This is a ‘bone to pick’ post. Yesterday a patient who has done well on buprenorphine for the past 6 years shared his pharmacy experience. His experience is typical of whatI hear far too often. I understand that pharmacists are overworked and understaffed, but the complaints I hear so often have nothing to do with staffing. Pharmacists should be more careful to protect privacy and promote good health for ALL patients, even those on Suboxone.

I practice in a relatively small town – the type of place where it is surprising to go to the grocery story and NOT see someone you know. And now that the COVID emergency has mostly passed (and living in an area where people rarely wore masks unless required), people line up at counters directly behind one another.

My patient is always annoyed when the pharmacist takes his boxes of Suboxone Film and stands them up on the counter during check-out. I assure him that most people have no idea what Suboxone is used for, but he has always seen it as an invasion of his privacy. At his last visit, he asked the tech to please put his medication in a bag so that the line of people behind him didn’t see what he is taking.

But that was just the start. Before allowing him to take the medication, the technician told him he had to speak to the pharmacist for a ‘Narcan check’. Before he could object, a loud-spoken pharmacist asked if he knew what Suboxone did, and whether he had Narcan at home ‘in case he overdosed’. The patient said that he could have heard the pharmacist from 10 feet away, meaning that several people in line behind him heard the Narcan lecture.

I hear similar complaints often. I hear about pharmacists loudly asking a person ‘why they have been on this medication for so long?’ or saying ‘you’re only supposed to take it for a year! (which isn’t true). I hear about pharmacists telling waiting patients ‘your Suboxone is ready’ when they are sitting with strangers. Are there no rules requiring pharmacists to maintain privacy?

While I have a pharmacist or two reading this post I’ll add another beef. As I mentioned, almost all of my patients have been with me for many years, and haven’t used illicit opioids for a long time. But almost all of them report interactions that make them feel judged. People can wrongly imagine that feeling, but I pick up on the same attitude when I speak with pharmacists. For example, a long-time patient had medication stolen by a visiting family member, an issue that I deal with by requiring such patients to buy a safe going forward. But in the meantime, pharmacists act as if it is their duty to avoid an early refill, causing the patient to be sick from withdrawal for a couple weeks and maybe lose his/her job.

I understand if a patient has had medication lost or stolen before. I understand if there are signs that things are turning downhill. But frankly, even if a patient is struggling, it is not helpful to deprive that person of buprenorphine. All that will do is guarantee that the patient’s life will become worse. Why do some pharmacists have a punitive attitude about buprenorphine?

A local pharmacist called my office a month ago to say that since a patient had filled his script at 28 days for 6 months, she wouldn’t fill his new script for 12 days. I explained that some patients make the mistake of thinking they can take an extra dose on two days each month — usually when they are struggling with chronic pain or working 12-hr shifts and think the medication will help them get through the day. I can see explaining to those patients that we need to find a way for them to avoid the practice. But make them get sick for two weeks? Seriously?

I will add that I feel lucky for having several very GOOD pharmacists in my town – pharmacists who will discuss and consider problematic situations, rather than fall back on ‘I could lose my license!’, a nonsensical concern for filling a 30-day script at 28 days. Might as well say ‘if I fill it, a piano might fall on my head from the sky!’ To those good pharmacists who may have come across this post, thank you. To the others, pleasure comes from providing a service for people who appreciate you, and you’re missing out.


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