Monday, August 19, 2013


The term "POLYPHARMACY" can mean several different things:

1. A patient sees two different doctors. Each prescribes the patient Vicodin. The patient gets the prescriptions filled at two different pharmacies and pays cash. That's Polypharmacy.

2. A patient has different medications on her profile transferred to various pharmacy chains in order to take advantage of the $25 transfer coupons. That's Polypharmacy.

3. A patient sees ONE doctor but gets multiple prescriptions for the same condition. That's Polypharmacy.

SITUATION NUMBER 1: Most cases of Polypharmacy are the result of the first example above. This is so common with the misuse of narcotics that for years it went undetected unless pharmacies communicated with one another about the same patients. Most states now have a prescription drug monitoring program to help with this problem. Pharmacists can log into a website and see the narcotic history of the patient's drug use. Pharmacies are required to submit narcotic logs to the local Board of Pharmacy which indexes all the drugs by patient. From there any pharmacist at Goofmart Pharmacy can see if I.B. Takingtoomuch is filling Vicodin at Jimmy's Pharmacy or Wigglegreens or wherever. It's a valuable tool.

I'm sure you can see the danger of a patient getting multiple prescriptions from different doctors. Nobody dislikes pain more than I do, but serious harm and/or death can result from the misuse of narcotics. When you add benzodiazepines (such as Xanax or Valium) and alcohol to the mix, the danger skyrockets.

SITUATION NUMBER 2: Considering situation number two above... this is a problem that gets generated by pharmacies themselves. These decisions are made by muckity-mucks at the corporate level who don't have a clue as to the danger here. Sure, it SEEMS reasonable to go after business any way you can. Walfart Pharmacy has clients and we want them. Let's offer an incentive to get them to come to our pharmacy and thus shop in our grocery! Let's offer them $25 to transfer a prescription. Who cares if there is inherent danger to overloading pharmacists with having to take the time to manually call all over creation to transfer a prescription over the phone and risk getting the wrong information or making a mistake in transcription? It's all about the bottom line.

In case you don't know, pharmacies DO NOT share patient information with one another when they transfer a prescription. Suppose your drug profile is extensive and you usually get your meds at Pharmacy A. You transfer one of your medications to Pharmacy B and then bring in another prescription to Pharmacy B -- a med which interacts with another medication on your profile at Pharmacy A. The pharmacist at Pharmacy B HAS NO WAY OF KNOWING what is going on. Yes, the pharmacist will counsel you on interactions, but the potential for a mistake or error or drug interaction increases dramatically when you have your medications at different pharmacies. As tempting as the transfer coupons are to your budget, you're best off to stick with one pharmacy for safety.

SITUATION NUMBER 3: You might know someone with two medicine cabinets. They take soooo much medication that they can't keep it all in one cabinet (25% of people over age 65 take 10-20 medications daily). I have patients like that in my pharmacy. I have a couple of ladies who literally see a doctor several times a week and they're bringing in new prescriptions every week for something new. Some doctors get so overwhelmed with these patients and/or are so prescription-writing-happy that they write for anything and are unaware of how this could affect the patient. No one wants to see grandma suffer, especially grandpa, but most prescribers are unaware of the extensive amount of drug interactions, especially when multiple medications are involved.

Here's the bottom line:

If you see multiple doctors for the same prescription, YOU have a problem. Get help HERE. There's people out there who want to help. 

If you use multiple pharmacies for your prescriptions, STOP. Find a pharmacy and stay there. If you need to get something at another pharmacy, give the new pharmacy a complete list of your medications.

If you're taking a large list of different medications, ASK for a pharmacy consult. Your doctor or local pharmacist will be happy to enter all your medications into a drug database and discuss interactions with you.


Anonymous said...

Thank you very much, especially for linking the information on where to access help for addiction and dependance. The more people speak out, the less people suffer.

Unknown said...

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Anonymous said...

'Nobody likes pain more than I do'?
Because it allows you to have a job.

Merlvin said...

Great post man. Would like to write something similar tailored for the UK market

Unknown said...

Great post! Have you seen specific instances of polypharmacy that have led to adverse drug reactions? Particularly ones that are ambiguous after reading the prescribing information? We'd love to hear what novel or potential drug-drug interactions you've discovered in your experience over at the Sternfels Prize - and you have the possibility to win $35k for your ideas!