Getting lectured by the pharmacist at each script drop off

I've been seeing a pain management doctor for 2 years now. I don't want to get into all of my surgeries (it would take a while)but will answer any questions from you guys .
I have been with the same pharmacy for years. I don't know why, but the head pharmicist has lectured me about my prescriptions the last 3 times i dropped them off. Her lecture is about how there are "studies" that show that the morphine equlivent of what i take is way too high because these studies show that a lower amount does the same thing.

Unfortunately i have been in chronic pain for years and know not to argue with a pharmacist because it can be torture to try to find a new place yo fill scripts. The forst time she did this, i was annoyed. I shouldn't have to tell her my history. Especially when the place i go to is a supermarket pharmacy with my friends and neighbors in earshot of her and myself. Also because frankly, it is none of her business. My doctor knows everything about me, what has happened to me, my surgeries, what meds work, what meds don't. He is not only a pain management doctor but also a practicing anastiologist. He knows his medications way more that the pharmacist.

After the second lecture by the same pharmacist, on my next visit to the pain management doctor i told them about this and about how uncomfortable i was . I asked them what i should do if it happens again. They told me to stay calm and tell her that if she has any questions or concerns to call them directly. They unfortunately have had to deal with this before with pharmacist's.

So today, i drop off. There she goes again with her lecture. So i lean into the booth and say, i spoke to my doctor about you. If you have concerns or questions he told me to have you call him . Well then she said... ohhhh , ahhhh , well it will take too long (or something along those lines). That's when i got annoyed but am proud of myself that i held my composure, and said - i go to a specialist for a reason. Please call them if you have concerns about this.
She finally stopped (for today).

Was wondering if it's just me or if others have dealt with this also.
Oh, also i know i mentioned this already but my scripts are written properly. They say for non acute pain . And this is from a pain management doctor. I know that the laws have changed. But i am doing nothing wrong. I wonder if she is looking at me thinking that im not in the pain that I'm in every day because im not hobbling in to drop off my prescriptions. Idk but this is getting annoying.

Thank you Pitmom for your reply.
I was sad at first that my pain management doctor has had to speak to pharmicists directly that question his prescriptions. But on the other hand he did say that once he explains (calmy) that the reason that certain medications are prescribed are because they've tried everything else with no relief for the patientsand this is when he has to prescribe higher doses or stronger medicines that then the pharmacists agree with him. He said that he's only had 1 that would not budge from their own opinions and stance.

I was really happy that he was so nice about telling me to just tell them to call him directly and that he would handle it.

Just sucks that a pharmacist is questioning a pain management doctor with her (the pharmacist) not knowing a darn thing about what I've been through. She shouldn't even be lecturing me. Ok, maybe one time, i might have understood. But 3 times, the same thing....
I so wanted to snap and tell her the hell I've been through but in retrospect I'm glad i didn't. For so many reasons. The main one being --- it's none of her f ing business. There are HIPPA laws for a reason.
Luckily i have a great doctor and he has a really good staff.

Hope the rest of you don't have to deal with this.

Hi Avid,

I go to a small 'Mom and Pop' pharmacy and have gotten the same thing. I was using a supermarket and had no trouble filling my scripts but I am not driving any longer because I can't with my meds and my husband preferred the closer pharmacy. The smaller one 'counseled' not only me but my husband! What about HIPPA? If he is picking up or dropping off the scripts/meds they whined to him about them. They did contact the primary care dr who was doing the muscle relaxers and sent him an article to read! He said pharmacists think they are the Dr. I started bringing in my patient summary after my PM visits and then they calmed down. I do feel hostage to getting all my arthritis meds and general stuff filled with them because they don't want to only fill the pain meds. We have worked out a good relationship over time but every month I have to wait an extra day while they order the meds. I would think they could anticipate it and have it stocked after years of the same RX but it is tolerable. And the pharmacist did give me his cell phone for a hurricane med pickup...Pro's and con's of a small pharmacy I guess. Let's face it the world thinks people on pain meds are junkies. I also don't look too bad and that makes it look like I am not needing the meds.

Green Beans, Hi nice to meet you! I am interested in your experience with plaquenil. I would also like to talk to you about the Sjogren's. I will do a separate post because I don't want to hijack Avid1s. So sorry!

Susie, Avid, GB...To me this is a symptom of the general climate. People on pain meds are not deserving of compassion or understanding. Rather, they are either misguided and need to be educated about the medication or up to something. What about respect and compassion.

As an individual myself on prescription opiates, I can appreciate the inherent discomfort and sense of unfair personal attack when questioned and scrutinized by a pharmacist.

Recognize that the makings of the current “opiate crisis” does have legitimacy. Cases of pill mill pain clinics, dispensing prescriptions for opiates that exceeded any reasonable need; physicians accepting lavish gratuities from Purdue Pharmaceuticals who agreed to lecture at educational seminars supporting expanded use of opiates; diversion of prescription opiates, often a family member or acquaintance looking through a bathroom cabinet and taking medication prescribed to someone else.

Legtimate pain patients are caught in the cross fires. Collateral damage.

Opiates are powerful medications and they need to be respected as such.

That pharmacists are asking questions is not necessarily bad or misguided.

How many of you are aware that long-term opiate use causes suppression of the HPA axis (hypothalamus-Pituitary-adrenal axis) and endocrine related disorders? Probably very few. HPA suppression is also not strongly recognized by opiate prescribing physicians and, lacking accurate diagnosis, can leave people languishing.

Opiate induced adrenal insufficiency is real and is estimated to affect between 10-20 % of chronic pain patients on long-term opiates. Opiate induced secondary adrenal insufficiency was the basis for issuing a Black Box warning on opiates by the CDC/NIH/DEA prescribing guidelines issued in April-2016.

I already had Addison’s disease (primary adrenal insufficiency) when I began taking prescription opiates. The risk of HOA suppression was a moot point for me. I already have complete Pituitary failure (pan-hypopituitary) and complete HPA suppression.

I can tell you, unequivocally, that I would not wish adrenal insufficiency on my worst enemy. It is a truly debilitating disorder that adversely affects the entire body. The bulk of my health challenges are endocrine-based.

To wit: Do not be too harsh on a pharmacist who may ask you questions about the dosage you are prescribed. Opiate dosing over a sustained period of time will suppress the HPA axis. You can not necessarily trust that your prescribing physician has an awareness of opiate induced HPA suppression and its ramifications. It serves us all well to be fully informed. Knowledge is power. Striving to take the lowest dosage of opiate that balances the ability to function and retain mental sanity is key. If a pharmacists’ questions cause you to stop, pause and reflect on your opiate prescription that in itself can serve a greater good and a greater purpose.
Karen

Even with good intentions of a pharmacist..that atmosphere where they are lecturing in public, is inappropriate...this needs to be between the dr and the patient..they do not know your circumstance.

No one wants to take pain meds, there are usually side effects, even ones we do not understand.., still i think just saying, you can call my dr. Is a good idea.

Avid , i am glad you have a dr who will work with you..lj

Just a guess but the pharmacist may also be covering her butt. People are sue happy and it's a sure bet that at some point they have been sued (or heard of it) by someone who blames them for not warning them about a possible problem. The laws are such that the medical profession has to walk a small edge when it come to medication and handling it. It's sad.

I wouldn't take offense the first time, after that I'm afraid I wouldn't have had your patience.

Seashell makes good points. .as always. In addition countless patients that were on high doses of opiates and had to reduce or stop their pain meds. Have realized they do not need the opiates like they thought they did. This takes time. For years chronic pain patients were told they had to have opiates. They would be on them the rest of their lives. Patients were also told taking opiates long term was not harmful. That was based on incorrect information. Addiction and overdose are not the only risks.

Do you know how long the pharmacist has been there ? Or when she graduated from pharmacy school? Pharmacists recently out of school do not have the knowledge and experience of working with patients. They go by the book because this is all they know at this point.

Chances are the store has instituted a new policy. All pharmacists have to counsel patients receiving opiate prescriptions at each fill. Pharmacists deal with countless patients. They do not remember anything about the patients. Including if/when a patient was counseled.

Post Edited (Mercy&Grace) : 9/11/2018 10:03:47 AM (GMT-6)

If this is a chain grocery i would email headquarters and let them know. Tell them your concern for your privacy due to the traffic.

Avid:
Believe me, I have had similar experiences to yours of being unilaterally judged by pharmacy staff when picking up a narcotic prescription. I would cringe when walking to the pharmacy pick-up counter, not knowing whether there would be a uneasy encounter. These episodes occurred during the first few months that I was on prescription narcotics - which also happened to be early 2016 when the CDC prescription guidelines had been released (formal CDC report was issued in April 2016).

It was a very visceral experience. I felt a pit in my stomach. I was anxious, hyper-vigilant. I felt as though I was a common criminal in the eyes of the pharmacy staff.

I was already a “frequent flyer” at the pharmacy as I have routine monthly prescriptions to correct for Pituitary failure.

I can appreciate your growing frustration with the pharmacist encroaching on your personal boundaries.

I think your strongest position is to continue to reply to the pharmacist in a calm and non-confrontational manner as you have been doing. “I appreciate your concern but ask that you contact my physician directly rather than counsel me again.”

Possibilities:

There may be corporate stipulations or demands being placed on the pharmacist that ask of her to interject herself and promote less opiate reliance when patients pick up a script. Many of the large/national pharmacy conglomerates are tightening pharmacist counseling surrounding opiates and benzodiazapines (ex. Walgreens, CVS).

If the pharmacist is acting maliciously as a bully or explicitly wanting to establish a base of superiority/power over you, then the less you engage with her the better. A mean-spirited bully wants to elicit a strong reactive response in his/her victim. By not reacting dramatically to the pharmacists’ taunts veiled as counseling, you are not giving her the response that she wants to further fuel her. She loses power when you respond calmly and politely, with 1-2 sentences.

Writing a letter of notification/complaint to the corporate pharmacy office would also be an avenue for you to pursue.

Let us know before you plan to pick up your next narcotic prescription at the pharmacy. We can send positive karma into the universe for you. The power of collective goodwill.
Karen

Post Edited ((Seashell)) : 9/13/2018 10:33:05 PM (GMT-6)

Avid:
Have you considered moving your prescription to a new pharmacy?

I was with Rite-Aide for years but became disenchanted when newly issued corporate policies took away from the neighborhood-feel of my local store. I am happyily established with a new pharmacy that fits my needs.

Pharmacies are like any business seeking new shoppers. Even with a pain contract, you have the option to change to a new “home” or primary pharmacy.
Karen

I have this problem at the CVS I use. I have been going there for 9yr's and when my refill falls on a weekend and they are using a fill-in pharmacist that's when I get the lecture about the methadone and oxycodone I am using. I've had a pharmacist refuse to fill it. So I took my scripts and went across the street to Walgreens. These are pharmacists that have become very paranoid of the DEA.

Thank you all for your replies first and foremost.
I had my monthly appointment this morning. When i went to the pharmacy to fill one of the prescriptions, i didn't recognize the new guy. But turns out his picture is on the wall as the head/main pharmicist. (The "lecture lady" is now the second in command).
Anyway, i walked up gave him my hydrocodone script (the main one isn't due until the 9th). He went on the computer for a bit then asked me if the prescription was for break through pain. I said yes. (The lady never asked me this, just gave me the lecture). So like for a hot minute i am thinking in my head, wow maybe this guy understands chronic pain.

Well then after that, he asks me, "how often do you take this?"
Well without thinking AND with my back throbbing in pain, i said to him - 'why are you asking me this' ?

*Sorry, i was in major pain & had a sports massage 2 days earlier that helped a bit but the muscles locked up last night and this morning So i was in a crappy mood.

Well, he replied - "Because I'm your pharmacist and I need to know".

Instead of sayin, - Well, why don't you read the f'ing script ?

I actually took a breath and said - "I take it once a day but try not to take it unless it's absolutely necessary ".

I had to go back later to pick it up. As i was thinking about this, i realized that i may be coming across as a bit#h, especially since my back and neck were f'n killing me and he doesn't know this. I just seem really mean.

So when i went back to pick up the hydrocodone medication, i did say to him, I'm sorry for being so short with you. I just really don't feel good today. He was actually nice , looked at me and said, no problem (in a nice way).

Not sure what will happen next month , or what will happen when i fill my other script on the 9th but i hope it gets better.

Gotta thank you all for the positive feedback , ideas and talking about what you all have been through. It seriously helps more than you know.
Also to Rjbeck, i also take methadone as the main pain medication so i appreciate you saying that you take this also. I've had a bad experience with oxycodone as the main one but methadone and hydrocodone as break through pain relief is really working for me.

Post Edited (Avid1) : 9/24/2018 2:51:57 PM (GMT-6)