Have You Kissed Your Pharmacist Today?

As many as 67% of patients don’t talk to their pharmacists about their medications, probably because they don’t know that pharmacists are trained to counsel them about their meds – not just count pills into bottles. It’s not surprising, then, that lots of people don’t take their medications correctly. Since prescription drug use is rising steadily (48% – up from 44% in 2000) it makes sense to learn as much as possible about the drugs you take. What, exactly, do you take? Why do you take it? What are the side effects? Are there alternatives that are cheaper? Safer? Pharmacists can help with these questions, so get to know that person behind the counter! In the meantime, here are a few things your pharmacist would like you to know:

Pharmacists are medical experts.

You may think a pharmacist just dispenses drugs but they are the most highly educated health professionals when it comes to the area of medication. They know more than your doctor about the drugs you take, so take advantage of that knowledge. Your pharmacist is the last line of defense between you and substances that are potentially toxic – even lethal.

Don’t be afraid to ask questions.

Health literacy is a big problem in the U.S. Being educated about the drugs you take means keeping you and your family safe. The only way to know is to ask.

Follow your dosage instructions!

OK. We’ve all done it – skipped a pill this morning and took two this evening. Or decided not to finish all the pills in the bottle because we felt better after a few days. Taking antibiotics incorrectly leads to resistance; their widespread misuse has lead to new strains of bacterium like Methicillin-resistant Staphylococcus aureus (MRSA), a virulent flesh-eating microorganism. We could eventually render antibiotics useless by using them incorrectly. No one wants to return to the diseases our grandparents witnessed or worse – so make sure you understand how to take your medicines and follow through.

Keep track of all your medications—especially if you’re a parent.

Pharmacists say that it’s common for patients to come in and say their prescriptions have been stolen. Recreational prescription drug use is common and most people who abuse prescription meds get them from friends or relatives. It’s easy to raid the medicine cabinet; kids learn a lot about which drugs to take from their peers. So keep them away from your kids and people in your circle with addiction problems. Hide them or lock them up and know how many you’ve taken.

Practice proper disposal of your drugs.

Drug contamination shows up in ground water and city water supplies so don’t throw excess pills in the trash or flush them down the toilet. Local Drug Enforcement Agencies have programs for proper disposal – talk to your pharmacist about possible programs in your area.

Pay attention to where and how long you keep your medications.

Keeping extra pills in the medicine cabinet in case you get sick again is not a good idea. All drugs have an expiration date and some drugs develop toxicity over time. Old medication can make you sick, so pay attention. Storage is also an issue. Most drugs degrade in a hot or a humid environment – like the bathroom. Your pharmacist can tell you how to store medications properly.

Use a local pharmacist.

Some people use multiple pharmacies to save money or get their prescriptions filled online. But using one pharmacist/pharmacy for all your medications can reduce the possibility of having a dangerous drug interaction or allergic reaction. The more your pharmacist knows about you and your medications – the better.

Consider using generic drugs.

People generally prefer name brands, whether it’s a can of peaches or a prescription drug. But because pharmacies must dispense products that are comparable to label brand products, generics have equivalent chemical properties to label brands. Once a patent on a label brand expires, other companies can manufacture a generic version of the drug with the same active ingredients, under a different name. They’re cheaper and most of the time work just as well. There are a few exceptions – if you’re nervous, ask your pharmacist. She’ll know which ones are appropriate for you.

Don’t be afraid to ask about over-the-counter drugs and vitamins.

Pharmacists know all about those over-the-counter (OTC) drugs and supplements, too. More drugs are being sold over the counter so there are a lot of questions that need to be answered. OTC drugs can interact with prescription drugs and with one another so don’t guess. Take that bottle over to your pharmacist and ask.

Your neighborhood pharmacist IS a font of knowledge. She can keep you out of trouble with your prescription drugs and could even save your life. Even so, the world of pharmacy isn’t all roses – here are a few things you should know that your pharmacist probably WON’T tell you:

Think you’re smarter than your pharmacist? Think again.

Prescriptions for pain or insomnia get extra scrutiny.

This isn’t McDonald’s.

Drive-through windows are a distraction for the pharmacist working the counter inside. Distraction and pharmaceuticals don’t mix: reconsider using the drive-through.

Generics are a great idea most of the time, BUT……

When it comes to blood thinners or thyroid drugs, for example, small differences can be a big deal. Ask your pharmacist if generic equivalents are safe in your case.

Pharmacists hate your insurance company as much as you do.

Insurance companies may insist that you switch drugs, even when you’re happy with them. Pharmacists get stuck in the middle but the person you really need to talk to doesn’t work behind the counter. Call your plan. If more people did insurance companies would be more responsive to patients’ needs.

Pharmacists don’t just recommend meds for the flu.

In most states they can give flu shots – maybe you’ll never catch it.

Pharmacists are human.

They make mistakes. Ask if your local pharmacy uses a barcode system to keep you from receiving the wrong drug or the wrong strength of the right drug.

Your pill might look different from the one you got last time.

Pharmacists can give you a generic refill that’s different from the one you started with. If something looks different, ask.

Pharmacists are not mind readers.

So far, there’s no giant database that tracks your prescriptions and flags interactions for all pharmacists. Use one pharmacy. If you start using a new one, get to know your pharmacist. Be sure they know what you’re taking.

Avoid the lines.

Mondays and Tuesdays are busy because many new prescriptions and refills come in after the weekend.

You know those $4 generics?

Don’t assume you have to go to Wal-Mart or Target to get them. Ask your local pharmacist if he can match the price.

Yelling won’t help.

If your pharmacist can’t reach your doctor and/or insurance company to approve a refill, there’s nothing he can do about it. Yes, it’s frustrating, but giving it to you anyway is illegal and will put his license in jeopardy. He’s not going to do it.

Problems? Have an Antipsychotic!

If I were to ask you what the single top-selling therapeutic class of prescription drugs in America was, what would you say? Pain relief drugs? GI drugs? Supplements? Nope. The answer is: antipsychotics. According to IMS Health, Inc., “Antipsychotics remained the top-selling class of medications in the U.S., with 2009 prescription sales of $14.6 billion.”

Really? Until recent years I always thought antipsychotics were hard-core drugs reserved for serious psychiatric diagnoses: schizophrenia, bipolar disorder, delusions, hallucinations and thought disorders. Today it seems everyone is being prescribed these drugs – unruly kids, elders with dementia, and the average working person suffering from too much stress. Just about everyone knows someone who is on one of these drugs because our medical and educational systems make it difficult to refuse them. My partner’s son, for example, was precocious, too quick for the pace of his teacher’s lesson plans and bored in school. So he found ways to entertain himself, as bored children will tend to do. The school administration branded him with ADHD and demanded that he be put on Ritalin or be expelled. He was snatched out of that school in a heartbeat and sent to a boarding school in his parents’ native Britain where the answer to every behavioral issue was not necessarily a pill. Today this problem child is a happily married father of three with a degree in physics and a job in the aeronautical field. The option of alternative schooling is not open to every parent, however. Another child I know may not fare so well. Suffering from insomnia, he wandered around the house all night. So his mother took him to a pediatrician and got talked into a diagnosis of bipolar disorder. The last time I saw him he sat at the table staring out from behind wide, blue eyes, strangely quiet and seemingly devoid of emotion. No doubt he’s easier to manage. He’s six.

Little wonder we’re using drugs more often to address difficult behavior problems – the pharmaceutical industry developed a new class of medications in the 90’s known as “atypical antipsychotics”. Zyprexa, Risperdal, Seroquel and the more recent Abilify are hyped as more effective than old-school drugs like Haldol and Thorazine. And they don’t cause tremors. AlterNet.org calls the atypicals the “bright new stars in the pharmaceutical industry’s roster of psychotropic drugs – costly, patented medications that made people feel and behave better without any shaking or drooling.” By 2009 Seroquel and Abilify were number 5 and 6 in annual drug sales, with 20 million prescriptions written for the top three atypicals.

Maybe the U.S. is suffering from mass psychosis. Or maybe the cause of the explosion in antipsychotic use isn’t about psychosis at all. It’s not news that drug companies woo physicians into prescribing their drugs with gifts, junkets, and money for research. Psychiatric treatment is subjective. There’s no biological test for mental disorders and with all the influence from Big Pharma, of course the treatment of choice has become chemical in nature. Add to that the fact that health plans won’t pay for traditional therapy anymore and it’s eay to see why a shocking 389,000 children and teenagers were treated last year with Risperdal alone. Of those, 240,000 were twelve or younger. Twelve. Most of these kids had been diagnosed with attention deficit disorder. Research in the Journal of the American Academy of Child & Adult Psychiatry found that the number of children five years and younger – some as young as two years old – receiving antipsychotic meds has doubled in recent years. These are some of the most powerful and dangerous drugs in the drug industry’s arsenal: antipsychotic drugs that in most cases are not even approved for use in children.

Sickeningly, a 2009 study in The New England Journal of Medicine found that 18 out of 20 psychiatrists who wrote the American Psychiatric Association’s clinical guidelines for the treatment of depression, bipolar disorder and schizophrenia have financial ties to drug companies. Mental illness is now the leading cause of disability in children because under Big Pharma’s influence the criteria for mental illness have simply been expanded so almost everybody has one. The over-prescription of antipsychotics amongst the elderly is as troubling as over-prescription in kids; neither group makes its own choices about what drugs to take. Their vulnerability makes them targets to be tranquilized when they have problems. Alternative treatments, on the other hand, require an investment of time and thought. And health insurance plans, including Medicare and Medicaid offer little in the way of coverage.

Increasingly, psychiatrists are moving away from cognitive therapy and into medication management. Insurance companies DO pay for that. But medications don’t solve behavioral problems, they just slow down the person who takes them. Children don’t always fall under the category of a pervasive developmental disorder. Rather than risking the health of these kids and incurring the long-term cost of the damage these drugs can cause, health plans should audit physicians to see if the meds are needed. And here’s an idea: compile guidelines for diagnosing and treating mental illness on the basis of an objective review of scientific evidence – not on whether the shrinks writing them get speaking fees from Eli Lilly or an ego-stroking award from Merck.

Happy 4th of July!

I’m moving to a new house this week and you know how that is! So I’ll return with more pharmacy news and views in a couple of weeks. In the meantime, here’s some Independence Day wisdom to fill the space. Have a wonderful 4th of July from all of us here at Apex Medical Placements! -CVH

You have to love a nation that celebrates its Independence every July 4, not with a parade of guns, tanks, and soldiers who file by the White House in a show of strength and muscle, but with family picnics where kids throw Frisbees, the potato salad gets iffy, and the flies die from happiness. You may think you have overeaten, but it is patriotism.
Erma Bombeck

Better to starve free than be a fat slave.
Aesop

I have always been among those who believed that the greatest freedom of speech was the greatest safety, because if a man is a fool, the best thing to do is to encourage him to advertise the fact by speaking.
Woodrow T. Wilson

Liberty means responsibility. That is why most men dread it.
George Bernard Shaw

Patriotism is the last refuge of scoundrels.
Mark Twain

There, I guess King George will be able to read that.
John Hancock, after signing the Declaration of Independence

Immigrant Picnic

By Gregory Djanikian b.
1949 Gregory Djanikian

It’s the Fourth of July, the
flags
are painting the town,
the plastic forks and knives
are laid out like a parade.
And I’m grilling, I’ve got my
apron,
I’ve got potato salad,
macaroni, relish,
I’ve got a hat shaped
like the state of
Pennsylvania.
I ask my father what’s his
pleasure
and he says, “Hot dog, medium
rare,”
and then, “Hamburger,
sure,
what’s the big
difference,”
as if he’s really asking.
I put on hamburgers and hot
dogs,
slice up the sour pickles and
Bermudas,
uncap the condiments. The paper napkins
are fluttering away like lost
messages.
“You’re running around,” my mother says,
“like a chicken with its head
loose.”
“Ma,” I say, “you mean cut
off,
loose and cut off   being as
far apart
as, say, son and daughter.”
She gives me a quizzical look
as though
I’ve been caught in some
impropriety.
“I love you and your sister
just the same,” she says,
“Sure,” my grandmother pipes
in,
“you’re both our children, so
why worry?”
That’s not the point I begin
telling them,
and I’m comparing words to
fish now,
like the ones in the sea at
Port Said,
or like birds among the date
palms by the Nile,
unrepentantly elusive,
wild.
“Sonia,” my father says to my
mother,
“what the hell is he talking
about?”
“He’s on a ball,” my mother
says.
“That’s roll!” I say, throwing
up my hands,
“as in hot dog, hamburger,
dinner roll….”
“And what about roll out the
barrels?” my mother asks,
and my father claps his hands,
“Why sure,” he says,
“let’s have some fun,” and
launches
into a polka, twirling my
mother
around and around like the
happiest top,
and my uncle is shaking his
head, saying
“You could grow nuts listening
to us,”
and I’m thinking of pistachios
in the Sinai
burgeoning without
end,
pecans in the South, the
jumbled
flavor of them suddenly in my
mouth,
wordless, confusing,
crowding out everything else.