I can respect Steve’s (Ariens) side of the story and appealing to his followers who must suffer through their terrible chronic pain. What I cannot respect is his unintelligent and demeaning rant about a pharmacist doing what is required by him by the DEA and looking out for bettering of patient’s therapy.”

I’ve been communicating via email with a couple of pharmacists who as of yet want to remain nameless. I have encouraged them to author a piece from their point of view — so that our readers can understand what the pharmacist is going through in this pain medication debate.

By the way, in the last month we’ve been drawn to an aptly named Facebook page called “The Cynical Pharmacist,” which has a robust following and gives the pharmacists’ point of view on any number of issues in the pharmacist-patient relationship.

We’ll renew our efforts to speak with the chain pharmacies, notably CVS and Walgreens, to get their point of view too.

Pharmacists and patients need to be talking to and with each other, not just at each other.

Authored by: Ed Coghlan

There are 8 comments for this article
  1. Justin at 9:24 pm

    My name is Justin and I have been a chronic pain patient in the state of Florida for just under 10 years. I currently work in the tree industry to support my family, as well as going to college full time to make a better life for my family and myself. I know from my past injuries and how I’m in constant pain, my body cannot handle this kind of work much longer. My injuries include: falling out of trees on 2 occasions, torn rotator cuff, knees and L hip Constantly ache, MVA accident (I was passenger in a car that struck 3 telephone poles @ 60 mph), and a compound fracture in my ankle (fixed with surgery and hardware which i feel everyday). I have recent MRI’s of my entire spine showing 6 herniation’s and 3 disc bulges, along with stenosis and degenerative disorder.
    With that being said, I have been a patient of the same legitimate doctors office for over 4 years, and the SAME Cvs pharmacy for the past 2 1/2 years.
    Yesterday I went to the doctor and when I got to the pharmacy, the pharmacist whom had been filling my pain meds for over 2 years simply refused to fill my medication (after telling me that they were IN Stock). His reason for doing this is that my doctor is not in the same county, its 15 miles away, and closer than MOST other pain doctors within my county. Now, my mother lives in the same neighborhood, goes to the same Dr., and he had no issue with filling her prescription just 4 days prior (last Friday).
    If the pharmacist would of given me some kind of notice last month, and given me time to find a pharmacy, it wouldn’t be as bad. But my fill date comes ONLY when i’m out of medication (28 day supply, every 4 weeks), and i’m not early. The thing that really gets me tho, I got a call from CVS (my pharmacy) the day before telling me my prescriptions were ready to be refilled on the following day. And he is just totally refusing to fill my scripts. I am reading online that I could possibly have a stroke and die from not having these medications, which I have been on for the past decade!!! I don’t understand how any medical professional can refuse a long time customer their medications, fully knowing the severity of what not having this medication can cause..
    In the past 2 days I have been denied by at least 35 other pharmacies in the area. Because of this situation, I am probably going to loose my job (I cant do that type of work Sick AND in terrible pain). There is still 3 weeks of college left before the end of semester, the hardest 3 weeks.

    I am at a loss for words and don’t know what to do. Nowhere to turn. Bills are due. I guess I now get to watch everything that I have worked so hard to build, for my family, crumble in front of my eyes because of the decision of one man. And that man is NOT my DOCTOR, so how is it he can tell me what medications I can and cannot have.

    This is not right. Can someone please give me some advise on what to do, It would be greatly appreciated, by my family and myself. Thank you for taking the time to read about my problems.
    Justin

  2. Pharmacist at 9:20 am

    I am a Pharmacist in a store that fills many narcotic pain medications. A large amount of my patients I am on a first name basis with, they call me on days they have MD appointments so I get all the paper work done I need to and process their script when they drop it off to get them out as soon as I can. Unfortunately when I get a new patient it is now my job to do my “due diligence” to ensure the prescription is for a “legitimate medical reason”. Those are not my rules; that is the DEA’s rule – they do not practice medicine but they control how I practice. I went to school for seven years studying nothing but medications and am confident in my knowledge of pain management – a subjective disease state that requires tight monitoring for optimal control; including long acting and short acting medications. It saddens me to read these stories and see how my fellow professionals are practicing; personally I feel these are older pharmacists who are not comfortable with the new regulations we have to follow and are not used to patient interaction. However there are a few things I would like to clear up, as a healthcare professional it is not a violation of privacy rights for me to call your doctor for more information on a prescription. This is an inconvenience for everyone involved, including myself but it is required today to ensure compliance with regulations on my part. Retail pharmacy is a job with high demand in my area because of new regulations, nobody wants to be the one to tell a patient they cannot get their medication but if there are obvious “red flags” (as the DEA has named them) my hands are essentially tied and I have to deny it or fill it after receiving more information. I would be happy to answer any questions/complaints as I would like to try and repair the image of the retail pharmacist. Unfortunately today pharmacist will get in trouble for prescriptions they DO fill but will never lose their license over a prescription they REFUSE to fill. This is what is shaping our practice and this is why some pharmacist act how they do. In my opinion the entire system of pain management is flawed, the pharmacist is caught in the middle of it, and the legitimate pain patients suffer – not necessarily from actions of a pharmacist but from the current system in place. Thank you and god bless.

  3. Karen at 9:01 am

    Pharmacies fear being cut off by wholesalers and investigated by the DEA when their ratios seem out of balance. I’ve never seen a clear number, but most pharmacies are advised to keep their CIIs below 25%. One reason that this happens is mandatory mail order. Patients are sometimes required by their insurance to fill their maintenance medications (blood pressure, diabetes, cholesterol, etc.) through the mail order pharmacy. This leaves the retail pharmacies with pain meds and antibiotics. It’s unfortunate, but it’s one of the reasons.

  4. Kathy at 6:15 am

    I am absolutely furious with CVS Pharmacy in Altamonte Springs, FL for their refusal to fill my legitimate pain pill prescription, of which I only require about 16 pills at a time, once or twice a year! I had part of my pancreas removed a few years ago because of a tumor and I periodically suffer with acute bouts of pancreatitis. If I’m too sick, I will allow the hospital to admit me, but I can usually manage the attacks at home. The attacks require that I ingest nothing but water for a few days and I HAVE to take a strong narcotic (percocet or oxycodone) until the intense pain subsides, which usually takes 2-3 days. Although I’ve been going to the same CVS for years, they now are suddenly having problems getting any stock of pain meds since the new laws took effect. But what gets me SO angry is the fact that they told me they couldn’t even call another CVS to see if it was in stock. They told me I would literally have to drive around from CVS to CVS to see who might have it. That is B.S.!!! When I called their corporate office to complain, I was told they won’t call other stores because they never know if an abuser or thief is trying to find out which store has it in stock. Regardless of the fact that my husband and I have been getting all our scripts filled there for years – and that I only have a small narcotic script once or twice a year – it doesn’t matter. They will not call another store on our behalf. Oh, and GET THIS – they said their stores don’t have Caller ID so they wouldn’t be able to tell if it was actually another Pharmacy calling to check stock or if it was just someone seeking painkillers. What a load of garbage.

  5. ginbug at 7:36 am

    Independent pharm., You are giving the same stereo type patients examples as every other pharm. gives & uses to deny any wrong doing on your part!!
    Let me try once more to break this down for you & try to make it very clear as to why we (chronic pain patients) are upset.
    We DO NOT expect you to fill for all patients or put your license on the line!
    We DO expect you to use the tools you have been given (even though pain patients are forced to give up privacy rights that all other patients get, in order for you to have those tools!) to make sure that we are legitimate!
    Once you see that we are NOT doc shopping, we expect you to fill our rx. How much more simple can we make it for you?
    I would LOVE it if you would read my story below & give me some HONEST answers w/o just giving the same stock scenarios that EVERY pharm. gives! The moment a pharm. sees that you have a narcotic rx, they automatically lump ALL patients in together & start judging or passing judgment BEFORE they even run your name to see if you are legit or not!! God forbid if you look healthy or young because apparently pharms. can tell just by looking at you whether or not you need these type of meds.!
    So I will await your HONEST answers after you read my story below or challenge any other pharm. to answer me!

  6. Independent Pharmacist at 12:27 pm

    I’ve worked in an independent pharmacy in a small town for the past 10 years and I have only had a handful of negative interactions with patients. With the recent regulations requiring pharmacists to look up patients in the Prescription Monitoring Program in my state, I must say we have been cracking down on the dispensing of controlled substances, particularly for pain management. When I look someone up in the database and see that they have filled at 10 different pharmacist during the past year, often with Rx’s written by multiple prescribers (I’ve seen people with upwards to a dozen prescribers in a year’s time), this is a red flag to not just myself but surely any other pharmacist I’ve met. Not only is it a red flag, but an expectation by the DEA to think twice about these prescriptions; we are risking our hard earned doctorate degrees by filling these prescriptions. I respect patients in chronic (or even acute) pain, however there are certain patients that you just know are doctor shopping. I can’t speak for each and every pharmacist practicing out there, or what the chains are doing, but I think as a general rule, it is those patients that we are on the lookout for, not those suffering from pain with legitimate prescriptions from a prescriber with whom they have an established medical relationship with.

  7. ginbug at 12:50 am

    I am a patient advocate that is also a life long chronic pain sufferer & not only do I hear the same awful stories everyday, I myself, have been treated in a humiliating & abusive way by many pharmacists!!
    While this is a nation wide problem, Fl. is ground zero & even if you find a pharm. most times he will either honestly not have it in stock or he will only except cash for it!
    I had been w/ cvs for 10+ yrs., same doc. for 6yrs., same meds. for 4yrs. I NEVER filled even 1 day early, always used my ins. & thought I had a good relationship w/ my pharm. However last oct. I went in like I did every mo. & was told that they could no longer fill for me because my doc. was not in the same county as my home & cvs. & the cvs that was right next to my doc. said no because I did not live there! So what am I supposed to do? They would not even give one last fill so that I could find a new one! I went to almost 30 pharms. before finding someone to help me & wish that I had recorded the way more than 75% of them treated me!!
    The pharm. I have now is a mom &pop store & even though I have been there for over 1yr. every single month, there is some kind of problem w/ them getting my meds. in stock if at all. 3 mo. ago, I was told that they could no longer except ins. for my break thru med. (oxycodone) because they have to pay more for it than my ins. covers, which I have no problem paying the difference; but for a med. that had always only cost me about $10, they claim that now my cost is $625 for the exact same thing!! Are they now buying from street dealers, because I do not believe that the price went up by that much & I have even heard of higher prices elsewhere! I can’t afford that & now I have to go through a compound pharm. ($160 for a 28 day supply) & that mixes it w/ ginger(gives me awful heartburn) & naltrexone which has made it less effective. Also most pharms. require you to fill 3 non control rx for each control rx. So I am forced to fill & pay for meds that I don’t need. (I was already on 4 non control; but my ins. makes me get 90 day supplies, which the pharm. will only count as 1 mo. so I have to have my doc write 5 other rx in order to get my 2 control meds.!!)
    In my opinion, if a patient is legitimate, verified, is not early, has followed all LEGAL rules, has a legitimate doc. & is compliant, then a pharm should NOT be allowed to turn a patient away & if they honestly don’t have it in stock, then they should have to do what they can to find their patient another pharmacy that does have it!!! If they turn away patient without a good & verified valid reason, then they should loose their license!!
    When someone like myself who has other health problems, that have been on long term opioids (oxycontin, methadone, etc…) & is dependent (NOT ADDICTTED) to have our meds. cut off cold turkey, it can put our life in very real danger!! ( I had this happen & was in icu for over a week because my heart stopped twice & I had a stroke that caused lasting damage to my eyesight & short term memory!! all due to withdrawal shock!!)
    So if a pharm. is going to put my life in danger, they better have a damn good reason, because if I live thru it, I will do everything that I can do to take his/her license away for good!! This is NOT a game!! We are human beings that did not ask to be in a nightmare of 24/7 pain!! Our lives matter just as much as everyone else & we should have the same rights to life quality as every other patient!! Just because there are those that abuse these meds. does NOT mean we all do!! I wonder if people found a way to get high off insulin if diabetics would be treated this way & turned away? It is exactly the same w/ us, as neither med. will cure anything; but we need them to live!! Do you know the difference between a end stage cancer patient & a chronic pain patient? The cancer patients’ misery & suffering will end soon!
    THANK YOU STEVE!!!! PLEASE CONTINUE SPEAKING THE TRUTH!!!!! as you seem to be the only one who does!!!

  8. Pharmacist Steve at 1:42 pm

    IMO.. if Pharmacists are getting a bad rap.. it is mostly self inflicted.. I find it hard to believe that all the pt stories being denied their medically necessary medication that find their way to my inbox is representative of a few “bad apples”. Particularly since these emails come from pts from all over the country. Here is just one from this week
    ” I’ve been going to the same pain center for over 4 yrs now. For the last 18 months, I developed a good relationship with my local pharmacist, & he filled all of my prescriptions. He retired at the end of the year. I went into pharmacy on Monday to pick up a prescription. I know this pharmacist too, & said my pain mgt appointment is next wk, could you help me? He lied to me, & said the distributor won’t ship to us, go somewhere else. The pharmacist that filled my prescriptions said the 2 other pharmacists that work there won’t fill schedule 2 meds. ”
    I was also recently told by a pt that his kid was a tech in training and that the two pharmacists at the pharmacy PRIDED THEMSELVES that they hadn’t filled ANY CONTROL MEDS since they had started working there and just sends them to the local independent pharmacy..
    The AMA has threatened pharmacists that they are going to file complaints of them practicing medicine without a license.
    I am sure that there are a number of Pharmacists that try their best to take care of their pts.. I don’t know if that is a large or small number… I don’t hear about them.