There’s a reason “sexy pharmacist” is neither a popular Halloween costume nor a porno trope. “What, the guy who hands you the pills?” you say. “That sounds like a job that could easily be self-serve. You trust me to buy my own cough syrup, right?”
But there’s a little more to life as the gatekeepers of the great narcotics vaults that span this nation, including finding yourself at the forefront of a deadly drug epidemic. We spoke with Miranda, a pharmacy technician in a major American drugstore chain, and she told us …
#5. Misinformation Is Rampant
Once, Miranda had a woman refuse a certain brand of Xanax because, “it’s made in Pakistan, and I don’t want medicine made by terrorists.” Another guy came in with a gash on his arm. He had helped out in a car accident down the road and wanted some butterfly strips to bandage his gaping wound. When told he needed to go to the emergency room to get the wound stitched and sterilized, he informed them, “No, I sterilized it with diesel. It’s fine.”
Zero out of five trauma surgeons recommends diesel fuel and tiny Band-Aids for massive lacerations.
And don’t even get her started on the people coming in asking where they can find the homeopathic remedies. “Homeopathy,” she says, “is the biggest rip off on the face of the planet.” It’s so useless she can’t legally recommend to anyone — it literally contains no active ingredient.
But then there are those slightly more well-informed customers who are following the advice of the experts — only here, “experts” mean “drug company ads on TV.” For instance, after promotion for a drug called Lovaza hit airwaves, Miranda immediately saw patients coming in with prescriptions for it (the ads literally say, “TOO MUCH FAT IN YOUR BLOOD. … Ask your doctor if LOVAZA is right for you”).
Blood weight is always the hardest to drop.
It turns out Lovaza is just fish oil, the same stuff you can get for a few bucks in the vitamin aisle … only this is more concentrated, and a pharmaceuticals company charges hundreds of dollars for it. As a result, many insurance plans won’t cover it, and the patient finds themselves staring at a bill for $400 for fish juice pills.
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Also, it makes your burps taste like fish. That’s not a joke.
#4. Addicts And Dealers Will Stop At Nothing To Get Narcotics
If you thought this job was just about counting pills and printing labels, you’re not thinking about what exactly it is they have behind the counter. Pharmacists are a major target for armed robbers, since they hold the keys to the hydrocodone cabinet. In 2011, four people were murdered at a Long Island pharmacy for a backpack of painkillers.
Miranda had a co-worker get attacked late one night. The suspect had a can of bug spray and tried to spray it in the pharmacist’s face, then grabbed a folding chair and swung it at him. The pharmacist — an ex-Marine — reacted by stabbing him with his box cutter.
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“I should have just stayed home and huffed the damn spray.”
And the thing is, there are so many easier, more subtle methods for an addict or dealer to get their hands on the goods. A prescription is, after all, just a slip of paper — it doesn’t exactly take Danny Ocean’s heist crew to forge one. “I’ve only caught five in my four years as a tech,” says Miranda. “You have to know the doctor to catch it. You’ll know they write their prescriptions one way, but then you get a different looking one.”
Some people steal blank pads and sell them on the street. Some doctors actually write up prescriptions on Microsoft Word and print them out on ordinary paper — meaning with five minutes’ effort, patients can hop on their own computer and print out their own.
Fancy security stationery saves lives.
And then there’s the theft from employees — people inside the building who realize that they can make a hell of a lot more just selling the Vicodin on the street. At Miranda’s company, they have three safes for addictive meds, and there’s a camera pointed at each one. There are even more cameras within the store itself, and many of them are in employee-only areas. “It’s like living in a fishbowl.”
Not that theft is always necessary, considering …
#3. Doctors Are Feeding A Prescription Drug Epidemic
If your doctor gives you a hard time about refilling your pain meds, there’s a reason for it. More people die from overdosing on prescription pain pills than cocaine and heroin combined. There areabout two million people addicted to painkillers in the U.S. That’s tens of millions of pills hitting the streets every year, and lots of times the supplier has an “MD” after their name. Miranda says there’s a term for a doctor who gives out pills like candy: pill mill.
She can usually spot them. Doctors who don’t file insurance claims, for example. If they don’t have their own office, that’s another sign. The most obvious, of course, is when they write prescriptions for obscene amounts. She’s seen prescriptions for 750 methadone and 120 OxyContin, which you will recognize as either “enough to kill a horse!” or “enough to buy a gently used Toyota Corolla” depending on the path your life has taken up to this sentence.
“That’s an awful lot of hydrocodone. What do you need this much for?”
“Uh … horse murder?”
The U.S. government is trying to crack down. Pharmacies use a database that tracks all the controlled substances you’ve ever bought using your driver’s license. The program will supposedly stop people from getting new prescriptions filled within 28 days, regardless of whether or not they use the same pharmacy. But it won’t, say, stop someone from having a friend get the prescription for them.
And then, of course, there’s the meth problem. You presumably know from season one of Breaking Bad that meth typically requires lots of the popular sinus medication pseudoephedrine. As a result, the federal government has set limits for that drug at 3.6 grams per purchaser, requiring cooks to send out an army of kids buying it a box at a time. Miranda can usually spot them, too. “If you come in with no teeth, that’s the biggest symptom. Also, they ask for things by street names. One store brand has 20 24-hour Sudafed, so they’ll ask for ’20/12s.’ Or they’ll want ’96 reds.’ They’ll pay for it with a wad of hundreds.”
In fairness, they could also be sick. Lying stoned in a gutter does probably lead to a lot of colds.
If the person gets hostile, the pharmacist will call the police. Otherwise, they’re buying a legal substance. There’s only so many barriers you can put down before you’re just taking the medication away from the people who actually need it.
But once we start talking about what drugs people actually need, another complication arises …
#2. The Pharmacy’s Information About Drugs Comes From Very Biased Sources
A certified pharmacy technician has had two years of formal education; a full-blown pharmacist will do two years of university and then go into a doctoral program all about drugs for four years. But the problem is that new drugs come out all the time (which means new and exciting ways those drugs may interact with existing drugs), along with new research about old drugs that changes how they’re used (for instance, if a blood pressure pill has a side effect of treating headaches, doctors might start prescribing it for the latter). All of this means the job is a continuing learning process, but a lot of that “knowledge” comes from pharmaceutical reps. That is, sales people.
20th Century Fox
Know that movie about the smarmy drug dealer? It’s based on a true story.
Miranda has firm opinions on them. “Pharma reps are vultures.”
Reps visit her practice about twice a month. They bring information booklets, coupons, and (mostly edible) bribes. One rep promised ice cream in exchange for the distribution of coupons. Their salesmanship is so paramount to the job that recruiters target university cheerleaders. Their major is irrelevant. Demonstrated cheerleading skills is enough.
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And it works! They wouldn’t do it if it didn’t. Doctors and other professionals along the way can be dazzled by a sales pitch just like anyone else. It’s not like doctors are going to dig up the raw data from years of clinical trials for every drug that comes along; if a perky rep insists a new pill is a miracle drug, they’re going to start prescribing it.
#1. The Pharmacy Is The Last Chance To Catch Fatal Mistakes
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A medical doctor spends eight years at a university. They’ll have a semester or so of drugs, but mostly it’s assumed they’ll pick it up along the way. As we mentioned, that’s a huge amount of information to try to absorb, particularly when it comes to drug interactions. And even if a particular doctor is a walking database of dangerous drug combinations, he or she is not going to hunt down all the other doctors a patient sees and check what drugs they’re prescribing.
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“You also issued him a Cialis prescription? Damn — I hope I’m that spry when I’m 90.”
Pharmacists, however, keep detailed records. That means they’re the last line of defense between you and a drug that will make you start squirting blood from both eye sockets. “We have a patient that takes a very old drug called an MAOI. They just put him on it and didn’t check any interactions with his current medications. MAOIs are dangerous, specifically due to medication interactions. We actually had to call the doctor and get them to change the medication.”
Also, a patient might not tell his doctor about his allergies. If the pharmacist has it on file, she can catch it. This is why you need someone behind the counter who knows what the fuck she’s doing, is what we’re saying.
This is pretty harmless, except to the people it can kill.
And then there’s the equally common economic factors. One reason health care prices skyrocket is that no one involved really checks the prices — if the doctor decides you need it, they’re going to prescribe it. “Doctors don’t know prices of medications. I had a patient with shingles (very painful blistering rash) and the antiretroviral that the doctor placed him on cost over $200. The patient had no insurance and the doctor knew that. I called the doctor and had the medication changed to something cheaper.”
Doctors may not like being questioned, but they must work with the pharmacists. After all, they are the gatekeepers of the drugs. They have the power to refuse to dispense the meds if there’s something wrong. And, as we’ve made it very clear by now, doctors are as fallible as the rest of us.
“I had a dentist try to fill out a prescription for himself for Viagra. As a medical professional, I had to reject it because it’s not in their scope of practice.”