"l get a lot of druggies in here to buy syringes," explained the owner of the pharmacy where I was filling in one morning. "Maybe it’s the location, I don’t know. They’ll tell you anything to get you to advance them a couple of Vicodin while you’re trying to get the refill authorized, then hit you up for a box of syringes because their grandmother is visiting from out of town and hers have run out. Just use your own judgment."
     He left me in charge and headed for the convention, while I settled in to make friends with his computer and his regular staff. The first customer looked as if he were recovering from a week of Miller time, and he smelled like he’d spent most of it in the dumpster outside. He wore a tattered flak jacket (long sleeves in 90-degree weather that I hoped didn’t cover a sawed-off` shotgun), mirrored sunglasses, a plethora of ear rings, and a swastika tattooed on his left cheek. The clanking of chains ceased as he stopped in front of the pharmacy counter.
     He wiped his nose on his sleeve and handed me the tattered remnants of a prescription written on the local emergency room blank. The prescription bore the signature of a physician with whom I was well acquainted, but the DEA number was all wrong. The prescription was written for hydrocodone/apap 5/500 #100, though one of the zeros looked as if it might be in a different ink. It had six refills authorized.
     "Hmm," I mused so he could hear. I’ll have to phone your doctor for a clarification," I said knowingly. "Can you give me a little while? Sometimes he has to phone me back." I almost expected him to bolt for the door.
     "Sure," he said, a bit disappointed. "I’ll be back in a little while. But could you maybe give me a couple of ‘em now? I’m not supposed to go without ‘em."
     "Sorry, no," I said. "Got to speak to the doc first."
     "Okay. I need a hundred U-100s, too," he said. "My brother-in-law’s out of ‘em, and I promised I’d pick ‘em up for him."
     I was incredulous. I got the doctor on the phone
quickly because he thought I was going to invite him to go sailing again.
     "Sorry," I told him. "Some of us have to work. Tell me you didn’t write this prescription, so I can get my work
done." I read him the unbelievable details.
     "I’m really sorry," he said to my surprise. "He and I were talking about the family—he’s my brother-in-law, you know—and I just got distracted. I know you can only put five refills on that hundred hydrocodone—that’s what I meant. But be sure he takes a couple immediately: I don’t want his analgesia to wear off and undo the progress he’s made over this past week after his surgery.
     "And be sure to send me those syringes. I can’t go sailing if I can’t get my insulin into me."

     I don’t have a solution to the problem of selling syringes. I know pharmacists who absolutely refuse to sell them to anyone without a prescription on file, wishing to avoid cultivating a certain kind of clientele. Others would sell a pack of syringes to absolutely anyone, adhering to the philosophy that they are helping to slow the spread of AIDS and hepatitis (though the $5 they get for 10 syringes might be a part of the philosophy).
     I’ve even known pharmacists who sell syringes to anyone, then supply the police with license numbers of the cars the customers drive away in. I’ve worked in pharmacies that make more money on syringes than on prescriptions in a day’s time, going through cases every day, 10 syringes at a time. I know I’ve inconvenienced
a number of legitimate diabetics along with the hordes of imaginary diabetic grandmothers.
     I really don’t feel good about selling syringes to just anyone, but I also feel strongly about reducing the practice of reusing contaminated syringes, As pharmacists, we’re placed in the unique situation of having to police both sides of the dilemma; and it’s one of the few things largely left to our professional discretion.
     The debate about the merits of syringes, and even insulin remaining non-prescription continues; and no satisfactory answer seems forthcoming. It’s difficult to imagine the FDA allowing non-prescription status for a medical product requiring special storage and administration only by injection. There aren’t many products out there in such a unique category. Diabetics I’ve asked about it have their own strong opinions, too, with very good reason.
     “As an insulin-dependent diabetic for many years, it’s difficult to imagine taking a non-diabetic pharmacist seriously when even giving recommendations concerning my condition," said one diabetic to me on CompuServe "I know much more about diabetes, its daily control and
its inherent problems than 90 percent of the pharmacists out there. When they try to explain problems involved with my condition, individualized as it is, the conversation is almost laughable."
     Some days, it just seems harder to be appreciated.

FTP