Tom is diabetic, asthmatic, and broke. He’s back for a checkup.
“I take my Metformin every morning with my grits,” he says, “but I don’t need no refill. I just got me some Metformin XR.”
“How did you get extended release? They’re super expensive.”
“Well, my neighbor runs a tattoo shop. We live behind her store. Her doc switched her up to insulin, so she gave me her old meds—a big sackful in the alley. That’s gonna last me another year.”
Prescriptions dispensed behind a tattoo parlor? Wow. I’m constantly impressed by my patients’ ingenuity. One gal this week told me she’s on her deceased grandfather’s antidepressants. Another gets his pharmaceuticals from the farm supply store. I’m just glad to know he doesn’t have fleas.
“Are you good on your inhalers?” I ask.
“Well, the cheapest inhaler is 52 bucks. So I basically can’t afford to breathe. On Craigslist, I found some for ten bucks. I contacted the guy, and he met me at the Walmart gas station in a black Jaguar. I went to the door. He asked if I was Tom. Then he said, ‘You know this is illegal.’”
“Then what?”
“He let me in the car and he opened up a box. Each inhaler was in an individually sealed silver pouch. I took all twelve and handed him 120 bucks. Said he could use the money ‘cause him and his wife split up. He was wealthy. When his wife left him, he just ended up with the car. And the inhalers he got through her insurance. Wouldn’t a done him any good to use ’em, ‘cause he was smoking cigarettes.”
As I refill his meds—the ones he didn’t get in a back alley or from a Craigslist drug deal—he says, “You know what illegal means?” He pauses. “Illegal’s a sick bird.”
“What?” I ask.
“Illegal just means an ill eagle.”
Pamela Wible, M.D. is a family doctor is Oregon. Watch her TEDx talk here. Photos by GeVe. To protect patient privacy, a professional model has been used in the photograph.
I’m not surprised by your patient’s resourcefulness. We turn in thousands of dollars in drugs every year to the local sheriff’s drive instead of pouring them down the drain. We’re going to see a larger amount of drugs being dispensed over the coming years as Tricare for Life and Medicare Part D require mail-in-prescriptions. Both plans will issue a three month supply at one time never stopping to think about how often medications are changed with patients 65+.
We’ve had medications filled for 30 days and our insurance covers them 100% only to discover that within a week or less that we cannot tolerate the medication or it simply doesn’t work for us.
IMO, patients are turning to this secondary source of ‘drugs’ to fill their medication needs as a means of survival along with the individual that has the drugs and no longer uses a particular prescription.
I’m not advocating this practice but I also believe firmly that had pharmacy benefit managers stayed out of the retail component of medication, almost everyone would be able to afford their medication and insurance companies wouldn’t be taking risks with our lives.
People are getting desperate because of the economy, the destruction of the middle class, and sky-rocketing out of pocket co-pays and draconian mangled-care policies that have totally disrupted the “Sick care” basis of our contemporary medical practice. Tragic. I commend your patients resourcefulness. It’s the American way. (Resourcefulness) And, of course, in this case, quite illegal.
I work for an organization that sends thousands of expired medications to third world countries every year because they can’t be used in the U.S. due to regulations. This does not help those in the U.S. that need affordable medications, but at least they are helping someone.
There are many docs who continue to pass out expired meds to their patients right here in America. Patients can not afford to get their medication even through insurance. These doctors unfortunately must break the law to help their patients. The Department of Defense did a study years ago on expired meds to see if they really needed to throw out their Rx supply yearly (at huge taxpayer cost) and lo and behold most meds are still good (minor loss of efficacy) a decade after expiration. 9
This is something that I’ve suspected about expiration dates. I know a vet with over a dozen bottles of Pepto Bismol, because of his name being on the bottles. He tells his doctors that he doesn’t need any-and the doctor just sent him 4 bottles. Yesterday he asked me if I needed any Pepto.
When people are denied care they will resort to other means. The will to survive is built right into our bodies and will surpass even our knowledge of what’s “legal,” because our bodily logic is far more basic. I saw online the story of a woman who was alone and dehydrated in the wilderness. Her body was so thirsty that she cut into her skin and attempted to suck out her own blood. It was the closest liquid she could find. In the end, she was rescued and lived to tell the tale.
I know plenty of people who are denied care. I am one of those people. “You are too old.” “Too young.” “You don’t qualify.” “Too sick.” “Not sick enough.” “Your insurance is used up.” “You’re the wrong gender.” “You couldn’t possibly be in pain.” “It’s all in your head.” “Asking for a second opinion is a mental illness.” We go elsewhere. Drugs aren’t necessarily the answer. Quality medical care would be far better than a pill, but it seems that lately our medical people would rather throw pills at patients because it’s cheaper. But if a patient is denied care, they often resort to drugs. People feel trapped and see no other way out.
What’s out there? If we’re lucky, family and friends, perhaps the Internet if we can read with caution. There are plenty of Golden Calves out there with high price tags. I know far too many folks that tune out and give up, burying themselves in a cloud of smoke, one way or another.
Julie Greene
I can’t believe how whacky some people are! Is this a true story? I wonder how many people obtain drugs for actual health problems from a source other than a doctor? Are there any stats available regarding this problem? I would love to research this conundrum!
This is a true story Marv! And yes, when people do not have the money they will do some creative things to stay alive. The will to live is strong among mots patients.
Dr. Wible,
Thank you for the selfless work that you do for patients and your fellow physicians.
You are right about the opiate guidelines being just that, guidelines. While doctors shouldn’t dole an opiate script for “anything,” It should be up to the doctor to treat the individual, what is best for them according to need and individual diagnosis, and most importantly quality of life. It is after all pain management, and yes, we will do whatever necessary by whatever means to survive extreme suffering. As you mentioned the human will to survive is strong, but due to the now opiate hysteria existing in the medical community; There’s neglect happening and lack of compassion to the patient’s plight and effort to “live.”
In the interim of the current opiate crisis, we are forgetting it’s about quality of life in an individual, what works for them won’t necessarily work for someone else, but rather than having this conversation with our patients, we are quick to emphasize OTC medications and non-opioid therapies work best, not taking into account the diminishing effects of the quality of one’s life when these therapies fail causing loss of life function, increased depression and thoughts of suicide with the added effects of the fear and stigma that keep one expressing their pain and discomfort out of concern of being labeled.
It’s management of symptoms that allow optimal living that should be determined by the doctor for that patient. When we begin to generalize what’s best for everyone, we lose the ability to determine the detrimental effects on life according to diagnosis and severity of pain. This mind set is dangerous. We are human and not designed for immense suffering. It’s about striking a unique individual balance that includes both opiates if needed to make life bearable at best as well as non-opioid therapies for living with severe pain. When pain is a debilitating force that keeps one bed-ridden, then it’s counter intuitive and destructive. Granted it may not be easy for docs to determine who’s abusing and who isn’t, but this is where proper screening and monitoring should be the focus rather than avoidance of prescribing opiates at all. Again we are talking about the individual needs, whatever the modality. No, opiates shouldn’t be first line therapy, but that doesn’t mean they are of no benefit, especially when there are no adverse health risks.
To allow undue suffering in the patient to live in the shadow of contemplating suicide; You are doing indirect harm. I’ve been with my clinic for 16 years with the determination of having never abused medication confirmed by pill counts and UA. I have severe chronic pain, one of which is LPHS, a debilitating rare kidney disorder with no cure. Due to its rarity, there haven’t been any clinical trials, studies or even recommended forms of treatment.
We must take care to not increase psychological suffering while withdrawing medication. The suicide rate is now surpassing the overdose rate, and that’s a fact. There are also studies showing there are just as serious health risks for leaving someone in pain such as uncontrolled vitals, and the stress pain plays on all your vital organs. Suicide is an epidemic among doctors as well. Thank you Dr. Wible for getting this info. out there. We must not be insensitive to suffering!
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Perhaps desperation could play a role in a patients need to find alternate resources for the drugs they need?
I myself have three predispositions for diabetes. Having had gestational diabetes and being overweight are two and the third is the ethic group I belong to. I do not know if any family members have been affected since I was adopted. I have been checking my blood glucose with a self-purchased meter and an over-the-counter A1c test.
I finally screwed up enough courage to go to my local Federally Qualified Health Center (FQHC) and was met with the most condescending, arrogant doctor who could care less about my care. She was aware of my financial situation since I’m sure that my chart showed I that I paid (up front) the lowest level on the sliding scale, and took no time telling me that I ate too much bread (I rarely eat bread – I just told her I baked a loaf each week, what she also didn’t know was that I also take care of an elderly relative on a full time basis and she needs to eat) and that she needed to do a lot of tests during the course of several visits. She knew I could not afford this and I even showed her a copy of my last A1c. I don’t think she needed whatever kidney test she was proposing to diagnose diabetes or pre-diabetes. I was told they had an in-house A1c that could have been done for a mere $25 but I was not offered this option.
I completely feel as though I was stereotyped as a low-income illiterate. I was dismissed and wound up being so upset that I left the office in tears. Now I sincerely doubt that I would be able to set foot inside a doctors office for a long time, even if I could afford the visit, especially since I will not see a refund from the money I just paid Dr. X so that she had the pleasure of belittling me, my health and my feelings.
Some people are low-income through no fault of their own – in my case I could quit work and care for my elderly relative or I could watch her be put on the street – or worse yet – die from her situation. It didn’t help that I am in a state that didn’t expand Medicaid and I fell into the Affordable Care income gap.
Not all of us speak in slang and meet people behind the chicken coop for illegal prescription drugs. Some are in genuine need and have no choices.
when your older and your dont have or a small amount of income you do what you can do get what you need…..as it stands right now……I am copd and cant get an inhaler because they cost so much. Thank God there are a few neighbors around that use them and have extras…….so you do what you got to do to stay alive……..and this dont mean no drug drugs either…..it means i take them to breathe or stay alive type of stuff ty have a nice day 🙂
I have Primary Addison’s Disease & for a lot of reasons,I can’t take steroid pills for control. Instead, I take daily Solu-Medrol shots.
When I go to the ER in Crisis, they give me the same shot I take at home; just in much higher doses. When I am admitted to the hospital in Addison’s Crisis; they also give me the same shots in a much higher dose & then wean me down to my regular dose before my discharge. It’s still the same drug I use at home & I take it the same way; in a shot form.
When I leave the ER, or I am discharged from the hospital; they throw the [more than 3/4 full] vials of Solu-Medrol away.
I started asking for the vials of Solu-Medrol about 6 years ago. I saw that it was often more than 3/4 full. In on instance, they had removed only 0.05mg of Solu-Medrol for my daily maintenance shot. There was still 19 days worth of medication in the vial. I had paid for that 19 days of medication & she was going to toss it? No how. No way.
I pointed out that it wasn’t a narcotic. It’s a drug I have used for over 35 years & must keep using until I die.
I pointed out that they were just going to throw it away, as drug sharing among patients was not permitted.
I also point out that I paid for the vials [or will pay for, when the bill comes]. I point out, again, that since the vial is not allowed to be used for any other patient; they are going to throw it in the bio waste bin.
By that point in the conversation, they generally know what I’m after & will slip me the vial. They always do it quietly & tell me to keep it hidden. They are supposed to throw it away, not give it to me; even though I paid for it & it’s mine.
Sometimes, literally, it’s my Solu-Medrol. They won’t have the correct dose or proper amount readily avail. & my husband will have to bring mine to the hospital. They then act like they own it & try to throw it away on moving/discharge day.I don’t let them get away with that.I also have them compensate me for a free vial of Solu-Medrol afterwards.
If I get moved to a new floor or a new facility,that means a new vial of steroids, each time. I can end up paying for 4-6 separate vials; if they are playing musical rooms due to a bed shortage.
Yes, I get the steroid vials. I use them at home & yes, they save me a lot of money. Each vial is 20 days of life for me.
As long as the medication is properly prescribed, for you, is not a narcotic,nit a drug that has a short shelf life, or short expiration date; you should be able to take them home. You paid for them; why not?
My son gets inhalers all of the time. He leaves with the inhalers used in the ER & on the hospital floor. He uses them up before he fills his prescriptions. Saves him hundreds of dollars a year,& they are just going to throw them away.
I once got two antibiotics that way, and didn’t have to buy them in the pharmacy. They were giving me the pills while I was in the hospital & were going to throw them away. The pharmacist had sent up the full 10 day supply, because he didn’t know when I was leaving hospital.[I stayed in 6 days that time.]
So, grab the meds at the ER & from your hospital stay. IF it is a medication that you will need/use.
You have/will pay for them, when you pay the bill.They are yours. Why pay for something to be thrown away? Why not take it with you & use it?
It’s not like anyone else can or will use them. No patient sharing of medications,ever.
This way of getting medications may be against hospital policy, but it’s not illegal & you don’t risk prison time.
Laugh & Smile; it’s the best medicine out there. Cool breezes and warm wishes to all.
Sorry for typos. This phone keyboard is so much smaller than mine.
I’m currently looking for a drug dealer because I can’t get meds I need to function. Wish I had a neighbor who didn’t need theirs anymore.
Doctors need to think about where patients will go when they with hold medicines that help them just get through the day. We’ve tried to do it the right way, at great expense and a lot of hassle, only to be told no refills. Backed into a corner it’s street drugs or suicide.
I’ll have to remember the ill eagle – good answer.
This drug thing is so stupid, all the time I see people waiting in line at the drugstores the first thing they ask the pharmacist is where the drinking fountain is or the bathroom so they can get water! They are catching a buzz before they are out the door! I just broke my pelvis I Cab’s Drive, my husband gets up at 4am to go to work gets home at 3:00 takes me to therapy 3 days a week makes dinner cleans the house cause I can’t walk, than I call for my 40 painkillers a week I can take 1 every 4 hours or 1 every 6, I can barely walk I’m supposed to leave the country in a few weeks and my therapists are telling me I’ll pribably be using a walker or a Cain I’m going to be doing a lot of walking it’s a 1 week cruise! And I’m asking that doctor for at least 60 painkillers for that week! I don’t abuse them my hubby has to drive to the doctors office after work every 6 to 8 days pick up the prescription take it to the pharmacy usually has to wait a day to go back and pick them up! So for a month he is makeung approximately 12 trips between the doctors office and pharmacy for pain meds and it’s not like we live 2 minutes from these places! If a person wants pain meds all they have to do is open up their computer and get anything they want! By the way my hubby is 65 and I’m 59. When the government made this law the joke is on them! I could walk 3 doors down right now and get OxyContin it would be expensive but I could do it! All it is,is a waste of people’s time running back and fourth. And if they can’t wait get a coke take your pill you will have a buzz before you get to your car! Dumb dumb dumb and a waste for people who are really in pain and need it! Thank you
I have suffered with chronicle pain for more than 35 years. Last June my methadone was reduced from being able to take up to 5 10mgs a day to only 3 10mgs a day. I have not adjusted to this power does and continue in pain every day. I have been going to this pain clinic for 13 years and I had been a model patient, get I am now being punished for the crimes of others. I was off this medications once about 16 years ago and was still in withdrawals 2week’s after stopping. I absolutely feel for people who suffer from chronic pain for whatever reason. Since the stupidity taken by doctors and legislators nothing has changed concerning illegal drug abuse. But us older folks are suffering because of people trying to legislate morality. This is impossible. Was tried back in the 1920’s caused the biggest crime wave in history up to the point. Man is getting more insane each day it seems. Thanks. I pray for all who are suffering.