Life-saving Prescriptions


#1

This news item is off interest. This is the kind of legislation we should have universally:

http://www.wkyc.com/story/news/local/lorain-county/2015/12/24/diabetes-law-changes/77893956/


#2

Thank you, Thas, for posting this powerful story.

I consider myself fairly ignorant, politically speaking. What would be my first step in trying to get similar legislation passed in the state of Orgeon?


#3

I’m like you - not really sure where I’d start (though I do have a friendly relationship with one of the State Senators in Illinois). It’s terrible that it took a death to initiate the Ohio law - hopefully other states can get the messages with less of a dramatic backdrop.


#4

I’m curious to the extenuating circumstances…

R and NPH insulins are already available without prescription… They’re not great, but they keep people alive.


#5

No clue on the particulars - I believe they’ve been debated before in depth, if he was getting sick, he most certainly could have gotten insulin at the ER. There were likely many contributing factors involved in the tragedy; however, even though there are options (the pharmacist should have suggested them?), there aren’t for some other life-saving medications, so the usefulness of such a law remains.

(Note: I’m usually the last one to advocate a legislative solution to problems – politicians usually get it wrong – though in this case, it’s legislation to fix other legislation… :dizzy: )


#6

This is indeed tragic. I used to work in airline maintenance. When a crash happens, the investigation usually shows a chain of events, any one of which could change the outcome, caused the crash. I suspect in this case, many people share some responsibility, the doctor’s office, the pharmacy, even the lack of knowledge of options of the diabetic himself. Every pharmacy in this country should be able to dispense life-saving medications, like insulin. No pharmacist should ever need to turn away a person in need. Our society, our culture failed.


#7

While you and I know our way around R and N, not everyone has so much experience under their belt, and they might take warnings of “do not change insulin type without advice from your doctor” a little too literally.

Even doctors act surprised that insulin is often available OTC. Just quoting from a recent NPR radio interview http://www.npr.org/sections/health-shots/2015/12/14/459047328/you-can-buy-insulin-without-a-prescription-but-should-you :

"Dr. Jorge Calles, an endocrinologist at MetroHealth, Cleveland’s public hospital, is alarmed to think that some people are self-medicating with any sort of insulin. “It’s a very serious situation if they are selling it over the counter — without any control with a prescription, specifically,”

Historically there’s always been a give-and-take with regards to insulin - while an increasing number of docs think it’s best for patients to be empowered with dosage adjustments etc., many are still strongly opposed to such self-adjustment.


#8

I get that… Some patients also aren’t really very capable of making rational decisions regarding their medications either so doctors tend to keep them on stricter programs with little leeway… I remember my initial diagnosis the doc sent me to a CDE the same day (even though I was traveling and far away from home) and said the “CDE’s main job is to figure out how complex of a regiment is suitable for you and advise me and your primary care doctor at home on that”

Anyway, the doctor / patient relationships that involve the doctor being in absolute control of everything also need to involve the doctor being very, very responsive to the patients needs such as filling prescriptions … It is unfortunate any time that’s not happening, and if that combination contributed to this case, it’s tragic.


#9

more info in this article:

http://insulinnation.com/treatment2/medicine-drugs/death-by-expired-insulin-prescription/


#10

OK, I am starting to be able to connect the dots here. The NPR story interviews a diabetic from Ohio and a doc from Ohio who acts surprised that diabetics can get insulin OTC; Kevin Houdeshell died in Ohio from not having insulin; the legislation is for Ohio. I’m now pretty sure that the NPR story (and others in the media) was a result of some kind of push-journalism by docs or others who are opposed to the proposed Ohio laws. Now an actual law!


#11

just today i had an opportunity to find out about emergency dispensing in nj. i called my doctor’s office on dec. 23 to have them call the pharmacy to renew my metformin prescription. the office worker said she would call it in. i had 3 days of medicine left, and i won’t die if i go without it, so i didn’t call the pharmacy until today, dec. 26 to see if my meds were ready. they said the doctor’s office had never called in the prescription. i then called the office several times, leaving messages. i did not want to call the doctor’s emergency cell phone number since it wasn’t a life or death situation, and i don’t want to risk antagonizing her since she is prescribing me two drugs that have improved my health. but i was irritated. i was also curious if the pharmacist would give me an emergency refill.

the pharmacy tech put me on hold while she said she was going to ask the pharmacist if he would do the emergency refill. i was out on a walk and was on hold for like 5 minutes, so i just called the number back and the pharmacist answered this time. i told him my situation, and he said he would give me an emergency supply, which i got.

i then researched nj’s law regarding emergency dispensing:
Emergency Dispensing3
All pharmacists encounter the following situation several times a year. A patient comes
into the pharmacy on Sunday afternoon at 4pm and is completely out of their medication. The
physician is not available to authorize a refill for the patient on a Sunday. The last thing any
pharmacist wants to do is have the patient go without their medication for any period of time.
9
However, there is a statue that covers just such an example in New Jersey. In the absence of a
current, valid prescription, a pharmacist may dispense an emergency supply of a chronic
maintenance drug if in his/her professional judgment refusal to dispense the drug would
endanger the health or welfare of the patient. However, for a pharmacist to do this, there are a
few conditions that must be met:

  1. No more than a 72-hour quantity can be given.
  2. The pharmacist must determine to the best of his/her ability, by direct communication with
    the patient or caregiver, that such medication was prescribed for that patient by order of a
    practitioner.
  3. The pharmacist must document the communication in the patient profile record system
    maintained by the pharmacy.
  4. The pharmacist must document the dispensing of the emergency supply in the prescription
    record system.
  5. The pharmacist must require the patient or caregiver to provide suitable identification.

i have my prescriptions done through this pharmacy, so that probably made it easier for me. the pharmacist didn’t even ask for identification. i’m not sure if things would have gone so smoothly if i were asking for a medication that was not as benign (when it comes to side effects) as metformin.


#12

Sounds very reasonable… I understand there would be a lot more hesitation for narcotic drugs etc… But I imagine the potential abuse black market for metformin is probably pretty small…

I’ve lived kind of a blessed life when it comes to prescription issues, because since I’ve had real health concerns, my primary care doctors office is VERY responsive, thankfully, and before that my mom would always call in any prescription I reasonably needed (she’s an MD) so I never encountered a lot of hardships getting things filled…


#13

i’ve lived a blessed life too- because up to now i don’t need any prescriptions that would throw me into a crisis if i didn’t get them. but that probably won’t always be the case, so i am glad this law exists in nj.

but i had to be persistent.


#14

It’s a pity he didn’t know that he could have driven a few hours north, into British Columbia, and purchased insulin from any pharmacy without a prescription. Insulin does not require a prescription in Canada, unless you are being covered by an insurance plan. I bought if OTC most of my life.


#15

i’m, Wonder, if my state, have some, type of legislation, for this, ?.


#16

I am Dan Houdeshell … Kevin’s father. Anyone interested in state legislation such as Ohio’s can contact me at dhowdy1965@gmail.com. We have Ohio, Florida passed a year ago, Pa is on the verge of passing their legislation this year. Thank you Dan.


#17

FYI…Ohio also had and has the 72 hour requirement. What comes into play and does often many pharmacists will not give a 72 hour quantity as insulin and other life sustaining meds do not come packaged that small. So they feel they are breaking the law and could lose their license, a legit concern. Many pharmacists will take care of their patients but some prefer to follow the law. If that is the case then you have to figure out what to do if you can not reach your doctor… Ohio’s law still has 72 hours BUT for life sustaining meds that are packaged more than 72 hours they added on a 30 day emergency supply with some other qualifiers