Saturday, July 25, 2009

aWash in OxyContin

This past week I worked in one of my usual pharmacy locations -- a nice area, nice clinic. I could not BELIEVE how many C-2's we blew through on this one day. Percocet, oxycodone, MS Contin and Oxycontin by the shovel full. In fact we blew through our entire stock of one strength of Oxycontin and all of our oxycodone 5's.

In no way am I suggesting there are people who don't need these medications to have a reasonable quality of life. But I gotta believe the prescribing of Oxycontin has gotten way out of hand. We are forced to increase our stock more and more and it becomes a safety issue considering it's the target of so many pharmacy robberies.

I recall when Oxycontin first came out, and it was clear that it was heavy stuff. It was no trivial pain med and would probably be mainly for people towards the end of life with intractable pain who would otherwise be in the hospital getting a continuous IV drip. This oral form of the drug might help them remain at home and productive --- a good thing. I went back and reviewed the package insert the other day and was surprised to read it is indicated for "moderate to severe pain when a continuous, around-the-clock analgesic is needed for an extended period of time."

MODERATE pain ???? Seriously? And how do we define "extended" period of time?
I'm dispensing this drug all the time to young people -- people with migraines, back pain, knee pain, post-op pain --- all things that it clearly wasn't intended for. Again, I know medicine isn't black and white and every situation's different. But knowing the med history of many of my customers I am often stunned when they present the first Oxycontin script. I want to ask them if they really want to go down that road. What's the long-term plan here?

The other thing that disturbed me that day was walking into the pharmacy and seeing a pad of $60 coupons for Oxycontin! Wow, coupons for a C-2. I honestly don't recall ever seeing that before. Cripes, that's all we need.

And still another thing occurred the day before where (due to a lack of diligence) we allowed someone to pay cash for their Oxycontin script. The whole thing was fishy from the beginning and to make a long story short, we realized we got scammed.....

I'm kind of tired of it, as all pharmacists get tired of being the police. But the damn drug is so out there, and we're ordering bottles and bottles and bottles...............

And please, no coupons.


Lipstick said...

It absolutely drives me *crazy* to see the post-op rx's for very wrong.

Anonymous said...

No good will come from it is my gut feeling! The Pharmacy Act restricted the sale of opium in 1868 mainly because its long-standing effect on society as a whole. Maybe it's time to reassess the oxycodone situation in light of whether or not it's impacting crime, and its value to humanity i.e. addiction vs. human productivity. Does acute use of oxycodone increase addictiveness, and does repeated use contribute to only those individual susceptibilities that wouldn't have chosen to use it in the first place? (The old idea of whether there are more alcoholics in societies where alcohol is freely accessible e.g. France?)

Grumpy, M.D. said...

Insanely overused. I agree.

Part of the recent surge, though, I suspect is from 2 factors:

1. The shortage of immediate release Oxycodone.

2. The FDA crackdown on APAP containing Percocet.

#2 has driven up the demand for non-APAP oxycodone, and #1 has pushed a lot of docs to use Oxycontin instead. I know they're not interchangeable, but most docs don't, or just don't care.

Grumpy, M.D. said...

And here is a scary article about how this can be abused.

pharmacy chick said...

I get post partum rx's for oxycontin and oxy 5 used to be ibuprofen and tylenol 3 (only if she had an episiotomy... what the hell???

MomNurseWife said...

postpartum oxycontin?????

There is no way that can be appropriate. Even after a c-section. We send them home with Motrin and Percocet. And usually just the c-sections need the percocet.

Linkhelpers said...

What's with post partum oxycontin?