I haven’t exactly been writing up a storm here lately. I could give you all sorts of excuses, but instead, I’ll just share the fruits of my procrastination. I created this word cloud using wordle.net and all of my publications to date.
Pharmaceutical Follies February 14, 2014
The abuse of prescription drugs has been a growing problem in the United States over the past couple of decades (1). As a medical writer who has done a fair amount of work in the arena of treating chronic pain, I am well aware of this, and I am familiar with many of the actions that have been taken by the government and other entities to allay the problem (for example, placing restrictions on the prescribing of certain drugs and the development of tamper-resistant and abuse-deterrent drug formulations). Whereas some of these approaches have been effective, others have ostensibly done little but make it a greater pain in the butt for legitimate users of such drugs to obtain their medications. I do not claim to have all the answers to the problems of prescription drug misuse, but after my recent experience, I could not help but be perplexed by some idiocies of the current system.
I currently take a schedule 2 medication. Current regulations require that prescriptions for such drugs be written (except in case of emergency when oral orders may be acceptable) and cannot be refilled (2). In other words, prescriptions cannot be sent electronically or phoned in. I need a new written prescription from my doctor every month. However, it is acceptable for a doctor to write out 3 months worth of prescriptions for schedule 2 drugs, provided that an appropriate “fill after” date is written on each one. I have never understood the wisdom of allowing this but not allowing refills (which tend to have associated “fill after” dates), but I have gotten used to it. I have also never understood why the powers that be seem to assume that paper slips are somehow more secure than prescriptions sent electronically, but again, I’ve gotten used to it. I roll my eyes, shrug, and move on with life.
A few days ago, I left my doctor with my prescriptions for 3 months worth of my medication. Only after I had filled the first prescription did I notice that there had been an error. The pills looked different. I checked the label and checked the other prescriptions I had been given, and indeed, my doctor had mistakenly prescribed pills that were half the dose of the ones I had been taking for several months. I don’t know what happened, but my guess would be that he glanced at the wrong line in my record (I had been on the lower dose some time ago, so it’s on my chart) and wrote down the wrong number. Never mind the fact that this probably could have been avoided if he were sending the prescriptions electronically (that is, if he had just had to click a few times to send the prescription for the dose I have been on for months, the error probably would not have occurred), now I had a month supply of the wrong dose pills. Sure, I could take 2 per day, but I would run out in half the time, and prescription regulations would prohibit his prescribing more to make up the difference in the error. I also had two more prescriptions for the wrong dose of medication that could be filled one and two months down the line.
After speaking with my doctor, I drove over to his office to pick up 3 new prescriptions for the correct dose, in addition to a note (written on his prescription pad paper) explaining that the previous prescription had been an error. Although he had not asked me to, I had brought with me the remaining 2 erroneous prescriptions in case he needed them back to properly shred them, kill them with fire, or whatever needs to be done with such things. He simply wrote “void” on them and handed them back to me, suggesting that I keep them to show the pharmacist as further evidence that this was actually a mistake in the event that I encountered any trouble in trying to fill the new prescription.
I drove to the pharmacy, fully expecting that this was going to be a hassle and they were going to look at me sideways, take secret pictures of, and make notes about how I was probably up to no good. I was wrong on that, and the whole transaction went smoothly. Although it’s nice to know that the pharmacist was understanding that mistakes sometimes do happen, I was struck with what I had (or could have had) in my possession from this whole bungle:
- A one-month supply of my medication at half my current dose
- Two prescriptions, each for another one-months supply of my medication at half my current dose
- Three prescriptions, each for a a one-month supply of my medication at the correct dose
My medication happens to be an extended-release formulation that, as I am told, is not particularly “likeable” by abusers and is relatively tamper resistant. If that is true, one might reason that this particular formulation should not be on schedule 2. However, if it is not true and some creative addicts or entrepreneurial types have figured out ways to modify this drug to make it more abuseable, then I would like to point out that the current regulations (which prohibit refills and electronically sent prescriptions) have left me with (and with the ability to obtain, if not for my honesty and integrity) much more drug than I actually need.
So, yeah…paper and pen…much more secure than electronic transmission. o_O
1. Prescription drug abuse, addiction and diversion: overview of state legislative and policy initiatives, a three part series. Part 1: Stat prescription drug monitoring programs (PMPS). Santa Fe, NM: National Alliance for Model State Drug Laws and the National Safety Council; 2013.
2. US Food and Drug Administration. Controlled Substances Act. http://www.fda.gov/regulatoryinformation/legislation/ucm148726.htm.
Charmingly Odd and Seemingly Random February 2, 2014
A List of Very Brief E-mails and Texts From My Mother:
- Have you ever heard of lexile measure? (August 7, 2013)
- Do you eat potato salad? (August 8, 2013)
- What size shoe do you wear? (September 8, 2013)
- Have you ever worn stockings with seams up the back? (September 24, 2013)
- OK, there was the Beat Generation, the Hip Generation, what came next? (October 6, 2013)
- Festivals is on! (December 23, 2013; I’m pretty sure she was referring to the Festivus episode of Seinfeld)
- Do you have any brown/white paper lunch bags? (January 15, 2014)
- Ain’t. I’ve been hearing this more and more. It bothers me. (February 1, 2014)
Winter Haiku January 5, 2014
I, blissfully spoiled
By two years of mild winters,
Think this one just sucks
The Gift That Keeps on Sucking December 23, 2013
There are any number of awful stories I could tell you about the relationship I had in my late college and early graduate school years, but that’s not really what this post is about. The relationship was catastrophic in innumerable ways, but I will say one thing: he had an extraordinarily generous family (his mother in particular). She was generous not only with her attention and affection, almost instantly making me feel like part of her family, but also with gifts. In the time I was dating Bob*, I received an embarrassment of riches on birthdays and holidays. Rollerblades, a really nice watch, a couple of vacations, and a variety of other items I would never have expected were bestowed upon me, and my protests of “Really, no. This is too much!” were met with the wave of her hand. Giving these things made her happy, she assured me, and to not accept them would make her unhappy.
One Christmas, she gave me a vacuum.
Don’t get me wrong. I appreciated the generosity. It was a useful, not to mention expensive gift, particularly for a poor graduate student who did not own a vacuum. I smiled and thanked her, doing my best not to show her that inside, I was bristling. She may not have meant anything by it. She may have simply saw a need in my life and found a gift that filled it, but in my mind (which granted, at the time, was greatly influenced by the rather shabby state of my relationship with man-child Bob), she was saying, “Look! Now you can clean up after my son just like I used to!” My thoughts were not completely out of left field. As nice and generous as she was, Bob’s mother had often given me the sense that she was (whether intentionally or inadvertently) cultivating “motherly” behavior in me. This, of course, usually made me recoil because I did not want to be anyone’s mother, much less my boyfriend’s.
All that said, the vacuum was certainly useful and saved me the choice between living with dirty floors or shelling out the money to buy one myself. When Bob and I broke up, he made a claim to the vacuum. “My mom bought that for us,” he said. “It’s mine.”
“No,” I protested, clearly remembering the T0: Liz tag on the shiny paper. “She bought it for me.”
“I’m going to ask her and see what she says,” he said smugly, obviously quite sure that his mother would side with him.
“Okay, yeah,” he muttered some time later in humble annoyance. “She said that was a gift to you.” The vacuum was mine.
Some 17 years later, that vacuum is still working. My husband, who takes care of vacuum detail at our house, will tell you–it still does quite a nice job!
*Not his real name.
Yes, Virginia…Well, Sort of…in a Certain Sense Anyhow December 15, 2013
I’m not sure I ever really believed in Santa Claus, at least not in the way that most people mean when they describe such a belief. There was probably a time when I was very young when I simply took Santa’s existence as a given. Adults said there was a Santa Claus, and I had no reason to question the concept. At some point, however, I began to realize that Santa’s existence really wasn’t a given. People talked about believing in Santa, and I gradually started to understand that, when people talked about whether or not someone believed in something (or someone), whatever it might be, it was usually not generally accepted as a fact. It required faith in the absence of evidence (or sometimes in the presence of evidence against it), and, as far as I can remember, I never really had that faith.
My parents were clever in that they told me that none of the Santas we would see at malls, in parades, or on street corners ringing bells was the real Santa. They were simply Santa’s helpers who would receive children’s requests for presents and report back to the real Santa. The only way you would ever see the real Santa is if you happened to catch a glimpse of him on Christmas Eve when he visited your house. Of course, then you would risk getting no goodies because you were not a good little child asleep in your bed when you should be! So, that eliminated any difficult questions about how Santa could be at 3 different malls, a parade, and the zoo all at the same time.
Even so, once I understood that the existence of Santa was not a fact to be taken as a given, I don’t think I ever really believed. I admit that I could be wrong—memory is a funny thing, and I know it is very much shaped by the sum of our experiences that occur before and after any so-called memory. However, I can say with relative certainty that there was never any crushing moment when I “found out” or was told there was no Santa. As far as I can recall, I just thought Santa was a nice story you went along with until you were a certain age, at which time you (or your parents) decided you had grown out of it.
All of that said, I do believe in Santa Claus in some sense. I believe in the good things he represents. I believe in generosity without the expectation of reciprocation. I believe in wonderful surprises. I believe in peace, love, and kindness. And whether you celebrate Christmas, Hanukah, Festivus, Yule, Kwanzaa, Belka, New Year’s Day, and/or something else, I believe in a time to celebrate these good things with family and friends.