May 6, 2015

Pharmacists or quiet killers?

Recently a very bad thing has started happening in rural areas of the US. There has been an upsurge in the number of new cases of HIV and Hepatitis C. HIV is usually spread by sexual contact. Hepatitis C is usually spread by sharing needles between drug users. The odd thing about this newest outbreak is that both diseases are being spread by sharing dirty needles.

I have read that there has been a huge increase in the use of heroin in the rural US. I have also read that until recently the drug of choice in the rural US has been meth. Meth is pretty easy to make, cheap, and gives a good high. Out in the boonies where everyone has an old shed that is a long way from neighbors or major roads, cooking meth is easy to do without getting caught.

Because it has horrible health effects, no one in their right mind would want to use meth. And, authorities have been cracking down on it in many different ways. I have pretty nasty sinus problems so I know how hard it is to get pseudoephedrine at a pharmacy these days in Texas. You have to ask for it over the counter, show ID, your ID is logged, and then you can over pay for pseudoephedrine.  Used to be that people cooking meth would just steal pseudoephedrine off the shelves and go off to do their dirty deed. Much harder to get the basic materials. Hey! Making it hard to get the materials makes it hard to make the stuff.

I have read and seen TV reports that say that most of the meth in Texas now comes across the border. And, of course, the availability has gone down and the price has gone up. Capitalism works!

On the other hand the war in Afghanistan seems to have had an unintended consequence. The poppy fields are alive and doing very well. No one is burning them down or killing the farmers. I'm sure the farmers are very happy about that. But, the result appears to be that the supply of heroin is up and the price is down. Hey capitalism really works!

So, if you live in the rural US and your choice is between expensive meth and new reduced price heroin which are you going to chose? The answer is "what ever you can get". That is what it means to be an addict. You need to get whatever you can get. I have a few old friends who are recovering addicts of different types. Many of my old highschool friends are dead from drug overdoses. I have experience dealing with people close to me who became addicts. Some died. I was lucky to learn from their mistakes.

I can remember the late '60s and early '70s which means I did not experience them. Too many dead friends. Drugs scare the shit out of me. Doctors who do not share my experiences scare the shit out of me. I can't believe some of the addictive crap that doctors have tried to get me to take. My experience living through that time and going to school next to an open air drug market taught me way to much and has strongly shaped my opinions.

The increase in the use of heroin in rural areas of the US has directly resulted in the spread of HIV and Hepatitis C from sharing dirty needles.

I am not a lawyer, but I can read and what I have read has lead me to believe that in most states of the US it is legal to walk into a pharmacy and buy a clean needle and syringe. So why would anyone anywhere share a dirty needle? Good question. A question in which I have a great personal interest.

To say the least I am not a well man. I have several potentially fatal conditions. I to not expect to die from any of them. While they are not curable they are treatable. Due to a wonderful thing that gets called ObamaCare (The Affordable Care Act) I still have health insurance and can actually afford the treatments needed to keep me alive.

As a result of my medically necessary treatments I go through three to five needles per day. A couple of hundred needles is almost a two month supply. I like to buy two or three hundred needles at a time. Most places will not sell more than two hundred at a time because it depletes their stock. But, if I call ahead I can usually get full boxes at a case lot discount. Such a deal.

I live in Texas. I have talked to my doctors about getting needles and syringes. I was surprised to find out that in Texas you do not need a prescription to buy them. It is legal to buy them over the counter in any quantity at any pharmacy in Texas. I recently carried about 50 needles of several different varieties out of the US into the UK and returned with a smaller number of them. They went through customs both ways with not even a comment. Buying, owning, and using needles and syringes is pretty much legal most places.

So, again I ask you, why would anyone anywhere reuse a needle and syringe let alone share one and risk getting HIV and Hepatitis C?

Well, there are lots of reasons. If you live in a rural area how far are you from a pharmacy? How many pharmacies are their within 50 miles of where you live? Do you trust the pharmacist not to call the police and report you? Will he actually sell you the needles and syringes at all?

I looked up some statistics about the rural US. One said that 15% of the population lives on 72% of the land. One said it was more like 10% on 90% of the land. If I did the math correctly that comes out to about 18 people per square mile. I can show you square mile after square mile where the total population consists of people in cars on the Interstate.

Pharmacies rarely deliver, but drug dealers often do. People I knew back in the '60s did time for delivering to the wrong people. Idiots...

So what has this got to do with me, pharmacists, and killing people?

Recently I have been finding it harder and harder to buy syringes. Like I said I am not a lawyer, but to the best of my knowledge, in Texas, there are very few, if any, restrictions on selling needles and syringes. There is also a pharmacist's shield law that keeps a pharmacist from being held legally responsible for what someone does with what they sell. There seems to be no legal reason for a pharmacist to refuse to sell needles and syringes. It is quite clear that refusing to sell them leads to slow lingering death for drug users. Refusing to sell them can also lead to immediate death or serious medical issues for people who have to use them to stay alive. People like me. To me there is no moral or ethical reason not to sell them. No legal, moral, or ethical reason not to sell needles and syringes to anyone.

I can not find a legal, moral, or ethical reason not to sell needles and syringes to anyone who asks for them.

Recently I went into the local Walmart to buy needles and syringes. I have bought them there many times. I like to buy them there because they have a large stock on hand and they are open late. So, it was fairly late and I needed a shot. I went in and told the tech what I needed and he went off to get it for me. No problem, just like normal.

The pharmacist intervened and started asking me a bunch of questions. Funny thing, we have a law called HIPAA that defines Personal Health Information (PHI) and restricts where you can talk about it and under what conditions you can ask for it. During the conversation that followed the pharmacist demanded PHI that in my opinion he had no right to. I wanted my shot, I was under duress, so I gave it to him as quietly as I could and he proceeded to shout it out as loudly as he could. He yelled out the name of my medication and my health problem several times in front of a growing crowd of people. He committed several violations of HIPAA.

The end of the story is that he refused to sell me anything. The techs in the pharmacy looked shocked and embarrassed, and I told the pharmacist that he could fuck off. Yes, I did. Right there in the middle of Walmart. I told him to fuck off.

Before I go on with the story I should say that I complained to Walmart. Walmart gave me a written apology, the store manager called me and personally apologized. The pharmacy manager called me and gave me what can only be described as a groveling apology. Plus, I was told that what the pharmacist did was against company policy, that he had been disciplined, and counseled on Walmart company policy regarding needles and syringes. It seems Walmart has a policy of selling needles and syringes, without question, to anyone with the cash to buy them.

So, why did that guy refuse to sell me needles and syringes? That is, before I told him to fuck off? Well, the answer I got from his manager was that the guy said it violated his personal ethics to sell me needles and syringes. What? Please explain to me how your personal ethics can allow you do deny people access to medication? Or, even kill them? Well, it turns out that a lot of pharmacists have personal ethics that require them to kill people and some companies share their opinion.

The next time I went into Walmart I was able to buy what I wanted with no questions asked. They were out of one kind of needle I needed, but what the heck. They apologized for not having it and offered to order it for me.

I did not get my shot that night. I did not know of any other place where I could get the syringes I needed that late in the evening. I had to wait until the next morning to get what I needed. I had to go out and find another place to buy them. I was now more than 12 hours late for my medication. If I didn't get a syringe soon I was going to have to go to my doctor's office and pay for a specialist visit to get a shot. Expensive. I didn't want to do that.

I went to the local CVS. This is a store that is about a mile from my house and where I buy all my prescriptions. No love for CVS, but it is close and it has never lied to me. Other pharmacies have lied to me.

So, I went into my local CVS. They know me there. I asked to buy the needles and syringes that I needed and they asked why I needed them. I told them that I needed to give my self a shot. They asked if I had a prescription for the medication I was going to inject. I told the nice young lady that yes, I do have a prescription. She asked me what the medication was and if I could prove it. I told her that yes I could prove it, but no, I was not going to blurt out my medical history in front of the rapidly growing line of people waiting to talk to her. I also told her it was none of her business and that asking me about personal health information in front of a group of people was a violation of HIPAA. She did not care at all.

At that point the pharmacist yelled across the pharmacy asking me if I was, well he yelled out my full name with middle initial, born on my full birthday, living at my full address. What he did is as blatant a violation of HIPAA as you can get, except for what he did then. After a pause he yelled out the names of the three injected medication I use, asked which one I need the needles and syringes for, and told the tech to sell me the needles. To say I was shocked, and enraged, would be an understatement.

I did get the needles and syringes I needed. Federal law was broken, my rights were violated, I felt humiliated, but no one but me seemed to give a damn.

I talked to the pharmacist and he said that it was CVS policy to require customers to prove that they had a medical reason to buy syringes and needles. I tried to explain that there was no legal, or moral, reason to do that. He said that even if CVS didn't require it he would because of his personal ethical standards. After all he said "you might be using illegal drugs". In other words, the more real need I had for them, the less likely he is to let me have them. Nice guy. I just love people who think that their personal bigotry trumps our right to stay alive.

I called CVS and complained. The representative explained that the pharmacist was following company policy. They were sorry I was upset about it, but that is their policy. On the HIPAA violations? They didn't even apologize. Federal law was not a concern for CVS.

I did get a call from another pharmacist at the same pharmacy, who also was sorry I was upset. But, he explained that the pharmacist was within his rights to refuse to sell anything to anyone and that he was following company policy. He didn't care about HIPAA either.

I always thought that pharmacists were in the business of helping people stay healthy. Some of them are, I suspect that most of them are. But, some of them are in the business of playing God. They have the power of life and death and if they don't like the way you look they will let you die. If they suspect you are could possibly be doing something illegal, they will just kill you to make sure you don't. No proof required.

There are assholes everywhere, but they should not be allowed to have the power of life and death. What do you do when a whole company, the second largest pharmacy chain in the the US, decides to use their sick twisted morals and ethics to justify killing people by denying them medical supplies they need to stay alive?

Last time I needed syringes and needles I went to Walmart, got two hundred needles of one kind, but they were out of the other kinds I needed. I was driving home when I saw a Walgreens I pulled in and walked inside. I asked for what I needed and the tech got it off the shelf, and put it in a bag. I paid for it and left. No one in either store had ever seen me before. I have no prescriptions on file with either of them. They asked no questions. They just sold me what I needed. Walmart and Walgreens seem to have the right idea: Sell people what they need.

CVS clearly thinks they have the right to decide what you need and whether you get to have it, even if not getting it can kill you.

So, you are a rural drug abuser or addict. You have to drive 20 miles to get to a pharmacy, the only pharmacy around. And then you have to hope the pharmacist will sell you clean needles and syringes. You have to hope that the pharmacist will not yell out your request while the local sheriff is deciding what kind of snack will go best with the six pack of beer he just picked up. What are you going to do? Share needles and die.