Thursday, May 24, 2007

Jack Lost his oxycodone

I felt a comment on last night’s Lost season finale was necessary. First of all, it was brilliant. Second of all, I was so happy to see a depiction of pharmacy on television. Not only that, the depiction was actually quite true to form. The incident to which I refer is of course Jack’s now infamous downward spiral into drug addiction. I will spare you any show spoilers, but essentially Jack gets addicted to oxycodone (probably Oxycontin, but they couldn’t use a trademark on TV without paying for it). Along with his alcoholism, this puts Jack in a state of complete shambles. In order to gain access to oxy he steals from the hospital narcotics cupboards. He also presents to the pharmacy with a story very familiar to me. He wants his pills refilled, upon which the dutiful pharmacist informs him that he has no refills remaining. He asserts that this was quite impossible and that they must have made a mistake. When the pharmacist insists no mistake was made, he presents a prescription from a Dr. Sheppard (his name) who he insists is not himself, but another Dr. Sheppard. The pharmacist tells him that she will have to call Dr. Sheppard’s office to confirm the authenticity of the prescription, at which point Jack says ‘Don’t bother’, throws a big hissy, and walks out. Now, you might say to yourself, “That would never happen in real life.” But boy does it! It happens so often I feel more like narcotic police than a healthcare professional. I’ve heard them all. I dropped them down my sink (never happens with blood pressure pills). The bottle says 60 but you only gave me 30. My house was broken into and they were stolen. The airline lost them in my luggage. I left them in a faraway place. I’m going on vacation so I need them refilled early, etc. etc. I’ve also seen forged prescriptions and double-doctoring (a federal offence whereby a patient gets a prescription written by one doctor and fills it at one pharmacy and then does the same with a different doctor and a different pharmacy, usually on the same day.) A colleague of mine was held up at gunpoint for narcotics. My methadone patients have told me so many stories. They stole prescription pads. They would pay $100 a day to get their fix from Oxycontin diverted onto the street. There is even a pharmacist being investigated nearby where I work for giving narcotics to patients in exchange for sex. I have approximately 65 patients on methadone because of an opioid addiction, most commonly to Oxycontin that they first took for pain as prescribed by a physician. They were rarely warned of the powerful addictive potential of this medication. Police officers, parents, workers, unemployed, young, old, white, Aboriginal (contrary to popular assumptions, a very small percentage of my patients). All of these people have been drastically affected by this medication and the lifestyle associated with addiction. Thankfully, we have methadone, an incredibly effective medication, which while difficult to deal with, is also extremely rewarding. Also quite thankfully, Purdue Pharma, the makers of Oxycontin, were recently hit with a $645 million (US) penalty for “misleading the public about the drug’s risk of addiction” (Globe and Mail, May 11, 2007). While this drug is extremely useful for pain, it needs to be used with caution. And if companies have so little ethical concern that they recklessly treat it like a commodity, purposely misleading the public and prescribers about its risks and benefits, than they deserve much more than a hefty fine. I hope this is the start of a new era of accountability in Big Pharma. I hope that the public begins to hold them as responsible for their actions and the consequences of those actions as they have for Big Tobacco. And I hope that one day, pharmaceuticals will be seen as chemicals with risks and benefits, to be taken seriously and prescribed with regards to best practices based on expert opinion and clinical research. Every time a physician prescribes a drug solely based on a flashy marketing presentation, a little part of me dies inside. And a little part of society suffers needlessly.

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