Here’s a surprise… patient’s who were addicted to opioids from the age of 15 and seek help at age 30 sometimes have issues. Some pharmacists seem to think that every patient should be perfect. Those of us who work in the psychiatric and addiction fields know that such patients are rare. I’ll describe today’s experience. Another day, another Walgreens pharmacy hassle.
I’m not going to start out by writing that these issues seem to happen more with my local Walgreens than with pharmacists at any other company. I waited until the second paragraph to say that.
My patient contacted me by email today, my day off because I want all of my patients to email me whenever any problem arises (this is Wisconsin, early winter, so what else should I be doing?) He was leaving town for five days and the pharmacist refused to fill his buprenorphine on day 28. Until today, filling on day 28 of 30 was OK. Personally I usually go to the pharmacy on Wednesdays, my day off, since most local pharmacies in my town now close on weekends. Filling my sleep med on day 30 each month would be difficult as I’d have to go on a different day of the week each month.
And frankly, I’m not perfect. Maybe once per month I’ll go to a restaurant for dinner and enjoy a cup of coffee. And I’ll take an extra half tab of my sleep med. Doesn’t seem like a huge deal. I do encourage patients to avoid extra doses as much as possible to keep the medication working for them. But an extra dose once or twice per month shouldn’t bring in the Spanish Inquisition (nobody expects the Spanish Inquisition!! — those were the days….)
Most patients on buprenorphine went through years where more opioid was better. That conditioning persists throughout much of their lives. My goal, and job, is to help extinguish that conditioning. The process works, sometimes, but takes years and years. So patients who have been on buprenorphine and in treatment for, say, 5 years are still subject to that conditioning. Some rare patients take two tabs of buprenorphine per day from day one, and never take more. But some take an extra buprenorphine tablet a couple times per month for a placebo effect, usually when they are experiencing difficult situations like a new job with 12-hour shifts, or working swing shifts. And I understand why. Working from 11 PM to 11 AM one week, then from 11 AM to PM the next week, makes mediction timing a little confusing.
Luckily, the partial agonist properties of buprenorphine mean that an additional dose does NOTHING. There is no ‘high’, no sedation, and no extra pain relief. It is a placebo. There is no risk of overdose — none at all. The only real issue is that the patient is wasting fifty cents worth of medication.
The local pharmacist might say ‘they might be selling it!” But I doubt my patients, almost all who have seen me for many years, would risk going to prison in exchange for selling two tabs of buprenorphine at $10 each. And is it a pharmacist’s duty to think that needing medication at 28 days implies that their customer is a drug dealer?
The long-term goal is to help patients understand that life will generally work better if they strive for ‘regularity’. Although as I type that sentence I think about the lives of working-class Americans these days, trying to hold a job when the car breaks down, or feeding four kids with today’s inflation. Regularity is easy for ME to say!
A few months ago, a (Walgreens) pharmacist said that because my patient filled on day 28 for six months, she would not fill his script for 12 days. That person didn’t email me to ask me to send it elsewhere. He didn’t want to bother me. Instead, he got sick as Hell and missed a week of work, then lost his job. Now a previously ‘stable’ patient is unemployed and trying to hold it together. Good job, (Walgreens) pharmacist!!
Today, a (Walgreens) pharmacist said that when he called to ask if his script was ready, he didn’t mention his five-day trip until his third phone call. The horror! So no script for him. I called it in to a different pharmacy, where it was filled without problem. Apparently they didn’t get a good look at him!!
Does (Walgreens) fill heart medication on day 28? Or if a person with diabetes wants to refill insulin, will (Walgreens) make the person wait twelve days if it was filled on day 28 for six months? Asking for a friend.
There was a time when many pharmacists would tell me that almost every buprenorphine patient ‘looked suspicious’ for some reason. Those experiences were what drove me to start writing about buprenorphine 15 years ago. I guess the good news is that now more pharmacists have an understanding of medication-assisted treatments. They realize that addiction is an illness that could happen to anyone, and those who work the hardest will find their way out, and take a medication that keeps OUD in the rearview mirror. If their (Walgreens) pharmacist will fill it…