@gwajnberg asked for my opinion on his article about good drug but bad usage. Click here to read
Image taken from his post as I'm replying to it so I'd keep the view the same --hope you don't mind there @gwajnberg
Now I've been a Pharmacist for 29 years. When I first started in Pharmacy I was a bright eyed young man with dreams of helping others. After graduation I had an awful lot of knowledge about medication and was given a neat little plaque with the Oath of Maimonides inscribed on it:
Here's the Oath
"I swear by the healer, by the creative hand, and by the sustainer of life, that I will be loyal to the profession of medicine. May the love for my art actuate me at all times; may neither avarice nor miserliness, nor thirst for glory or for a great reputation engage my mind; for the enemies of truth and philanthropy could easily deceive me and make me forgetful of my lofty aim of doing good to humanity.
May I never see in the patient anything but a fellow creature in pain. Grant me the strength, time, and opportunity always to correct what I have acquired, always to extend its domain; for knowledge is immense and the spirit of man can extend indefinitely to enrich itself daily with new requirements. Today he can discover his errors of yesterday, and tomorrow he can obtain a new light on what he thinks himself sure of today.
Oh, God, Thou hast appointed me to watch over the life and death of Thy creatures; here am I ready for my vocation, and now I turn unto my calling.
Now I look back on how things have changed since I first read that oath. At first I thought easy keep up to date and help others. No problem
I was simple and naieve
I'm a simple black and white guy
I'm almost ashamed to say it in today's world. I'm a simple man. If I answer YES I mean yes. If I answer NO I mean no. If I say I will do something I try very hard to do it. If I say "I don't know" then I truly do not know. I try to be as honest as I know how to be.
I grew up in a time when Men were men
I grew up in a time when Women were women
I grew up in a time when things were good or evil and in a time of right and wrong
I grew up in a time where there were 10 Commandments
- No other gods before me.
- No idols or images.
- Do not misuse God's name.
- Keep the Sabbath holy.
- Honor your parents.
- Do not murder.
- Do not commit adultery.
- Do not steal.
- Do not bear false witness.
- Do not covet.
However, the world has changed. The Profession has changed. I've been forced to deal with a world of gray in the profession of Pharmacy. I'll admit it doesn't sit well with me.
What causes me issues in Pharmacy?
Non-medical uses of medication
May I never see in the patient anything but a fellow creature in pain.
But what if the patient isn't in pain?
More and more medications are coming out that aren't really treating a disease as much as making life easier on people.
@gwajnberg mentioned Ozempic (diabetes) and Wegovy (weight loss) which are both the same ingredient semaglutide.
However, that's certainly not the first time a medication is being marketed both for its medical and non-medical uses.
Other examples:
Wellbutrin (Depression) and Zyban (Smoking Cessation)
or
Lumigan (Glaucoma) and Latisse (longer eyelashes)
or
Revatio (Pulmonary Atrial Hypertension) and Viagra (Erectile Dysfunction).
Do I have any particular issues with medication being used for things that are not medical in nature. Not really. For Wegovy weight loss is a big issue for many and losing weight helps people's health. For Viagra..well, erectile dysfunction leads to a decrease in quality of life. For Zyban stopping smoking is beneficial for health. For Latisse...I can't see longer eyelashes being of particular importance so if someone wants to pay the money they go for it.
BUT
I do have issues with it when I have to commit fraud. Why am I commiting fraud? Well, many insurance companies do not cover medication when used for non medical purposes. When I know someone is getting Revatio or Adcirca and the Doctor has sent letters to the insurance company saying its for heart issues but the patient jokingly tells me his heart is fine then I know I'm aiding someone in committing fraud.
* Do Not Steal
Do I report the person? It's just my word against theirs. I lose a patient. I'm breaking trust. BUT I don't like commiting fraud either.
@gwajnberg also mentioned that Ozempic/Wegovy ran into shortages because so many people were using it for weight loss. I can attest to this. I was fielding half a dozen phone calls a day for people looking for Ozempic and I had no date when it would arrive. When it DID arrive I often only got enough to treat one patient for 3 months...and I had over 20 people waiting. Who do I give the medication to? Our longest clients? The people with the worst diabetes? The people who had to lose the most weight? The most annoying person I wanted to get off my back?
And again, it is covered by insurance for Diabetes but not for weight loss. How do I feel when I'm defrauding the system by sending off claims that shouldn't be paid 😐
Now there is the whole issue of people needing more than just a hormone in a shot to make them slim. They need proper diet to make sure the weight doesn't come back to be sure. There is the issue of what is going to happen after using this medication for decades if they don't change the diet. There is the issue of what happens when someone loses all that weight and their skin hangs in folds around them.
However, the bigger issue I worry about is: A person who loses weight is still the same person they were before. Many people think I'll lose weight and be attractive. I'll lose weight and I'll be accepted. I'll lose weight and I'll be a better person. The sad truth is that getting skinny doesn't change who a person is...they can still be unattractive, they can still be socially awkward, they won't become a different person--just a lighter one.
When I know the medication is being misused
Want to know something that makes me queasy in Pharmacy?
When I see a mid 70s gentleman getting a big order of Viagra.
Do I have any problems with an elderly gentleman getting Viagra?
Usually no. However, When I hear that same man is going to Thailand on a mission to have sex with as many young prostitutes as he can and the younger the better.
It doesn't make me happy. Knowing I'm giving out medicine that is likely going to aid someone in harming another makes me cringe.
But again, if he doesn't get it through me it will just be on the street somewhere else. If I say NO someone else will say Yes and I could lose my license for denying medication. All the man has to do is say its to use with his wife/girlfriend and that I'm lying.
When I know the medication causes harm
How about when I get a prescription for Potassium Injectable with some barbiturate and anti-cholinergic?
That's another one that makes me cringe. Why?
Because its used as a lethal injection. The medication goes out. Someone is killed with it. Then the injection set and unused medication comes back for disposal. When I see the returned injection kit come back I know the medication went out to kill someone.
You shall not commit murder
It's not much better when I have to give out Mifeprostone. Indeed I just can not do it and have been lucky enough to be able to give it to a different Pharmacist.
Mifeprostone induces an abortion. Use it and the mother's both will expel the growing baby. Some may use the word foetus but use whatever word you wish. The result is the same. Someone who was pregnant isn't pregnant anymore. Now in my eyes birth control prevents a pregnancy from starting. OK. But to terminate life after its started..
You shall not commit murder keeps ringing in my head.
But after that I have to let the woman know that after the pill in a couple of days there is going to be a lot of cramping as the body expels the baby. The woman is going to have to go to the washroom, get rid of the waste, then flush. If I saw a partially developed baby going down the toilet I'd be sick.
But it's not my body. It's not my decision. And in some instances it is warranted as much as I wish it was otherwise.
It brings me back to a Bible verse about marriage and divorce. When Jesus was asked about divorce he says it was a concession to man's sinful nature and that God intended marriage to be for a lifetime.
In the same way I believe that abortion should be a concession to man's sinful nature and the evil in the world. I believe babies are a gift and should be brought to term but also understand that is not always the case.
So, I will not condemn the woman who needs the medication but it doesn't make me feel right dispensing it.
Actions have consequences
In my province there were 33,500 overdose calls in 2022 alone. If you want to see the official numbers click here
Each overdose is typically someone making a terrible choice in life. However, it is their choice to make. Should society as a whole be responsible for keeping someone from facing the consequences for their actions?
Now I do not mean to sound callous and again....
..... may I only ever see a person in pain....
However, I've lost an uncle to drug overdose. I have a nephew who is recoving from substance abuse and I'm certain my son's are immune to being tempted by their peers to try things they shouldn't.
But where do we draw the line between helping out and enabling people?
Should people who are law abiding and substance free be paying the costs for those who are making risky behavior and risk death?
In Singapore I've heard they have a slogan "If you deal drugs we will hang you" and indeed the death penalty is legal there. I really wish we had that here. I see so many lives ruined by illegal drugs and so much burden on the healthcare system from the people locked in a fight with them. I am of the opinion that Drug Dealers are just murders in disguise. but I digress.
How much should we protect people from the consequences of their own actions?
Which brings up Methadone maintenance. It is not at all uncommon for Pharmacists to be the people who give people addicted to opioids their daily fix.
Nothing makes me feel more like a drug dealer than giving someone their daily dose of Methadone. I understand that without the methadone they will engage in risky behavior and have a strong chance of overdose or death. I also understand that I'm just perpetuating an ongoing cycle of addiction.
Well, I could keep going on and on.
Talk about hormones to help men become women and vice versa.
Talk about people taking medication for a problem when lifestyle changes would be more beneficial.
Talk about being forced to make judgement calls on quantity limits when I really don't want to.
Talk about having to choose between following the law and putting a person in distress or helping the patient out and putting myself in the position of breaking the law.
And so many more reasons that I'm tired of being a Pharmacist.
However, I'll leave with just one more thing.
How many condoms are a one month supply?
This may seem like an odd question. However, when I was working as a Pharmacist in Washington state I was allowed to give out a "One Month" supply of condoms under the family planning statute. But here is the question: "How many is a one month supply". I had one woman come in and ask for 196 condoms.
Is that a one month supply?
Well, that's the problem. If I give it out and am audited then we don't get paid for them.
So, I have to ask the patient how much they use and why. Which of course means I'm being nosy and personal. Sure to get the person mad at me. Perhaps they are a prostitiute. Perhaps they are a nymphomaniac. Perhaps they are a newlywed who has an overactive sex drive. But I'm stuck in the position of not getting paid if I don't ask and being a nosy busybody if I want to protect myself from getting audited.
Being in that situation sucks :(
Just a few reasons why I'm finding it time to retire.
Thanks for reading
Thanks for letting me rant.
Thanks for @gawjnberg for giving me something to post about :)