Our pharmacy is medium busy. During the day we run it with just a pharmacist and a technician. My technician types the labels and fills the bottles, and I, the pharmacist, verify the prescriptions, counsel the patients, and then charge them for our services at the cash register. The two of us make a good team, because I stand out there with the customers, solving the pick up problems, which leaves my technician undisturbed to solve the prescription processing problems. Our place is one of the big chains, but at one time it was a privately owned drug store. I guess you could say that the prescription department is somewhat shabby and old, and on the small side. Other than a video camera, it has zero security. I never know who is going to walk through the door. Standing at the register I see plenty of good and some bad.
The kid in the halloween costume was a good memory. During the middle of a hot summer, a little boy dressed as The Green Lantern darted up to my cash register. It was a sight that put me into one of my better moods. This kid was no more than nine or ten, and was all skinny energy. He had the green legs and green arms, and eyes like bright sparks shone behind his hero’s mask. He pointed his lantern ring at my head and shouted, “boom!”.
His parents followed a few seconds later. The mom was holding prescriptions, the dad was holding his jaw. They had dentist prescriptions. Those were easy work. Dentists usually write for two types of medications; a morphine-family drug for the ache and a penicillin-family drug for the bugs.
-”Will it be fast? He’s in a lot of pain.”, asked the mom.
-”Daddy, is the man going to make you feel better?”, asked the super hero to his father.
I looked at the first prescription. It was for a ”morphine-family” drug called Percocet. This is a stronger narcotic, so the pain was probably bad. We would fill it right away. This is a part of my job that I really liked. It’s an example of the immediate difference that a pharmacy can make for a patient. Suffering and worry will usually start to melt as soon as you hand a patient their bag of pain pills. Even before they swallow a single tablet.
This triggers a memory of my own Percocet prescription, that was once written for me by an oral surgeon, after taking a wisdom tooth out of my head. It was a stubborn tooth, so he advised me to fill the prescription right away. Well the surgeon was right. Before the pharmacist completed the filling of my prescription, a bullet of pain fired from my gum and lodged in my lower jaw. As soon as I could, I gobbled down a tablet and within thirty minutes that wild fire was reduced to a few glowing embers. The first day after oral surgery the Percocets were my miracle life jackets, and I clung to them every four to six hours. After that, I was out of deep water and I saved the last two tablets. Like a boy scout, I took them with me when I lived away from home, attending pharmacy school.
And sure enough, one night I was awoken by another aching tooth. To be honest this discomfort was only a fraction of that first one, but there is another component to all pain. It is anxiety. I was awake, alone, and feeling the first hints of an ache, which may, or may not, have grown into an agony. This was nerve wracking anticipation. So I had the two tablets in my bottom drawer. What the hell, I took a Percocet, even though I really didn’t need one.
Within minutes, I started to feel a warm sensation that began in both of my legs, and with it came a feeling of super human relief. Wow. It was like being in the middle of a rush of perfect peace, and just prior to falling asleep, my entire body felt like a prop in a porno movie. It was my first and only time that I abused a narcotic. I had been an accidental junkie. Since the pain wasn’t severe enough my brain had been focused on a Dopamine explosion that was caused by the Percocet.
Scientists will tell you that all addictive drugs involve an elevation of the neurotransmitter, Dopamine. It is the chemical that, under normal circumstances, rewards the organism for good behavior. But man found drugs. And narcotics, which are very effective for taking away pain, artificially elevate Dopamine to an all time high. It was responsible for that rush that I had felt. Luckily, my brain isn’t wired to become easily addicted. The next day I realized that the pain pill felt abnormally amazing, and I never touched the Percocet again.
It is not the same for the poor narcotic addict. This individual will always remember the first time they felt the rush. That flood of Dopamine fires from the base of the brain, then reaches into the frontal cortex, to wreak havoc with behavior and decision making. The addicted person can spend a good portion of their lives chasing that feeling. Their mind is consumed by a pursuit of that high.
This triggers a lot of bad pharmacy memories of me fighting battles with drug seekers. The board of pharmacy did not dress me for battle. They didn’t hand out a Green Lantern ring with my pharmacy license. Addicted individuals will try anything, tell any lie, and ruin any life, in order to stay high. Their actions can range from mildly amusing to breath-stopping scary. One night I got fed up and called one of the doctors. While my rather large patient sat in the waiting area, I told the doctor that this guy had been getting multiple narcotics from prescriptions written at Emergency Rooms all over town. His doctor instructed me not to fill the prescription. He said to mail it back to him. After I hung up the phone, I was left with the task of telling this two hundred pounds of muscle he would not be getting his oxycodone; and I was keeping the prescription.
I am not complaining about people in real pain. I interned at a pharmacy in New York City during the late eighties. AIDS was out of control. The pharmacy was located a block from a VA Hospital and NYU Medical Center. I was there when hospice care first exploded in the city. Hospices with names like Cabrini and Beth Israel. My pharmacists bent all kinds of laws to keep the patients out of pain. Back then you could only dispense these powerful medications with a written “triplicate” prescription. My pharmacists were taking thirty day supplies from hospice nurses over the phone, and worrying about getting the written prescriptions later. If they didn’t do this, I’m sure the health care system in New York City would have been overwhelmed.
The issue I am talking about is an epidemic of out of control abusers that are sucking the life out of my job. It was never like this twenty years ago. I left retail for a time, and when I came back, I discovered all these prescriptions for oxycodone 15mg and oxycodone 30mg. Whatever happened to good old Percocet? This oxycodone 30mg is rarely a good idea for my pharmacy. We hardly ever carry it. The one time I ordered a bottle for a patient, we got a call from Medicaid. They suspected that the patient wasn’t legitimate. And for weeks after that, my pharmacy was getting shady calls from all over the state. People somehow found out we stocked oxycodone 30mg and were determined to get some. To use up the stock bottle I filled a few, and, honestly, for every single one I filled, it felt like I was part of a drug deal.
This triggers all the old arguments I’ve heard over the years about the war on drugs. I really think its time to fight it in a different way. One pharmacist and one technician aren’t trained to fight in a war. Really. Currently, its up to the two of us to figure out which patients are the phonies. After that determination, we have to decide if we have enough strength to engage in another battle.
I think I’m ready to say I’m done with it. Let them be addicts and get their fixes at some kind of state sanctioned pharmacy equipped to deal with a drug war and all the dangers that it entails. Narcotic abuse hijacks my energy away from helping my pain patients. And the dangers that it comes with are very real. I’d rather be removed from the whole damn transaction, than be removed from the planet.
I imagine there would be four people in New York who might agree with me. If they could still speak. Because this past Wednesday, someone named David Laffer was arrested for allegedly pulling a trigger on four people and killing them at a pharmacy in Long Island. He then stole the drug store’s entire supply of hydrocodone, so he could feed someone’s drug habit. On June 19th, pharmacist Raymond Ferguson, 45, clerk Jennifer Mejia, 17,and customers Jamie Taccetta, 33, and Byron Sheffield, 71, were all casualties in the war on drugs.
I wonder if the pharmacist was on the phone with an insurance company, or entering a prescription, before the robbery went down. He and his wife would have celebrated their 10th wedding anniversary this year. His partner that day was the 17-year-old store clerk. Maybe she was standing at her post near the cash register when it happened. She would have graduated from high school last week. I wonder if her family ever had a chance to take a picture of her wearing her graduation gown. It might have been one last memory that they could have slid into a photo album. On a page somewhere past the older ones of a little girl wearing halloween costumes. Then her family would close the book and re-shelve it.
Which reminded me again of the family that came to my pharmacy. Me and the tech filled the dental prescriptions very promptly. The mom thanked me when I handed her the bag of pain pills. The dad’s face showed a little spark of relief. Their little boy shouted boom, and he pointed his ring at someone as they exited the front door. I was glad they picked my drug store. They could have walked into any of the pharmacies in our town. Me and my tech couldn’t wait to go to our homes that day, so we could share dinners with our families. And tell them all about the Green Lantern that visited our drug store.