A pharmacist's toolkit should include a well-tuned scuzz-o-meter

November 3, 2009

Unkempt appearance is often the pharmacist's first clue that a drug-chaser has entered the store.

I know scuz when I see it. After all these years, I have a well-tuned scuz-o-meter. My ability to discriminate between just plain scuz and exceedingly scuzzy has been developed in the run-as-fast-as-you-can sweepstakes during numerous late-night shifts at a deep-discounter in Everett, Wa. They rushed me between nine and 10 at night.

I worked for an independent owner in Texas who preached, "If it is a legal prescription, we fill it." Cash prescriptions in the scuz market are very profitable. When word got out, some of them drove 50 miles. Four in a car. All with the same prescriptions. Finally I just said no.

Scuz alarms clang when I see a couple at the drive-through drinking from a paper bag, cigarettes dangling from their lips, while their 1989 Cadillac Coupe de Ville spews stinky plumes of gray exhaust. The "prescription" is an 8.5x11 sheet of paper with boxes checked off: 360 hydrocodone/apap, 180 carisoprodol 350 mg, 90 alprazolam 2 mg, and a pint of promethazine w/codeine as a chaser.

I have heard pharmacists lie to the drive-through fiends, "We don't carry any of these drugs." Not me. I am intrepid. "This prescriber isn't even a doctor. I'm not filling these ... I understand your bad car crash in 1978. I'm still not filling pain-clinic prescriptions."

It takes decades to calibrate your scuz-o-meter. I recently worked with a very young floater pharmacist. There was no gray area for Lee; it was all black-and-white. I was doing busy work at the time; she was the leader of the pack.

"I'm not filling these prescriptions," she said. This was a challenge for her. Her eyes were wide and her lips were pressed together tightly. She wanted to be strong.

"Why not?" They were for hydrocodone/apap and zolpidem. They were written by an orthopedic surgeon in Houston and looked good to me.

"Well, look at him," she said with distaste. "He hasn't shaved for days. His T-shirt is old and his shorts are dirty. Look at his hair. He hasn't showered."

"Lee, this guy lives on the Bolivar Peninsula. He probably doesn't even have a shower. Those folks are mostly a bunch of old hippies, free spirits, and artists. They don't have to shave if they don't want to."

Bolivar is a beach environment that's a 15-minute ferry ride from Galveston. The first retail store from the ferry dock is where I work. The Bolivar Peninsula was ground zero for Hurricane Ike. They got the dirty side of the storm. Heavy bombing could not have caused more damage.

I went with Lee to the counter. I asked the guy how he was doing. How was his home?

"What home?" He managed a laugh. "Before the storm, I owned three businesses. Now all I have left is my RV park. There's nothing to do these days except fish."

Lee lightened up. "Do you catch much?" I don't think she had ever seen a beatnik before.

"Baby," he said, "We get our limit of 24-inch trout before nine in the morning." He looked at her. "Do you like seafood?"

On his next visit, he brought us both enough filets for dinner for a family. We broke the rules and stored them in the Rx refrigerator.

"He's nice," Lee said.

I studied her. "Scuz is as scuz does," I said.

JIM PLAGAK is a community pharmacist in Galveston, Texas. You can e-mail him at jpgakis@hotmail.com and cc us at drugtopics@advanstar.com
. You can also check out his website at http://jimplagakis.com/.