March 2020

DANGLY BITS & BARBED WIRE

I had the honor recently to be invited by APhA to participate in a call with the U.S. Government Accountability Office (GAO) concerning State PDMPs. I’m not sure why I was on the call. Everyone else on there was really smart. I suppose my dual life, 45 years a pharmacist and 25 years a cop, had something to do with it.

As we were on the call, I could not help but think back many years to my experience with Michael. Everyone knows a Michael. He was a hardcore pill addict. Michael never met an opioid he didn’t like and would go to any extreme to get them. That extremism brought him into the purview of my cop life. Michael was not opposed to breaking the law to get his drugs.

I had a prescriber’s office call me irate about Michael. It seems, according to the office, he had lied and tricked them into prescribing him some oxycodone. As I opened a case and investigated (that’s a term cops use) I discovered Ole Michael had stripped down naked, out in a pasture, and run full tilt into a barbed wire fence in order cause enough damage to legitimize his need for oxycodone. He had torn himself up pretty good. He had torn places that usually don’t see the light of day, including some dangly bits. When he presented to this prescriber (the office that had called me so irate) they told Michael they would not see him because he had not paid for his last office visit. Michael convinced the office that he was, in fact, not Michael, but Marvin, Michael’s cousin. In that way he got his oxycodone. (And again skipped without paying for his office visit.) Unfortunately, along the way, he had also committed a felony. I made the case, applied for and received an arrest warrant, and waited for Michael to surface.

Michael did surface some 60 days later, right on Main Street in our little town. That’s where I arrested him. Put him over the hood of my patrol car, cuffed him, frisked him and hauled him off to jail. Right there on Main Street in broad daylight, in the middle of town.

I thought often back in the day when I arrested opioid abusers, that jail was their last best hope for recovery and a chance at life. That proved not to be the case with Michael. Michael bonded out of jail pretty quickly. It was quickly enough he didn’t have time to detox and went right back to abusing opioids. In fact, Michael presented himself at my pharmacy counter, not 30 days after I arrested him, with a prescription for (you guessed it) an opioid and wanted to know if I’d charge it to him. I declined to fill the prescription. I told Michael that since I may be in court with him soon, he’d probably best not fill this at my pharmacy.

Jail failed Michael. The system failed Michael. I failed Michael. All those years ago, we had no resources. There was (and still is not) a PDMP in my state. Nowhere could we see his opioid history. There were no resources where we could send Michael for opioid use disorder. In fact, OUD had not been coined at that time.

We’ve come a long way in our understanding of folks like Michael, but we’ve got a long way to go. As the front line of the opioid epidemic, Pharmacists need to be aware that times are changing. With Federal programs like CARA and Cures21 pumping money into addiction prevention, treatment and education, the US has begun to recognize patient care and treatment are the ways to prevent opioid deaths. Pharmacists, especially Community Pharmacists need to know what resources are available, and becoming available in our local area, and readily refer patients. We need to counsel on initial and subsequent opioid scripts, discussing treatment expectations, dangers, effects, options, Naloxone, etc.

This sticks in my mind. You see, Michael died no more than 18 months after I arrested him, succumbing to the effects of his drug seeking lifestyle. I had tried to get him the help available at the time, but I wonder, had that happened now, with more resources at our disposal would there have been a different outcome?

That’s the face of the opioid epidemic. That’s the face that sticks in my mind. I bet you have a face stuck in your mind, too.

Richard Logan, Jr. PharmD

rlogan@semorx.com

Richard Logan, Jr. PharmD, community pharmacist, community pharmacy advocate, and ESPhA founding member