Judgment Day

Seeking oxycodone became real to me this past April and it wasn’t because I was a patient with a drug addiction. I was a pharmacist that dedicated 21 years of my life to community pharmacy and I was never on the opposite end of the pharmacy counter. In fact, I never encountered any type of pharmacy prejudice until I switched my career from community pharmacy to academic pharmacy.

In April 2016, I needed pain management from a blocked 1.8 mm kidney stone that was the size of a nickel. The pain required medication that was stronger than ibuprofen. My body was in septic shock from a massive infection that landed me in the ICU for 6 days. The physicians did everything they could in the hospital to control the pain, but I never suspected that my profession of pharmacy, my colleagues and peers, would judge my medication and turn me away. I felt frustrated and defeated from the same situation I created when I was a community pharmacist making similar judgments. It was now my "Judgment Day" and I was at the mercy of the pharmacist to fill my pain medication. This situation made me ponder my past and support the fact that all pharmacists need to ask the difficult questions of why a patient is on pain medication. Pharmacists need to evaluate each individual patient and not speculate that they are a drug seeker simply because they have a pain medication prescription.

According to the Institute of Medicine, "Pain is a significant public health problem. Chronic pain alone affects approximately 100 million US adults.” In addition, there are millions more that suffer from acute pain from an experience such as mine. It’s these patients that are being turned away due to growing concerns for the potential for abuse.

While it is important to realize there is legitimate concern about opioid abuse, it is also important as pharmacists to understand that there are patients with authentic acute conditions that require pain medication. Many pharmacies are forced to turn away these prescriptions in fear that their businesses will be scrutinized for dispensing large amounts of pain medication. Drug wholesalers question pharmacies when they order high amounts of pain medication due to pressure from the Drug Enforcement Agency. These issues need to be addressed in order to safeguard the needs of our patients.

In addition, the requirement for all pharmacists to access Maryland’s Prescription Drug Monitoring Program (PDMP) should help to identify those patients that are filling multiple pain medications at different pharmacies to decrease the amount of abuse. Can you imagine coming out of surgery to hear from the pharmacist or technician, “we don’t have this medication.” Better yet, can you imagine hearing, “You are a new patient and your medication exceeds the limit we can order from our wholesaler.” These patients are being wrongfully judged as drug seekers and are being forced to search several pharmacies to obtain the necessary medication. It is imperative that pharmacists correctly assess the patient to manage their medication and pain level. Physicians and pharmacists need to work together to evaluate each patient as an individual. Only then will we be able to appropriately treat our patients and maintain their dignity while following the guidelines to avoid opioid abuse.

The first line in the Oath of a Pharmacist states that "we will consider the welfare of humanity and relief of suffering our primary concern.” In addition, pharmacists are also bound by the Code of Ethics that clearly states important principles based on compassion and respect. The portion of the code that is most applicable in this situation is pertaining to the distribution of health resources. “When health resources are allocated, a pharmacist is fair and equitable, balancing the needs of patients and society.”

It is up to us as pharmacists to professionally respond to the needs of our patients. As medication experts, pharmacists are responsible for distributing pain medication, which in this case is a resource. If we can’t fulfill this need, then we need to understand the barriers. This is critical as we advocate for our patients. It’s unfortunate that we as a nation are so focused on drug overdose that the innocent patient that is in need of pain medication is often turned away.

For me, seeking pain medication finally ended when I found a pharmacist willing to ask the right questions. She took the time to understand my particular situation and most importantly was compassionate, professional, and ethical in regards to my medical needs. After all, isn’t this the reason why all of us choose to be pharmacists in the first place.

Sherry Moore is a registered pharmacist in Maryland and currently the Assistant Director of Experiential Education at Notre Dame of Maryland University. She can be emailed at SMoore@ndm.edu.