Anyone from FL remember those pill mill Rx's from 2004 to 2012?

[sozetone]

I started as a Rph in 2012 and was a tech since 1997. Do you remember when they passed a law in 2010 which stopped the doctors from having pharmacies attached to their practice location? It essentially "forced" the users and traffickers into the big corporate, retail world for the first time. They started showing up with Rx's like this:

1) Oxycontin 80 mg 1-3 times daily
2) Oxycodone 30 mg #180-->240 1-2 q4-6 h prn (sometimes swapped for dilaudid 8 mg)
3) Xanax 2 mg #90 1 tid
4) Soma 350 # 120 1 qid prn muscle spasm
5) *optional adderall 30mg # 60 i bid* (probably to keep them awake/alive)

Then like 10 people would show up right after them for the same thing. It was so embarrassing and transparent is was laughable. Any self respecting, intelligent pharmacist should know this was a con job. I have never even seen this regimen used in "end of life care".....

You know the funny thing? no matter how many people i turned down in a day ( which was like 10-30 until they got the point not to come to my store) The doctor never called to ask "why are you not filling my patients rx?" NEVER...lol. This was all a scam to get the pills on the street. These doctors started the problem, and used their own "dispensaries" to keep doing this. They knew darn well what they were doing. And so did the pharmacists dumb enough to work for these guys. Back in 2012 roughly, the top 50 prescribers of oxycodone in the NATION were located in "Broward county", Florida! Was like the wild west. Thanks Rick Scott for never having a PDMP until 2012, awesome job.

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[owlegrad]

Oh I do, I do! Fun times indeed.

 

[FarmD711]

Why the animosity toward Rick Scott? He was inaugurated in 2011 and the PMP started the next year. It’s not like he was governor for years and years without a PMP. Also the authority to create one does not solely lie with the governor.

Why not thanks Charlie Crist?


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[CetiAlphaFive]

In another life, I would've had a very interesting plan for the pill mil customers.

 

[owlegrad]

In another life, I would've had a very interesting plan for the pill mil customers.

I am thinking "Dexter"?

 

[RxPreceptor]

Absolutely...totally nothing suspicious about a pack of vans filled with people coming up to drive through during rush hour all @ once from a solid 8+ hour drive from Florida

 

[Modest_anteater]

In another life, I would've had a very interesting plan for the pill mil customers.

I wonder if you would use the same condescendingly ignorant language towards substance dependent individuals if they were your son, daughter, brother, sister, mother or cousin.

The HUMANS you are describing are economic and societal victims. They have been mentally, emotionally and physically abused and ostracized a million times, a hundred different ways we can not even comprehend. No one wakes up and says, "Today I want to become an opiate addict because I love stealing from what little family and friends I have. I love preforming sexual acts on dirty, dark, dilapidated alleyways."

Perhaps one day when you mature you will realize that no means of measure should define our limitless love for humanity and will understand how anyone's life circumstances can flip in mere weeks. If you want to unceremoniously judge people you should go into law enforcement or the military. Healthcare is not a good fit for you.

 

[maria1oh]

There used to even be a dosage higher than 80mg with oxycontin. I remember getting calls asking if we had the old formulation.

 

[Charcoales]

Anyone ever seen oxycontin 80 mg 3 tab q 6 h #360?

 

[Gombrich12]

Absolutely...totally nothing suspicious about a pack of vans filled with people coming up to drive through during rush hour all @ once from a solid 8+ hour drive from Florida

Their drivers licenses always said they were from Ohio or Kentucky. That still didn't stop some pharmacists from filling their scripts though.

 

[PharmDBro2017]

I wonder if you would use the same condescendingly ignorant language towards substance dependent individuals if they were your son, daughter, brother, sister, mother or cousin.

The HUMANS you are describing are economic and societal victims. They have been mentally, emotionally and physically abused and ostracized a million times, a hundred different ways we can not even comprehend. No one wakes up and says, "Today I want to become an opiate addict because I love stealing from what little family and friends I have. I love preforming sexual acts on dirty, dark, dilapidated alleyways."

Perhaps one day when you mature you will realize that no means of measure should define our limitless love for humanity and will understand how anyone's life circumstances can flip in mere weeks. If you want to unceremoniously judge people you should go into law enforcement or the military. Healthcare is not a good fit for you.

Lol... dude you are in for a rude awakening when you graduate and work retail.

 

[BC_89]

I wonder if you would use the same condescendingly ignorant language towards substance dependent individuals if they were your son, daughter, brother, sister, mother or cousin.

If you want to unceremoniously judge people you should go into law enforcement or the military. Healthcare is not a good fit for you.

Yet your condescendingly ignorant perception of law enforcement and the military is yet again a classical theme of “unceremonious judgement”

Careful: your coming off as a “student” without a professional license (which...you are)

 

[CetiAlphaFive]

I am thinking "Dexter"?

We used to joke about it a little.
I'd watched a video of the raids in South Texas, with 5 to 6 figures in cash being seized from a few cholos along with only 2 or 3 low tier guns.
How hard would it really be?

Corrupt Chicago Police Were Taxing Drug Dealers and Targeting Their Rivals

I wonder if you would use the same condescendingly ignorant language towards substance dependent individuals if they were your son, daughter, brother, sister, mother or cousin.
The HUMANS you are describing are economic and societal victims. They have been mentally, emotionally and physically abused and ostracized a million times, a hundred different ways we can not even comprehend. No one wakes up and says, "Today I want to become an opiate addict because I love stealing from what little family and friends I have. I love preforming sexual acts on dirty, dark, dilapidated alleyways."
Perhaps one day when you mature you will realize that no means of measure should define our limitless love for humanity and will understand how anyone's life circumstances can flip in mere weeks. If you want to unceremoniously judge people you should go into law enforcement or the military. Healthcare is not a good fit for you.

There's a difference between dependency and addiction.
You'd know that if you were an actual pharmacy student or pharmacist and not just a flunky who couldn't get in to a Pharm.D. program.
Are you revealing something about yourself here? Do you have a history of substance abuse?

Furthermore, there's an even more significant difference between an addict and a gopher that obtains prescriptions with the purpose of selling them to drug dealers.

 

[PA_dud3]

I don't have much sympathy at all for pill millers, from those I've encountered. Maybe that makes me a cold SOB but hey whatever.

 

[899424]

ok, so in those situations the doctors are banking! Even without a pharmacy attached to it. They make more money than you can imagine. Their mistress have a 55k+ car and the wives dont notice it. Even with marijuana being a medical-use drug, the doctors make the most money writing scripts, not surprising right?! To me their jobs seem relatively easy, see a patient and write a script every 15 minutes compare to anyone else that works.
Regarding this I think sometimes depending on the situation it is better to give someone a script and that person get the drug from a pharmacy than from the streets. Getting drugs from the streets can be dangerous and you really never know what you are getting. The people that are addicts are addicts and there's people that will never try drugs in their lives no matter what.

 

[BidingMyTime]

I am thinking "Dexter"?

My first thought was "Detox." Dexter seems unnecessary, without detox, people on these levels of medication are dextering themselves.

 

[sozetone]

I wonder if you would use the same condescendingly ignorant language towards substance dependent individuals if they were your son, daughter, brother, sister, mother or cousin.

The HUMANS you are describing are economic and societal victims. They have been mentally, emotionally and physically abused and ostracized a million times, a hundred different ways we can not even comprehend. No one wakes up and says, "Today I want to become an opiate addict because I love stealing from what little family and friends I have. I love preforming sexual acts on dirty, dark, dilapidated alleyways."

Perhaps one day when you mature you will realize that no means of measure should define our limitless love for humanity and will understand how anyone's life circumstances can flip in mere weeks. If you want to unceremoniously judge people you should go into law enforcement or the military. Healthcare is not a good fit for you.

Hey, take it easy now.....not every drug abuser is a victim. They HAD a choice to take dope or not to correct? no body held a gun to their heads and made them pop pills or shoot smack in their arm.....knock it off. It's that mentality that fosters this behavior and enables them to "feel" as if society made them be junkies. Nobody is being judgmental but why are we not ALL sitting here with needles in our arms? because we chose not to!! economic and societal victims, thats a good one. And yeah, life can flip in a day or weeks , thats right....so what do you do? get high? no! deal with your problems.

 

[Modest_anteater]

Hey, take it easy now.....not every drug abuser is a victim. They HAD a choice to take dope or not to correct? no body held a gun to their heads and made them pop pills or shoot smack in their arm.....knock it off. It's that mentality that fosters this behavior and enables them to "feel" as if society made them be junkies. Nobody is being judgmental but why are we not ALL sitting here with needles in our arms? because we chose not to!! economic and societal victims, thats a good one. And yeah, life can flip in a day or weeks , thats right....so what do you do? get high? no! deal with your problems.

drug addition is a mental illness not a choice....

 

[BC_89]

drug addition is a mental illness not a choice....

People change their behavior despite their brains being triggered and/or altered in response to repeated abuse.

9/10th of the law (when it comes to common sense) says any and all addiction started with a choice.

Change my mind.

 

[Modest_anteater]

People change their behavior despite their brains being triggered and/or altered in response to repeated abuse.

9/10th of the law (when it comes to common sense) says any and all addiction started with a choice.

Change my mind.

yep a choice. Just when opiate dependent mothers give birth to babies that are born addicted to heroin. It all started with a choice to be born.

 

[BC_89]

yep a choice. Just when opiate dependent mothers give birth to babies that are born addicted to heroin. It all started with a choice to be born.

So you believe the majority of abusers from 2004 - 2012 in Florida was due to opiate dependent mothers and not self-addiction due to personal use as well as peer-pressure and influences of individuals?

TLDR; you picked a minority group to represent the majority (1/10 of the law). Calculate my reference #’s and compare it to NAS victims based on OPs region and time-frame. You picked pharmacy so it’s important to study the facts. Disagreeing with people on here is fine (like me) but careful when you assume to much.

Dramatic Increases in Maternal Opioid Use and Neonatal Abstinence Syndrome

Neonatal Abstinence Syndrome (NAS) has grown five-fold since 2000 - 2012 across the U.S. 2000 - 2009 from ~ 4600 to ~ 23,009.

Now, let’s look at comparable numbers:

CDC VitalSigns - Opioid Painkiller Prescribing

2012 we had 259 million prescriptions done with pain killers, Florida graph states that 72 - 82 prescriptions per 100 people in the state. Using today’s Census population for back then, there’s ~ 21 million people.

Calculate those numbers and find a percentage of NAS individuals vs “full autonomy” individuals turning to opiates.

Of all my text, that still doesn’t explain people having the ability to change behavior due to brains being altered due to abuse. Nonetheless I welcome disagreements, but don’t irradically attack anyone on here based on your own unceremonious judgement without bringing the facts.

As a soon-to-be pharmacist you need to rationally judge the setting of what your dispensing.... that’s your job. You picked it so learn from it.

 

[ifillrxs]

drug addition is a mental illness not a choice....

Seeking medical treatment for an illness is a choice.

 

[BC_89]

Seeking medical treatment for an illness is a choice.

I should have just said this

 

[BenJammin]

PMP implementation is such a waste of time and resources. Check the PMP all you want but it's not going to stop the patient who goes to the same physician, the same pharmacy, and gets the same prescription.

 

[smq123]

PMP implementation is such a waste of time and resources. Check the PMP all you want but it's not going to stop the patient who goes to the same physician, the same pharmacy, and gets the same prescription.

I'm a physician (in Florida), and I check the PMP regularly. So, from that stand point, I don't think it's a waste of time. You're right, it doesn't help me catch the patients who are going to methadone clinics or buying stuff off the street, but no tool is perfect.

I wonder if you would use the same condescendingly ignorant language towards substance dependent individuals if they were your son, daughter, brother, sister, mother or cousin.

The HUMANS you are describing are economic and societal victims. They have been mentally, emotionally and physically abused and ostracized a million times, a hundred different ways we can not even comprehend. No one wakes up and says, "Today I want to become an opiate addict because I love stealing from what little family and friends I have. I love preforming sexual acts on dirty, dark, dilapidated alleyways."

Perhaps one day when you mature you will realize that no means of measure should define our limitless love for humanity and will understand how anyone's life circumstances can flip in mere weeks. If you want to unceremoniously judge people you should go into law enforcement or the military. Healthcare is not a good fit for you.

I think that your attitude is admirable. But I will agree with the others that it's hard to remember this when said substance-addicted individuals are threatening to find you, kill you (or your family), ruin your life, ruin your career, etc. It's hard to remember this when you're trying to comfort a petite, 22yo medical assistant after a patient told her that she "deserved to be raped," just because she told him that lost prescriptions for Vicodin cannot be re-issued. It's hard to remember that when you've been lied to, again and again and again. It's hard to remember when you hear of another pharmacy that's been robbed because of drug addicts (especially when the pharmacy staff has been shot or hurt.) Drug addiction IS terrible and we should be compassionate - but after a while, it starts to get old.

 

[CetiAlphaFive]

PMP implementation is such a waste of time and resources. Check the PMP all you want but it's not going to stop the patient who goes to the same physician, the same pharmacy, and gets the same prescription.

It is useful.

*ring ring*
"Hello this is Dr. Jerry Atric's rural family medicine clinic, how can I help you?"

"This is the pharmacist. I have a patient of y'all's that started with Norco 5 1 Q 12hours three years and 2 doctors ago.
Are you sure Ms Contin 30mg 1-2 Q12h and Norco 10/325 1-2 Q 4-6h is appropriate?
You do?
I'll give the patient their prescriptions back."

 

[sozetone]

drug addition is a mental illness not a choice....

It starts somewhere correct? someone picks up for the first time? well thats on them....and exactly what science has proven addiction is an actual illness? what studies have been conducted to conclusively identify "addcition" as a "real" mental illness? with mechanisms of action and everything? show me something and i'll change my mind.

 

[sozetone]

drug addition is a mental illness not a choice....

Is Addiction Really a Disease?

A choice? read for yourself and see if it makes sense.

 

[sozetone]

yep a choice. Just when opiate dependent mothers give birth to babies that are born addicted to heroin. It all started with a choice to be born.

you just explained exactly my point.....thank you

 

[sozetone]

It is useful.

*ring ring*
"Hello this is Dr. Jerry Atric's rural family medicine clinic, how can I help you?"

"This is the pharmacist. I have a patient of y'all's that started with Norco 5 1 Q 12hours three years and 2 doctors ago.
Are you sure Ms Contin 30mg 1-2 Q12h and Norco 10/325 1-2 Q 4-6h is appropriate?
You do?
I'll give the patient their prescriptions back."

What if they had terminal cancer, weeks to live, and you just gave their rx back? what then....? their family struggles to find it all over town, while being called "junkies"....thats what...Some people need that stuff, period.

 

[owlegrad]

Terminal cancer, the end is near = hospice. I am not sure that anyone is arguing to restrict access to hospice care.

Truly, I sympathize with your view point. Some people really do need heroic doses of opiates to function through no fault of their own. However the laissez faire attitude of assuming every script is valid doesn't fly with the DEA and honestly has helped get us in the public health crisis we are currently in. Do you even know the magnitude of the problem? Your attitude that pharmacists are just a bunch of scrooges that want people to be in pain would almost be adorable if it also wasn't so dangerous.

 

[projektreverb]

You guys can argue until the cows come home, but the way I see it, there is a standard definition. DSM-5 has a definition for opioid use disorder, just saying.

 

[CetiAlphaFive]

What if they had terminal cancer, weeks to live, and you just gave their rx back? what then....? their family struggles to find it all over town, while being called "junkies"....thats what...Some people need that stuff, period.

I'd wonder why a decrepit PCP is managing a stage 4 oncology case, then tell the family that they need a referral and a lawyer.

 

[smq123]

What if they had terminal cancer, weeks to live, and you just gave their rx back? what then....? their family struggles to find it all over town, while being called "junkies"....thats what...Some people need that stuff, period.

I have had that happen, actually. A patient with metastatic prostate cancer (who died 3 months later) had their prescription rejected by a Wal-Mart pharmacist, and said that the pharmacy staff treated him like he was a junkie. A quick phone call to the pharmacist to clarify why he needed Tramadol was all that it took.

I'd wonder why a decrepit PCP is managing a stage 4 oncology case, then tell the family that they need a referral and a lawyer.

No, sometimes it happens for complicated reasons. Sometimes the oncologists don't want to manage it, and the patient is waiting for hospice to take over. That patient I mentioned above had a lapse in insurance coverage, and was uninsured for about 2 months. The front desk staff at the oncologist's office literally wouldn't let him get past the waiting room once they found out that he had no insurance - he had clearly failed the "wallet biopsy." Yeah, Florida is a really really fun state to practice in. </sarcasm>

 

[Sine Cura]

Ah, the terminal cancer excuse.

Some ****ty PCP sent me a regimen of nearly 900 MME of opioid that the pt was allegedly on for a year (more likely selling it to have some income) consisting of 3 long-acting opioid formulations with zero advance notice because Wags refused to take it anymore. Like **** I'm filling fentanyl + methadone + MSER

 

[CetiAlphaFive]

]

I have had that happen, actually. A patient with metastatic prostate cancer (who died 3 months later) had their prescription rejected by a Wal-Mart pharmacist, and said that the pharmacy staff treated him like he was a junkie. A quick phone call to the pharmacist to clarify why he needed Tramadol was all that it took.



No, sometimes it happens for complicated reasons. Sometimes the oncologists don't want to manage it, and the patient is waiting for hospice to take over. That patient I mentioned above had a lapse in insurance coverage, and was uninsured for about 2 months. The front desk staff at the oncologist's office literally wouldn't let him get past the waiting room once they found out that he had no insurance - he had clearly failed the "wallet biopsy." Yeah, Florida is a really really fun state to practice in. </sarcasm>

Aaargh, my non sequitur is getting holes poked in it by exceptional cases!
Hahaha, obviously I'd not turn such a patient away.
We do a lot of hospice.

In reality, if I'm very concerned I request a relevant chunk of the chart- if it comes back with generic lower back pain I send them on their merry way.

 

[Sparda29]

I get why the pill mill patients do what they do.

From what I've seen, most of them live in the projects. I'm guessing that none of them actually take the drugs (reason why some doctors started urine testing all their clients to make sure the drug is in their system), or they take enough for the drug to show up in the urine and sell the rest. It's an easy $1000-1500 a month for the pill mill patients to sell to the dealers.

What would I do to stop it? Move all opiates into hospital/facility use only and deschedule cannabis.

 

[Apotheker2015]

Hey, take it easy now.....not every drug abuser is a victim. They HAD a choice to take dope or not to correct? no body held a gun to their heads and made them pop pills or shoot smack in their arm.....knock it off. It's that mentality that fosters this behavior and enables them to "feel" as if society made them be junkies. Nobody is being judgmental but why are we not ALL sitting here with needles in our arms? because we chose not to!! economic and societal victims, thats a good one. And yeah, life can flip in a day or weeks , thats right....so what do you do? get high? no! deal with your problems.

Is it really because we choose not to? Or is it because we are not "wired" that way? Food for thought.

 

[lord999]

Report: Public at risk as Ariz. doctors not well vetted

Just right now, I went into my filing cabinet and took out a 2007 letter from Amanda Diehl (the Deputy Director at the AZ State Board at the time) about a certain doctor that I reported that no action was taken on but was immediately revoked four years later after the DEA busted him, and she took the additional step of getting my RxS at the time to retaliate for bringing these matters up. I actually have the writeup from the RxS at the time too for that action. When Amanda was forced to resign from the AZ Medical Board years later, there were a generation of AZ pharmacists burned hard enough to know that it wasn't worth the time or energy to do anything about any problem pill mill docs. Survivors bias at its worst.

Present day, it is my sincere personal hope that Amanda Diehl gets a personal encounter with this problem. You make a system, you live in it.

I'm taking the day off tomorrow, I can't believe I still this angry about it.

 

[sozetone]

Is it really because we choose not to? Or is it because we are not "wired" that way? Food for thought.

Explain "WIRED" what does that mean? and again like i have asked others on this thread. If you can provide some REAL clinical studies that show addiction is a disease, with mechanisms of action and everything else, i would love to see it. IT would make me think about it.

You guys can argue until the cows come home, but the way I see it, there is a standard definition. DSM-5 has a definition for opioid use disorder, just saying.

"opiod use disorder" huh? that is a VERY recent addition in response to the "opiod crisis". it means nothing. Other than a new way to cash in on a societal problem that has been here for thousands of years. People have been using opiates since the dawn of time. It's nothing new, and needs no label.

 

[sozetone]

Why the animosity toward Rick Scott? He was inaugurated in 2011 and the PMP started the next year. It’s not like he was governor for years and years without a PMP. Also the authority to create one does not solely lie with the governor.

Why not thanks Charlie Crist?


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maybe it was crist i was thinking of, its been a while and im not a big politics guy. whatever, nothing was done.

 

[Apotheker2015]

Explain "WIRED" what does that mean? and again like i have asked others on this thread. If you can provide some REAL clinical studies that show addiction is a disease, with mechanisms of action and everything else, i would love to see it. IT would make me think about it.


"opiod use disorder" huh? that is a VERY recent addition in response to the "opiod crisis". it means nothing. Other than a new way to cash in on a societal problem that has been here for thousands of years. People have been using opiates since the dawn of time. It's nothing new, and needs no label.

Nah, I would never get that time back.