Delinquent Drug Deniziens

Being a night pharmacist means you get to take care of a lot of custodial duties that the day staff may not have time for (or just don’t do because they’re lazy pigs).  Grunt work, in other words.  Some pharmacists feel above doing this kind of work (I don’t know why) and choose not to do it.  For the most part, I like it.  I’ll file scripts and count CIIs all night before I would work days again.  Most patients that come to me think that I have an undesirable job, or got demoted, or just drew the short straw.  Instead of telling them that I’d rather masturbate with sandpaper than interact with 99% of the public, I just fill their prescription.

One of the duties of the night pharmacist is returning unclaimed prescriptions to the shelves.  This is known as return to stock.  Every night around 1 AM the system prints off a list of filled prescriptions that have been waiting to be picked up for 2 weeks.  If you have not come to pick up your prescription for 14 days since it was filled, it is taken out of the waiting bin and returned to the shelf.  This means you have wasted a lot of the pharmacy’s time and should be shot.

Here’s the actual list of last nights return to stock.

Apri

This is birth control.  You know, that pill that keeps you from shitting out more hungry mouths.  If you’re a Medicaid patient, I don’t return this to stock.  I drive to your house and shove it down your throat so you don’t procreate.  Hey, I think that’s what Jesus would do.

Travatan Z

Glaucoma medication.  Do you like being able to see?  The next time you call me and harass me about not being able to read the pharmacy label, I’m going to make fun of you for not getting your eye drops, Gramma.

Humalog

Insulin!  This is for diabetes.  When your toes start falling off and you go blind, you may remember that insulin prevents your blood sugar from skyrocketing.  Guess in the mean time you’ll have to lay off the Twinkies, fatty

Blood Glucose Test strips

Allows you to see what your blood sugar level is.  Very handy for diabetics.  The same asshole that didn’t pick up their insulin also didn’t pick up their test strips.  Go figure.  I guess if you don’t know when your blood sugar is too high, then you don’t need insulin.  Right?  WRONG.

Cartia

Blood pressure medication.  You must like being a candidate for heart disease.  When your doctor asks you why your blood pressure is so high, just explain to them that you’re a worthless delinquent.  They will understand.

Cymbalta

Crazy pills.  You know, the ones that keep you from screamin’. 

Metformin

More diabetes medication.  See all the fat people walking around?

Fluconazole

For yeast infections (AKA nasty vag).  One time, a lady told me that she wouldn’t take fluconazole because she read it could damage your liver.  You only have one liver, she explained to me, and she didn’t feel it was worth the risk.  I almost asked her if she had more than one vagina.  I didn’t want a sexual harassment suit on my hands that badly.

Biaxin XL (name brand)

Antibiotic, used to treat your runny nose and bitchy demeanor.  This medication has a generic available.  This means that we had to special order this for the ungrateful asshole that decided to not even pick it up.  Moreover, it was a REFILL.  Antibiotics should NEVER have refills.  Allowing a layperson to decide if their cold requires an antibiotic is like allowing a hop-head free access to the narcotics safe.  BAD IDEA.  When our antibiotics no longer work because you’ve been overusing them, I’m going to come burn your house down.

Propecia

Prevents hair loss.  Guess you’re not getting laid tonight.

Viagra

We all know what this does.  Insert (ha!) your own joke here, there are a million shitty ones out there for this one.

Fluocinonide/coal tar compound

This one may be the worst offense.  Most medications at the pharmacy come made by the manufacturer.  A few (like this one) we have to mix up using eye of newt, hell’s bane, and a big black cauldron.  You also have to cackle really loud while you stir it or it doesn’t work.

In all seriousness, the pharmacist has to make this kind of medication from raw components, and it takes some time and effort.  They always tell people it takes 24 hours for a refill, so yours truly always makes the compounds overnight.  When I put in the time and effort to make this for you and you don’t come to get it, it pisses me off.  Although, I guess it does keep me from staring longingly at the booze aisle.

A side note on coal tar.  This stuff is the most foul smelling substance in the pharmacy, and there are some nasty ones.  Have you ever smelled fresh asphalt?  That’s what coal tar smells like.  One of the more common things it’s used in is dandruff shampoos like T/gel.  The shit is used topically, which I cannot imagine.  Smelling it while I’m working with it makes me want to run to the shower and scrub myself like a rape victim.  Gross.

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Last night of work for a week.  I'll be heading to Chicago for the weekend for a symposium being held by Dr. Warner on ethanol kinetics.  All reports indicate that it will be educational.

Don't Mess With Corpopharm

Every day, people walk into pharmacies across America and try to fill fake prescriptions.  What's a fake prescription?  It's a medication order that was written in the name of a physician by someone who is not that physician.  They're almost never a physician at all.  I'm sure you're asking yourself, 'Spiffy, why would someone do this?'  99 times out of 100, it's because they want a controlled substance (usually alprazolam or hydrocodone) and can't get a doctor to write them a prescription.  IE, a junkie trying to get their fix.  This is one of their stories.

As soon as I reported for duty last night my partner informed me that some fake scripts had been called in during the day. I asked him if he’d confirmed them with the doctor, and he said he had. I was a bit surprised. It’s pretty tough to get ahold of a doctor on any day, and most of them don’t work weekends. This particular doctor was at an urgent care facility that never closes. Rule number one for trying to call in fake scripts to the pharmacy: don’t imitate a doctor that I can contact with one phone call.

The doctor indeed verified that he had not called in the prescriptions, and no one at the facility had written them. This means that someone else entirely had called the scripts in to the pharmacy under the guise of being a physician. This is very illegal, and one of the best ways to piss off 1) the doctor and 2) the pharmacist. It’s illegal, it’s fraudulent, and it’s a HUGE waste of time for everyone involved. Plus, pharmacists hate junkies. Well, this pharmacist does.

The doctor agreed to help prosecute if we had the people arrested. As one of my technicians (Friendly) put it,

Friendly: Awww, Spiffy, it is ON!

If you want to make an arrest at the pharmacy for this sort of offense, here’s how it works. The alleged criminal usually calls in to the pharmacy before they come to pick up their fake scripts to make sure they are ready.  This is a pretty stupid mistake, because it prepares the pharmacy for their arrival. Once they call us, we call the to cops to let them know we would be needing their services within the next hour or so. Once the perpetrators arrive, the technician running the register stalls them out while another technician calls the police. The cops arrive, arrest the druggies, and the world is safe.

Last night worked out even more beautifully than we could have hoped. About a half hour before our fakers got the pharmacy, one of the front store employees witnessed a robbery and called the cops. A unit came down, and the officer was in back watching the security tape when the fakers arrived. That’s how dumb they were. There was a police cruiser in the parking lot, and they came inside anyway.

I actually happened to be the one to greet them at the register as my two techs were busy with people dropping off new prescriptions. I have to say, I wasn’t impressed. It was two older people of about 60 (I say older because they both looked about 80), both regular patients at the pharmacy. The guy even had an oxygen mask on. Picture that. Real hardcore criminals, these two. Just, uh, don’t forget to bring a spare oxygen tank on those extra long crime sprees. Christ.

I was pretty surprised because the guy had a bunch of scripts that were actually legitimate to pick up that we’d been working on the last few days. I pretended to go look for the scripts and winked at Friendly. These two criminal masterminds had picked about the worst time to show up. Friendly walked 50 feet to the back room where the policeman was watching our security tapes. It certainly was ON.

The actual arrest was pretty uneventful. The look on the couples face was fucking priceless, though. When the cops took them out of the pharmacy, it as about the saddest arrest in the history of arrests, I’m sure. The officers didn’t even bother to cuff them becase it was obvious they weren’t going to make a break for it. The old guy on his oxygen supply probably couldn’t break 2 MPH without wheezing and the old lady looked like she’d break a hip if she tried to juke left to avoid a tackle.

To me, the funniest part about the whole thing was that only one of them needed to come in to pick up the scripts. They had been called in in the old lady’s name, but that doesn’t mean that she had to be the one to pick them up. It did mean that she was already involved in the crime, so she should have been the obvious choice. Instead of just one going downtown they both got to spend the night in the clink. As far as I know, they’re still there. That’s rule number two. When attempting to fill fake prescriptions, bring as few accomplices as possible. Fewer people will get pinched that way.

Now, rule number three. As I stated above, the old lady was involved implicitly because they used her real name when calling in the scripts. It’s pretty tough to convince the district attorney that you weren’t involved when the scripts are in your name, Einstein.

Rule number four may be the most important. If you’re going to fill fake scripts, be sure to pay out of pocket for them instead of having them run through your insurance. Billing your insurance company for fraudulent prescriptions is, uh, fraud. Do you know anybody with larger litigation resources than insurance companies? I don’t. For whatever charges the doctor’s lawyer doesn’t level against you, the insurance company’s lawyers will. After they’re both through with you, the DEA gets a crack at you as well. You’re basically setting yourself up for a vicious gang rape by a gaggle of lawyers with no lube (not to mention no prayer).

So, there you have it. A perfect guide of what not to do when trying to illegally fill prescriptions. I wouldn’t recommend it, though. All the people that do try it are very stupid simply by virtue of the fact that they are attempting it (considering the legal ramifications involved). Stupid people are prone to make mistakes, especially concerning things they don’t know shit about. Like writing prescriptions. Feel free to give it a shot, but you’ll get caught. Just remember to lube up first.

Hot Pharmacy Phone Action

Case 1:

The phone rings.  The gentleman on the other end explains that he just picked up his prescription for zol-pi-dem  (generic for Ambien).

Gentleman: This pill looks different from the last time I got it.  Did I get the right medication?

Me: Yes, we just changed what brand we carry.  Generic medications are available from lots of manufacterers, and Corpopharm changes which ones they carry from time to time.  That's what the new one looks like.  

Gentleman: Oh.  Well, the new one looks an awful lot like the atenolol I already take.  Can you get the old one back in stock?

Me: We try to only carry one manufacterer of a medication at a time. It reduces medication errors, confusion, and inventory issues.

Gentleman:  Well, how am I supposed to tell these two pills apart?!?

He sounded a bit indignant.  And ignorant, now that I think about it.  Anyone who's gotten a script filled before knows that when you get a medicication, you get it in a bottle with a typewritten label on it.  This label has lots of helpful information, up to and including the name of the drug that's in the bottle.

Me: Are you having a hard time reading the label on the bottle?

Guy: No.

I let that sink in for a few seconds.

Me: So what's the problem?

Guy: Well, they just look so similar that I can't tell them apart.

Me: You can't tell them apart after you take them out of the bottle?

Guy: Right!

Me: (pause) What about before you take them out of the bottle?

Guy: (pause) I can read.

Me: Then perhaps you should do so.

Case 2:

Next phone call.  The very next one.

Do you ever get on the phone with an unfamiliar person and just know that the conversation is going to go nowhere?

Guy: Hey umm I uh need this medication (mumble mumble incoherent mumble trailing off into nothing).

Me: I need you to speak up.  I'm having a very difficult time understanding you.

Guy: Yeah um uhhhhh Risperdal uh uhhhhhhhh...

Me: Sir, what's your name?

Guy: James Jakj;a$%!@...

Me: (searching computer) I can't find you in the computer.  Do you get your medication at this pharmacy?  We're the Corpopharm at (location).

Guy: I get my medication at the pharmacy, the pharmacy, ahhh....

Me: (sigh) Touché.

We repeated the above conversation a few times before I asked him to find his prescription bottle.  All the medications he was asking me about were antipsychotics.  He either hadn't been taking them, or was very drunk. Or high.  Or, some happy-go-lucky combination of the three.  I didn't want to deny him the opportunity mental health just because he was having some communication problems.  The mentally ill are one of the very few populations that I am exceedingly patient with.  As long as they don't piss me off.

After sitting on hold for five minutes (literally) he got back on the phone and stated that he's found a 'subscription bottle'.  I told him where the Rx number was located and told him to read it to me.  He read me a 4 digit number, not the amount of digits in a Corpopharm Rx number.  

At this point, we'd been on the phone for about ten minutes.  I can be patient, but most Corpopharm patients are not.  While he had me on hold looking for the bottle, I heard some muffled conversation.  Although I was glad this guy was trying to help himself, I didn't have all night for him to do it. I decided that it may be a good idea to try and get some information from who he'd been talking to.

Me: Sir, I is there anyone else there I can speak to?  I want to help you, but I just can't understand what you need.

Guy: My girl is here she's sleepin'...

Me: Put her on the phone.  It won't take long, I promise.

I hear him waking up his girl and soon enough a groggy female voice comes on the line.

Me: Do you know this man?

Girl: Yeah watchoo want?

Me: I think he needs some medication, but I can't understand him.  Do you know where he gets his prescriptions?

Girl: He goes to Corpopharm 2.

Corpopharm 2... not my pharmacy chain.  This little revelation came 12 minutes into the call.

Me: OK, this is Corpopharm 1.  Do you see his pill bottles there?

Girl: Yeah.

Me: OK, the number to his pharmacy is on the bottle.  He needs to call them if he needs more medication.  Can

you help him?

Girl: It's the middle of the damn night, and I'm tired.

Now that pissed me off.  Her boyfriend had tried for 10 minutes to get his refill himself, and this chick wasn't willing to call some numbers into another pharmacy that would take all of 10 seconds.  I don't know why I cared.  I guess I've got a soft spot for crazy people.  Whatever the reason, I decided the only way that my new crazy friend was going to get un-crazy was if his lazy girlfriend got off her ass.  It was time to pass the buck.

Me: I know, but your boyfriend is sick.  If he doesn't get his medication, he's going to be very sick.  He just had me on the phone for ten minutes and couldn't even give me his name.  He really needs his medication to be able to take care of himself.  Otherwise, you're going to have to take care of him like this all the time.  I don't know how long it's been since he took his last dose, but he's not well.  

Girl: Fine, I call'em.