> preventi g addicts from getting it (who cares?)
I presume the families and loved ones of the addicts probably care...
I presume the families and loved ones of the addicts probably care...
Not US, Australia, but wouldn't be surprised if same rules apply there – suppose you are prescribed 50mg Vyvanse. You start to feel like 50mg is too much (the side effects are too bad), and you want to try 40mg instead. Can the pharmacist dispense you 40mg instead of 50mg? No. Because it is a controlled substance (or "Schedule 8" as it is called in Australia), the pharmacist can only legally dispense the exact thing you were prescribed – they'll tell you to go back to the prescriber and get a new prescription. If it wasn't a controlled substance, the pharmacist would have more flexibility; in the past, I've gotten pharmacists to dispense prescription drugs without a prescription because I hadn't got around to getting a new script – something they are legally allowed to do (at least here in Australia) for non-controlled substances. They can't do that again and again – it is important the prescriber is kept in the loop – but as a short-term once-off, it does no harm. But going back to the prescriber involves getting another appointment, taking the time out of one's day to attend it, paying for it, etc. In the end one might just decide to put up with the side effects–which is a clearly less than optimal health outcome. Or, one can be reduced to trying to cut the dosage one's self – open the capsule, dissolve the contents in a measured quantity of liquid, then measure out the liquid – which will seem like too much effort to bother with.
I can understand how someone who is prescribed 50mg asking for 60mg or 70mg could be a sign of a developing addiction, but asking for less than one is prescribed is the complete opposite of how an addicted person behaves. So why isn't it allowed? Because the rules only have a rather diffuse relationship with preventing addiction (or other health harms). I think, to a great extent, the rules have come to exist for their own sake, not for the sake of anyone's health.
Other regulations that hurt legit patients more than "drug seekers" : you cannot transfer a script between pharmacies, so if the pharmacy is out, you have to have your doc cancel the script and send to a diff pharmacy, a process which can take several days at worst. Some pharmacys say they are not legally allowed to disclose their stock over the phone, so you may need to repeat this process many times.
If you are in a different state, pharmacys will not fill your script from your home state, so good luck traveling anywhere if your script ends during your travels. And some docs/pharmacies will let you fill early to avoid this problem, but they may label you a drug seeker and put you on a list.
I don’t know what most American doctors are like. But my mother, brother, late grandfather, uncle, aunt, and two of my cousins are all doctors. (My uncle used to work in the US, but an Australian doctor working in the US probably isn’t very representative of the average American doctor.) I often mention this (without as much detail), in part because I suspect it makes them treat me better. Plus I’m unafraid of medical jargon, which probably helps too
A lot of my personal complaints are about the system and its rules, not the people who work in it, the vast majority of whom have absolutely zero input into what the rules are
For example I went to a derm once because I had a spot which looked like cancer for nearly a year. I went in, explained and asked for a biospy. He refused to even look at it, gave me a script for doxycycline to treat me acne (which I did not even mention) and sent me home telling me to come back if the spot was atill there in 8 months. When I came back and he looked at the spot he admonished me for not coming in sooner to have it biopsied.
This is just one example in a long line of medicial professionals refusing to listen carefully to what I have to say. They always think they know better
My mom gets pneumonia fairly frequently and gets very severe cases of it. She is an absolute tank who could be on deaths door and would look normal.
She currently is extremely ill with pneumonia. She went to her doctor last week and told them she was coming down with it, and explained to them that everytime she gets pneumonia she has to have X Y and Z medications in order to treat it. The doctor refused to prescribe them, gave her a much much weaker antibiotic and no steroids, and sent her home instead. She came back two days later after not feeling better and they sent her home again. She finally came back a 3rd time and waz given meds X and Y but not Z. Still not better, she went a 4th time and was given X and Y again without Z. She has fought tooth and nail to be properly treated and has STILL not been given the meds that she knows will help her. She is currently on hour 35 of sleep in 48 hours and is still sick as a dog.
This is just routine for american docs in my experience. Perhaps I live in a medical care desert, but this is just not even remotely unusual.
Doctors ignore your cincerns, fail to address them, and then when you play thr squeeky wheel in order to get some grease, act like you are a burden on their ability to care for other patients.
My experiences really don't match yours at all. From working as a tech a couple years back I know 1000% that every pharmacist I worked with made judgment calls on whether or not to help people out.
If you had a sketchy vibe, you weren't helped out. If you were a regular and amicable enough to be liked we'd figure out something we could do for you if it was legally possible. You can see how this falls apart when you're traveling or going to a non-usual pharmacy because of how subjective it all is.
(Ex: for Texas if it was actually illegal to say CII stock over the phone it wouldn't be "some pharmacies", it would be "all". I don't know of anyone that would fill a CII early, too much professional risk. I've also only met a single pharmacist that would do 90 day CIIs despite that being legal if written exactly for that. Pharmacists are generally very risk adverse.)
My experiences as a patient don't match yours either, at worst I went to a clinic that had on-site drug tests very infrequently. Never had any issues with doctors or PAs telling them how I actually took the meds, but I also wasn't dumb in the way I went about telling them.
I also never ran through primary care physicians for any of this. The fact that you said 3/10 of them would terminate the relationship just makes me wonder how much personal experience you have with that exact situation. It just feels extremely sketchy.
That some doc later prescribed me 2mg ativan and told me to "keep taking it till you feel it" which is how I ended up passing out in missouri and waking up in florida 48 hours later.
That same doctor gave me mometesone and after nearly 2 years of using it told me "oh by the way forgot to tell you : dont use that for more than 2 weeks consecutively because it can be life threatening"
My experience with healthcare professionals is consistantly that they do an awful job of listening and seem to think they can tell you more about how you feel than you can.
I am unusually educated about pharmacology and I think some doctors are suspicious of that. Fair enough I guess.
No, I do not look sketchy or aggressive. I am literally just a normal looking dude. Rather healthy, rather well kempt. Now what the fuck should that have to do with my medical care? I sure am glad I can afford nice clothes, glad I was raised to speak proper english, and glad I have adequate dental care, cause it sounds you are suggesting pharmacists will not work with you if you are an "undersireable". I think that is pretty fucking gross. If you gave 50 junkies their drugs but it meant you didnt hassle even 1 legit patient Id call it a win. What bizarre moral high grounds peoppe take.
Also I was at no point complaining about pharmacists - theyve always been super helpful to me, as much as they legally could anyway. I was complaining about the law itself, and complaining about primary care physicians.
And you are correct I should have said "some states" instead of "some pharmacies" - it was, in fact, in Texas where this happened to me and you are correct, The first pharmacy I called told me that no texas pharmacy could legally fill the script from an out of state doctor.
Everyone gets a baseline minimum level of care, but there are varying levels of "working with" when problems arise when you have a fixed amount of time you can get everything done in.
If you don't have time, you have to use SOME other heuristic to determine priority. (Mainly speaking to how much leg work the patient wants the pharmacy to put in, vs themselves)
From other Healthcare POV:
There's a reason why so many people burn out. The people that make a career out of it without getting jaded are actually incredible.
>If you gave 50 junkies their drugs but it meant you didnt hassle even 1 legit patient Id call it a win.
But the other moral hazard comes into place when you're the one okaying questionable prescriptions that could result in someone's death.
Insulin syringes was another case where junkies would lie to your face about what they were using them for. I worked with a pharmacist that wouldn't sell them to people that didn't have a reasonable way of proving that they needed them for legitimate purposes. Why? A junkie ODed outside his pharmacy after buying them.
How many junkies would you have to kill before changing your own personal policy? If you don't care about killing people, it's extremely easy to just say you'll sell them to everyone.
>I was complaining about the law itself, and complaining about primary care physicians.
My point was some of the blame should be on the pharmacists or techs when they aren't telling you the full truth. (And it felt like they weren't when I read your post)
The out of state script is a good example of what I'm talking about.
If it was a CII paper script they couldn't legally fill it.
But they could have also told you that an out of state doctor could eScribe in a CII if they really cared to do so.[1] And if it wasn't a CII but still scheduled they might have been legally able to fill it anyways based on the criteria in the link I posted.
I've gotten hassled for even out of city CII scripts, and it's the same play where they create just enough friction to make it easier for you to go somewhere else.
1. https://www.pharmacy.texas.gov/files_pdf/QUICK_REFERENCE_GUI...
I understand the perspective of not wanting to give out material that may result in a drug overdose/death. I get it on an emotional level, but it just doesn't really make sense to me. For example, what is safer for a junky - to recieve prescription grade norco, or to sniff a pile of heroin that came from god knows where cut with god knows what? so in the case of a pharmacy sweating people about the legitimacy of their need for a norco, my way of thinking is just give the damn things out. If its a junky, so what, they just got a cleaner safer high. And if its legit, then you have just helped someone who you would have otherwise burdened with the inability to get their drugs.
But there is no rational reason why a pharmacist shouldn’t be legally allowed to dispense a patient with a prescription for a controlled substance with a lower dose than prescribed. Prohibitions on them doing so are just pointless bureaucracy which have nothing to do with preventing addiction. They achieve nothing except harming patients
And I actually only learned that this was possible from a comercial I saw yesterday (Im out of town currently) weirdly enough.
In the US, when purchasing Vyvanse with cash (most insurance won't cover it), the price is dictated by number of pills, NOT by the dosage of those pills. So, it is half the cost to get 15 pills that you take a half of daily versus a standard 30 day supply.
I think the 30 day supply was somewhere in the realm of $400 by the way.
Vyvanse patent expired last month, so hopefully a generic product comes out soon!
My own comment was a knee-jerk reactive comment in reply to what I felt in your post, which may or may not have been a real thing.
Idk. My hunch is that we are all addicted to something, and if you don't see what it is yet, then either you or society (or both) must not have much of a problem with that particular addiction, and that can always change.
Wrong.
The definition of addiction is "physically and mentally dependent on a particular substance." (Oxford Dictionary)
I am addicted to coffee. I get mild physical withdrawal symptoms if I quit. In no way is it an impediment to living my normal life.
> Addiction is a neuropsychological disorder characterized by a persistent and intense urge to engage in certain behaviors, one of which is the usage of a drug, despite substantial harm and other negative consequences.
In fact, the article goes on to specifically refute the argument you are making:
> The term addiction is frequently misused when referring to other compulsive behaviors or disorders, particularly dependence, in news media. An important distinction between drug addiction and dependence is that drug dependence is a disorder in which cessation of drug use results in an unpleasant state of withdrawal, which can lead to further drug use. Addiction is the compulsive use of a substance or performance of a behavior that is independent of withdrawal. Addiction can occur in the absence of dependence, and dependence can occur in the absence of addiction, although the two can occur together.
You know what is cynical? Putting up barrier after barrier that makes it hard for ANYONE to obtain a medication that can genuinely help people because we dissapprove of how some people use the drug on their own bodies.
Criminalizing the possession if a drug doesnt do jack shit to help people who are addicted - it just drives them into sketchy situations to obtain it and throws them in jail if theyre caught. And to top it all off it makes it incredibly difficult to obtain it even if you play by the rules.
Especiallu in the case of something like amphetamine, which does not directly cause bodily harm (an argument could be made that things like heroin and alcohol, which can and do directly kill, should be withheld)
When you prevent an addict from obtaining via legal means, all you are doing is forcing them to find illegal means, which may involve interacting with dangerous individuals or outright theft.
I do not believe my comment about allowing people to destroy themselves displays a lack of empathy - I dont think a family member or friend should not intervene if someone is engaging in self destructive behaviour.
But I do think it is immoral for the government to prevent someone from destreying themselves. It is not the mamdate of the government to prevent self harm.
I think addiction is not an issue in a vacuum. It is caused by underlying issues. We need to learn to accept addicts as they are. You cannot help someone when their needs are not met. To an addict, the drug is a need. That need must be met before deeper issues can be addressed. It is a fallacy (and dare I say a lack of compassion) to push addicts to the fringe of society by denying them legal means to carry on with their addiction.
Opiates used at a sustained level are actually not that harmful--the danger comes from those who are deliberately seeking the extremes (things like crushing the time-release pills and snorting them) and from the lack of quality control of the illegal marketplace. We don't see the chronic pain patients keeling over left and right from ODs--except when we try to deny them the relief and drive them to the illegal market or to suicide. If the cause of their pain doesn't otherwise mess them up they can often lead reasonably normal lives.
We also have a problem with confusing habituation with addiction. A patient who needs controlled substances will likely habituate and be in a bad way if they're denied but that doesn't mean they are addicts--you can seek the relief the drugs bring without seeking the drugs themselves. If the underlying problem is resolved you taper them off and it's not an issue. Part of the opioid crisis was the doctors being deceived into thinking the tapering wasn't needed. The CDC has finally realized that cutting them too quickly is medically bad--but the system is still geared to persecute drug seekers and catches too many innocents in the loop. Woe to the patient that loses the doc that has been handling the drugs! (And it's not always because they were going to a pill mill. Doctors are human, they retire, they get sick, they die. And the DEA likes to pressure pain management docs into retirement.)
I think there’s way worse things to be addicted to than Adderall and feel like this guy is a “worst case scenario” but he’s still a productive contributing member of society.
I suppose he could have been gaming the system somehow by going to multiple places but I thought it was all from the same doc