Tranked out

April 15, 2013

Memories of the phenobarb generation

JP at Large 

The woman at the counter was in her mid-30s. She was fashionably dressed in black slacks and a diaphanous white blouse. I looked down at the prescription on the counter. Librium 25 mg tid. What the -? #90, with 5 refills. What the - ? again.

I gave her a little nod and pointed to the counseling area. We met at the window. “How long have you been taking this?”

This drug is a minefield. Especially if taken for a long time. Withdrawal is brutal.

Then I saw I had asked a stupid question. The patient was born in 1933.

“You’re blushing,” she said. “Have I embarrassed you?”

“Actually, I embarrassed myself. I see that the patient is 80 years old. Your mom?”

“My dear auntie,” she said. “She’s the last of that generation.” She looked grave. Obviously, her aunt was an important person in her life.

“Are you her caregiver?”

A deep breath. “I’m her part-time caregiver. For as long as it takes. She still has her own apartment,” she said. “She put me through college. If we have to move her to our place, we will.”

“I was going to warn you about this drug.” I said, “But when the patient is 80 years old, my only advice is to never allow her to run out. The withdrawal could kill her.”

The niece explained that her auntie had been taking one drug or another for decades. Her “condition” is “female hysteria.” It was a syndrome once known as “The widows’ disease.” Victorian doctors became very rich treating this condition.

Old wine in new bottles

Female hysteria ceased to be a real condition in 1952. But we have been treating the widows’ disease with prescription drugs for decades. We are still selling drugs for hysteria. They write prn for anxiety. I suppose it would not be helpful to write prn spinsterhood.

I knew nothing about female hysteria until I Googled it. My gosh, this has been a lucrative condition. There was no chance that the patients would die. They returned to the doctor regularly and refilled their prescriptions like clockwork. Ka-ching.

Phenobarbital. We dispensed it by the hundreds until the 1960s. Then it was butisol sodium (Butabarbital Sodium, McNeil). Amytal sodium (Amobarbital Sodium, Eli Lilly) was favored when the Lilly man had been in town, leaving samples. We bought both of these drugs by the thousands. I suppose these patients could have been suffering from simple anxiety, but then why were the patients exclusively female?

Could it be catching?

I was a young pharmacist in the 1960s and I formed a conclusion. Women were really nervous. Men were strong. That was worrisome because I experienced nervousness at times. Could I be a male anomaly? This was not a problem for me, but give young medical professionals a little bit of knowledge and it is amazing what they will come up with.

Librium was the first benzodiazepine to get into the game. We bought it direct from Roche. Eight to 10 bottles of 500 capsules of the most popular strength (10 mg) every month. Librium has a long duration of action, 10 to 24 hours. No wonder I believed that all of the women in Ashtabula, Ohio, were, like, mellowed out, like all the time. We had some male patients on Librium, but they were usually guys who had lost a job, or the wife had left.

You know what happened then. Valium, Tranxene, Ativan, Serax, among others. This class of drug solved a significant problem for doctors confronted with unhappy patients, who were liable to blow their stacks if the doctor did not do something, anything. This was an easy fix.

Still is. Write a prescription and authorize refills, and you will never hear from her again.

What would the drugstore do?

However, if doctors have to explain, it will most likely be to a good pharmacist. What will you do when your district RPh manager responds to a complaint, saying, “I don’t care that she has been taking it for 30 years and that the withdrawal is dangerous. Mind your own business and do what you are paid to do. Just fill the damn prescription.”

When the patient is harmed, will the drugstore say, “Your honor, this pharmacist is a loose cannon. Our policy is to always protect the patient”?