medication Question - sort of ethics

Discussion in 'The Watercooler' started by susiestar, Apr 6, 2011.

  1. susiestar

    susiestar Roll With It

    Some of you may know that I take very strong medications to control some health problems. I have been on the exact same dose for close to two years with no increase. I have not ever run short because I took too much medicine in one day so I didn't have enough for the entire month. I am actually apt to have medications left over because I cannot keep them down when I have a migraine.

    I have used hte same pharmacy but it has not been smooth. I like having a locally owned pharmacy and one pharmacist there was my pharmacist as ateen and he remembers many of the medications I had then and how they set me up for the current issues. He has often given me info on a medication that he thought I should ask the docs about.

    To my dismay, the first four or five months I get drastically lower numbers of tablets then the prescribed amount. NOT a situation where they didn't ahve enough and "owed" some. I would count them and they would be short and it was a hassle.

    So for about six months it was doing well. husband would stop and ocunt them at the store rather than bring them home.

    In Oct the bottles started running 3-10 pills short and when I called the message I got was that I was clearly trying to get more than prescribed. sorry, I just have too much of the "aspie rule following" to do that.

    So after not having medications for 2 weeks because the rx did not arrive in the mail, we saw the doctor, went to the pharmacy and were PROMISED that the counts were right. they told us they triple counted because I was in the car with a rice bag over my eyes because I had a migraine.

    So I realized last night that I was 22 pills short!! So I either didn't get the right amt of medications or I am in the ER and hallucinating everything I did today.

    We are changing pharmacies. Should I also make a complaint to someone? If so, who? Theoretically the pharmacy has all the medications in an automatic pill dispenser that counts out the right dose, but it would still be easy to swipe some as you put the lid on, wouldn't it?

    So do I report this? If so, who do I report to. I Hate the thought that somebody out there is getting high on my pain medications and/or profiting from medications I paid for. Cause I have to pay for the full amt even if I dont get it. Cause it is very clear that the pharm owner was trying to say I am stealing/scamming.

    Yhanks for the advice.
  2. Marguerite

    Marguerite Active Member

    It should work in a similar way to us here in Australia. Here, there would be two possibilities.

    1) The pharmacy (a staff member, probably) is swiping medications from your bottles


    2) the drug company is short-loading the pill containers.

    I would put your concerns in writing to the pharmacy, point out your long relationship with them, also point out your continuity of care (not drug-seeking behaviour) and make it clear - you do not want to take this further if you don't have to, but you do have responsibilities to report your concerns higher up, because sure as eggs, you will not be the only patient this is happening to.

    Also tell your doctor what is happening. Your doctor may have other patients using the same pharmacy, and can discreetly check with them if there are issues.

    Next - at the same time, actually - call around, anonymously (at least, not yet divulging the name of the pharmacy until you give them a chance to make this right) to find out who you report this to and what the consequences are. For us here, the Pharmacy Guild would be one place, as would our government body responsible for overseeing the regulated supply of strong pain medications.

    I also am a long-termer on strong pain medications. Mine come in foil packs so counting pills is not an issue. Each foil has ten tablets or capsules in it. My prescription is for a fixed number. Sometimes the pharmacist doesn't have enough to fill my prescription, and tells me. He writes on the box (and makes a note) that he owes me a certain amount.

    The problem here is, when we make a fuss we get labelled as drug-seeking. It's a nasty tactic which if applied to someone who is actually an addict, will shut them up. But it also muzzles those of us afraid of being labelled. You can't win./ But if you have your specialists on side to back you up (they know how often they write prescriptions for you) then it's easier to stand up for yourself.

    One more nastier possibility occurs to me - could someone be removing pills from your supply, after they come home? Or perhaps in transit from pharmacy to you? You need to be able to say with certainty that this is not happening, because the accusation will be made, if you begin to make waves. But your supply of pain medications is being compromised, so you need to do/say something. I do know how that can make you anxious, when the alternative is uncontrolled pain.

    Incidentally, I'm dealing with (I think) similar issues of disbelief (or at least scepticism) from my GP. She's the newest member of my health care team, my previous GP began to specialise about four years ago. But she has seen me through the liver crisis that forced my weight loss (demonstrating I have self-discipline), through whooping cough, my cancer diagnosis and she also writes the prescriptions for my pain medications with a letter justifying it form the pain specialist. She also has my full medical file form the previous GP. She should know me. When I started seeing her, my morphine dosage was 140 mg a day. A rheumatologist put me on prednisone which allowed me to cut back to 100 mg a day but I didn't want to stay on prednisone, I felt it was a bad exchange. Going off the prednisone, I had to increase morphine back, but managed to keep it at 120 mg a day. I take it as a once a day sustained release dose, taking it in the morning, and it has prevented the severe crippling headaches I used to get - a fringe benefit of managing my other pain.

    Then for whatever reason I don't know, I found I could cut back a little more, so I did. I saw my pain specialist in early March and told him I had managed to cut back to 100 mg a day from December. But December/January/February prescriptions were a problem. The GP did all the right things, rang the government body to get the paperwork organised, did exactly as they said (I was in the room, heard the phone call) dated everything right, posted off a special prescription to cover the period she would be out of the country and unable to re-supply me. The prescription was posted to my pharmacist for dispensing. But first I had my regular monthly script dispensed. When the special government one arrived a few weeks later, I had it dispensed. But there was apparently a glitch. "No problem, I'll sort it out, said the locum pharmacist. I found out later he had a problem because both prescriptions had the same date - even though, in this case, the government had specifically said to do it that way. But they cancelled my first script retrospectively, then issued it retrospectively as the first of my two government ones. Then issued what I thought was my FIRST government script, as my second. So when I went back a month later, I had no script. I had to urgently organise to see my GP as soon as she arrived back in the country, and I was almost out of pills. I had only coped, because I had a backlog accumulated over the years.

    Now my problem began and from here, I think my GP no longer trusts me. There was I, a month too early, asking for more pills. Worse, she had to talk to the government people about it and I had to explain to both sets of people why I was back a month too early. I told them what the pharmacist had told me and had a hard time convincing them I was not lying. I tried to ring the pharmacist - he was at a funeral, it turned out (one I would have gone to but I had to see the doctor, didn't i!) and had left the phone unattended. It made me look even more shifty.

    I got my script, but at 100 mg a day. The months I had been on prednisone in 2009, my GP had insisted on writing scripts for the 140 mg a day even though I was not taking that much (hence my backlog). Now, a day after I reported having cut back to 100 mg a day, she would not write the script for 120 mg a day even though from past experience the chances are high I would have to go back to the higher dose. Thankfully I didn't have to.

    When I saw my pain specialist in early March I told him I had cut back from 120 mg to 100 mg since December. He was pleased and surprised. Ironically later that day I realised I was late taking my pain medications and was not suffering too much, so I decided to chance it and cut back again. My capsules can be opened, the stuff inside is in little beads and the capsules have lines on the clear gelatine sides. So I have been literally cutting my medications. it takes ingenuity. Since early March I have cut back from 100 mg to 80 mg, then 70 mg and today cut further to 60 mg.

    I saw my GP yesterday for my monthly prescription. She was friendly, but increasingly treating me as an addict in withdrawal. "It will be good to get you entirely off this by the end of the year," she said.
    "At this rate it will be sooner than the end of the year, but frankly I think my drop in medications may have almost reached a limit. I am still in pain, it's just that I am managing on less. I have tried to do this before without this degree of success. This is not willpower; it is me taking advantage of a change in my pain levels, that is all."
    I don't think she believes me, and now I think she believes I've been indulging myself with this for years and have now decided to give up my drugging ways.

    I think I've done flamin' brilliantly to cut my morphine dose in half since December. All by myself, too. Mind you, having to take my capsules apart is awkward - the little beads inside can fall and scatter. On Monday I had to manage while at the airport. There I was with a palmful of morphine beads in Sydney Airport, trying to measure them back into a gelatine capsule. Sweaty palms can turn the capsule to unusable jelly. I was relying on mother in law to stay with me while I did this, because her walking frame is a steady work platform for this task and if she could hold my handbag for me, I had less risk of dropping the stuff everywhere and wasting an entire day's dose. But just at the critical moment she decided to toddle off to see how sis-in-law's check-in was going. There I was on my own, minding sis-in-law's hand luggage, my handbag at risk of being grabbed, while I was trying to measure a palmful of morphine beads. Thankfully there were no sniffer dogs around!

    So now I've done what I think is a really amazing thing which I think demonstrates my determination to NOT abuse my medications, I am dealing with more obstacles and more scepticism from my GP. Plus hassles from the pharmacist. Or maybe because of hassles from my pharmacist.

    You can bet that my next pain specialist appointment will be very interesting indeed! VERY interesting... I'm hoping he includes in his letter to my GP, his concern that I not be treated with suspicion because I have proven to him that I am not abusing my medications.

    I really get cranky with doctors who don't understand pain medications. Like the idiot who put me on prednisone for six months, thinking it was preferable to morphine. It took both the pain specialist and the neurologist to argue with him and in the end I had to refuse to take prednisone any more. It is highly possible that the prednisone reduced my immunity to the point where I caught whooping cough, and also allowed my cancer to grow. I know which treatment is preferable!

    So hang in there, I do get how you feel about this. You should not have to feel insecure about your pain medications.

    Last edited: Apr 6, 2011
  3. HaoZi

    HaoZi Guest

    If you're certain it's taking place at the pharmacy and you're not comfortable talking to whoever is in charge at the pharmacy (or the store manager where it is), two places you can contact to find out if others have reported similar issues are the BBB and local police. I know there have been incidents here of a certain person that was hired and stole pills from the pharmacy that hired her. The pharmacy pressed charges. Somehow she managed to get hired at another pharmacy after being fired and before court and did the same thing at that one as well.
  4. Hound dog

    Hound dog Nana's are Beautiful

    It sounds as if you have a pharm tech or pharmacist snitching your medications. When I worked at Rite Aide we had a young pharm tech who was "skimming off the top" of certain medications. At first he was careful, usually just a few off so that most customers didn't realize they were shorted......and the few that did, just brought it back in and demanded their full script amt. As the money started rolling in for it........he got sloppier and sloppier about it, and larger numbers of pills per script came up missing. Enough customer complaints to the store manager and district manager was enough to have the pharmacy closely watched and investigated. Didn't take much looking for them to realize that the scripts that were coming up short were ones he'd filled. He was arrested shortly after. Nice kid, but very gullable and dumb. He wasn't even taking the pills, he had been talked into it by his girlfriend. He went to jail, she went and found a new mark. ugh

    I'd go back to counting it in front of them everytime again. I know it's a pain, but better that than coming up short. And if possible, I'd report it to the store manager, then whomever his boss is. Otherwise only thing I can think to do is to go to the police or maybe call the district attorney to have them look in to it. If it's the pharmacist, he needs to have his license pulled at the very least.

    I know a "skimmer" who works at one of our local pharmacies. I know him because he used to supply bff from time to time...........and we took classes together while he was doing his pharm tech training. I've reported him a few times.....each time he supplied bff and I actually was there to see it myself. So far he's still working. I won't use that pharmacy. But at all of them, I dump pills out at the counter and count them before walking away. Because once you get home it's next to impossible to convince them they made the error. ugh
  5. Marguerite

    Marguerite Active Member

    Think about who you spoke to about the missing pills previously, and who it was who tried to suggest you were drug-seeking. Was it the boss? Or someone junior? Was it the same person dispensing each time you were short? Was it the same person dispensing, who said you were imagining things/drug-seeking?

    If others are suggesting talking to the police about it, then it sounds like an appropriate course of action in your area. They may at least be able to advise you. And going to the police is not something a drug-seeking addict would do.

  6. susiestar

    susiestar Roll With It

    This has been going on since my second rx of this medication over 18 months ago (I just looked at my records of receipts from these medications.). I have spoken to the owner (a Ph. D pharmacist), and each of the other pharmacists. I have only had 5 months where the right amt of medications came home. husband is the one who picks them up for me and since 2 ibuprofen knock him out, I am positive he is not taking them. On ONE occasion Jessie was holding the bag after picking it up and they had given a non-childproof bottle and it spilled in the sealed bag because the lid wasn't on (the lid was defective and I had to use an older bottle because neither husband nor I could get the lid to stay on). We searched the car and didn't find any spilled pills and it was short over 50 pills! That was about 9 mos ago.

    I have not written letters but have called and called and called. So I discussed it with my new family practice doctor and his PA and head nurse. We are seeing them because the new insurance. They were shocked at how long I have put up with it. They did tell me to NOT use Walmart pharmacy if I ever needed to get the medications on a tight schedule. The PA's daughter is in pharmacy school and she was a tech at a walmart pharmacy for a semester. If you walk in at 9:01 and are the first person in line you will NOT get your medications for a minimum of 45 minutes - even if you are hte only customer in the store. It is store policy to keep you in the store because the longer you are there the more you will buy. Apparently this was in the employee manual as a written directive for pharmacy training!! I don't have that kind of time to waste getting a prescription much of the time.

    My medications have to be counted out. they are not in a foil pack. They do come in bottles of 100, but I get more than that so they dump them out and count them with the additional medications. It makes it a LOT easier to swipe them, in my opinion.

    Each time I call about this I get hassled and more and more treatment like a drug seeking addict than a chronic pain patient following the directions of her doctor.
  7. KTMom91

    KTMom91 Well-Known Member

  8. Star*

    Star* call 911

    I wonder if you could "third" party your medications and have them sent directly from a pharmacy out of town. I used to get mine by mail order an they were never wrong or .......have the pharmacy sent to your doctors office for a while. If it were me? I would stand there and count them IN the pharmacy. DF has had to do this with a p tech more than a few times with his medications because once you leave? It's a done deal. It was a pain and eventually we switched pharmacies. Which is more than a BIG deal because if you short someone on a class 5 narcotic, and the doctor calls you for a medications check and you are short 22 pills? YOU are done with the doctor period and now you go into some sort of doctor shopping data base and are black listed.

    I'm not sure if it's nationwide yet - but it's coming.
  9. DammitJanet

    DammitJanet Well-Known Member Staff Member

    Susie i have had this problem before with my pain medications. When I went to a major chain i noticed that my pain medications were coming up 3 or 4 short every few months but then one month it was a whole 30 pills short! At that point I was getting 90 pills and they always put 45 in two bottles but this time it said on the bottle, 45 of 90 but no second bottle and 60 pills in one bottle!

    I called the pharmacy immediately and went back in. That store also lost scripts and found bags of filled bottles when i left them.

    Now I go to a little family owned place that has bankers hours but are so great. They know me by name and I never have to worry about my medications.
  10. susiestar

    susiestar Roll With It

    The doctor won't do them mail order because if they get lost he is not legally allowed to rewrite them. That was the problem with the scrip that didn't arrive that I am quite sure the nurse did not send but said she did. It was partly due to a scheduling error because I was sick, but she was too into judging me to listen. At least it was only 2 weeks worth was what I was told.

    The pharmacy that has been shorting me IS a family owned, local place that has been in business a long time. It is why I stuck it out so long and didn't report. we went there from a pharmacy in a locally owned grocery store that had an idiot manager who kept picking stupid fights with the decent pharmacist that was there. He wouldn't even hand you a prescription you called in if the other pharmacist had filled it already. he made you go back in to get it from her because it was "too much work". Of course this mgr couldn't count and often gave the wrong medication even if the rx was typed out (gave me inderal instead of imitrex one month and SWORE that they were the same drug, kind of thing. he is gone now but I won't go back. I am talking to other pharmacies here in town to see how they handle this stuff.
  11. Marguerite

    Marguerite Active Member

    The risk with a small family-owned pharmacy, is if they have a family member working there who is the problem, and they are covering up for him/her.

    Putting it in writing formalises it. Getting your doctor to endorse it, or mentioning that you have discussed this with your doctor, also sends a strong message ythat others know that the wrong thing is going on. it also hints that they are about to lose business big time. I would also talk to the police to ask advice on how to go legally - because this is theft, in a way. If the pharmacy shorts you even accidentally, it is still legally thefy because you have a contract with them. A prescription is a contract to supply the amount prescribed. Failure to supply the full amount, without saying so and maknig alternative agreement (ie contract) with you, is deceptive and theft. Even if it's an honest mistake. Because they are not supposed to make mistakes, even honest ones. it may happen once. But not that often and not by that big an amount.

    What I suggest you put in a letter - "I have been concerned about this for some time. The incidents I know about were as follows: [list them]. My GP was appalled that I have put up with this for so long. I have been distressed to be treated like a drug-seeker when I query the problem - this is an inappropriate way to treat a customer who is merely asking for the correct number of pills to be provided, but it seems to be a technique deliberately chosen to intimidate me into silence on tis matter. I require this to be resolved to my satisfaction or I will be taking this up with the proper authorities. I am already making enquiries with the police, since failure to supply the prescribed amount, especially when it happens repeatedly, constitutes theft of a prohibited substance. I look forward to your prompt resolution of this matter."

    Send copies (cc it, so they know) to the GP and to any other official body you feel should be informed. There should be an association of pharmacies that oversees good clinical practice, for example. Check the window of the pharmacy or their paperwork to see which group they're a member of. Call the mob first to find out what their professional standards are in such a matter. You can put cc on the bottom of the letter but not send the letter off to the copies immediately. You should, but a day's delay won't matter. But don't put them there unless you find out ahead of time that they can help. You do not want to cc the pharmacist's personal legal advisor, for example, because it tips them off to CYA. So make sure any mob they're a member of, isn't merely a legal liability service.

    Go for the kill. Interfering with pain medications is akin to torture, in my book.

  12. TerryJ2

    TerryJ2 Well-Known Member

    Oh, dear. What a mess.
    I would document the phone calls, since you haven't put anything in writing. That way you at least have a list of calls. You can look on your receipts for the days you picked up and guestimate the time that you called.
    My first reaction was "switch pharmacies."
    That's a LOT of pills to go missing.