She talked with a slur, slowly. I looked at her eyes. They were hooded with droopy lids. There were food stains on her T-shirt. She wore no makeup and this essentially attractive 35-year-old was showing her worst. I had seen her like this before. But she had been doing so well.
"Hi, Jim, rrr ma scriptions ready?"
Big goofy smile. "Did I already?"
"Yes you did, Laura. Are you OK?"
"Where are they?" She took a cigarette and lighter from her pocket. She put the cigarette in her mouth.
"Laura, you know you can't smoke in here."
"Oh!" Her eyes widened. "I forgot. I'm sorry, Jim. Sorry!"
In my career, I have seen numerous patients who were seriously impaired. For many of them, the difficulty was too many beers at the bar after work. Some of them mixed their alcohol with prescription drugs.
Then there are the benzodiazepines. What a great class of drugs when prescribed prudently by the doctor and used judiciously by the patient. Remember when oxazepam was in favor? Twenty-five years ago a very upset wife asked to talk to me. Her story was that the doctor kept on prescribing oxazepam no matter how many capsules her husband took in a day.
"Have you talked with your husband about this?" Her husband had been a respected businessman in town. His store had just failed.
"He refuses to talk about it," she answered. "He says he's OK, but he's not."
I looked and saw that there were no early refills by this man. "Is he getting this prescription at more than one pharmacy?"
"Yes! I talked with the other drugstore this morning. They were not very helpful. I don't know what to do."
"Try talking with Dr. Bailey. He keeps on writing the prescriptions."
"I did-three times. He told me to mind my own business."
I gave her some legal advice; not my job, but I told her to talk to an attorney.
Laura's problem drug was good old diazepam along with bupropion. After she left the store, I called the doctor and told him that Laura was seriously impaired and I was afraid that she could hurt herself.
"I don't prescribe that many pills, and I make her fill her Rxs every week on Thursdays. No early refills. She has serious anxiety and can get depressed. What can I do?"
Aha! He asked, so I told him. "Don't give her five refills. Make her call you every week. She will have to get sober at least once a week so you won't hear her slobbering. It's a start."
"Good idea," he said, "I'll do it."
Aha-A win for the pharmacist.
Jim Plagakis is a community pharmacist who lives in Galveston, Texas. You can e-mail him at email@example.com
and cc us at firstname.lastname@example.org
. You can also check out his Web site at jimplagakis.com.