Do pharmacists have too much power?

Fionne

I have spinal stenosis, am in a certain level of pain every day although far better since surgery last October.

Most days, I need to take a couple of Nurofen/Ibuprofen to get up and about in the mornings. Towards the end of the week is always harder, work makes me very stiff and sore. If I have to do something that causes extra pain (usually something that involves prolonged sitting like a train journey or even going to the cinema) I will take a Nurofen Plus.

I went to one of my local pharmacies a few weeks back for Nurofen Plus. I absolutely understand the need to ask the questions, I get that. But this pharmacist just kept telling me I shouldn't be taking any pain medication for more than a couple of days, wouldn't even give me the regular non-Codeine Nurofen Long-Lasting. I explained that I don't need prescription meds from the GP, thankfully I've improved since surgery and don't need that. In the middle of a (thankfully) almost empty pharmacy, she was making me feel like some kind of addict looking for a fix, not someone in chronic pain who's at the end of her tether with this constant battle to be heard or helped.

When I was on prescription meds from my GP before surgery, a different pharmacy refused to fill my prescription when I called to collect it. They basically decided they knew better than the GP who had prescribed me the medication. If it's not a case where a doctor has made an obvious mistake in dosage, should they be able to do that? If they think a GP is over-prescribing, surely they should go to the GP and not just leave the patient without meds. As it happened, I rang my GP (a whole rigmarole that takes at least half a day) and the prescription was filled as normal the next day.

Gremlinertia

You're as well off getting a script even for otc medications, it's the way I have gone

Tony H

my wife had a similar when my wife went to get codeine for me , treated like someone with a drug addict, whispering behind the counter and pointing out my wife ,

my wife complained to the owner /pharmacist and asked him to review camera footage of the interaction and he was shocked., made all the staff members involved apologize to my wife and promised it would never happen again ,

I have to say this was an isolated incident my pharmacist is absolutely brilliant , he actually hasore cop on than my doctor ,

I have amongst other severe joint pain and I take codeine/paracetamol at night and I asked him should I get something with higher codeine content , he had a chat with my doc and now I'm on a higher codeine dose for night use ,

there are good pharmacists out there , shop around and have a chat about your needs and if you are buying codeine over the counter , just get a not for the pharmacy to have on file as well just to be sure .

Fionne

https://www.boards.ie/discussion/comment/120634553#Comment_120634553

I've resisted it because it means spending at least an hour each month trying to get through to order the prescription, then ringing the pharmacy to say it's been sent through, then ringing again to make sure they have it ready and then - and I'm not joking - at least 50% of the time arriving to collect it (10 miles away from where I live) to find it's not ready or never got sent by the GP.

As someone with chronic pain, I just don't feel mentally able for that battle every 4 weeks.

Gremlinertia

Yeah I've been caught out doing the chasing myself, just reminded me to check actually.. I get a three monthly script for twenty quid but again communications and availability are terrible hurdles, I'm also with chronic pain

Former Former Former

https://www.boards.ie/discussion/comment/120635284#Comment_120635284

I know what you mean - I used to be a pharmacist myself and dreaded the codeine conversations because we know that 99% of people are taking them properly.

However, the pharmacist is also obliged to conform with a very detailed Code of Conduct on these meds;

01.3 Safe supply of Codeine to patients - April 2019.indd (thepsi.ie)

From your OP, it looks like the pharmacist is going by the book.

In a way, the problem is that the pharmacist doesn't have enough power. Your random GP is allowed full leeway to prescribe whatever he wants for as long as he wants, but the pharmacist has little discretion, they have to go through the little dance.

I appreciate this doesn't help your situation.

Fionne

https://www.boards.ie/discussion/comment/120635405#Comment_120635405

So they can even refuse to sell me the non-Codeine pain relief unless I go to a GP? Because that's what happened in my case. She said she wouldn't give me anything unless I went to the GP. OTC medication surely shouldn't require a GP to prescribe it? I don't go to this pharmacy more than a couple of times a year so she also had no basis to think I'd been getting them too often.

As it happens, I did make an appointment with my GP and got prescribed Vimovo (Naproxen) which to be honest isn't even half as effective as the Nurofen for pain but I'm trying to persist with it. It means I'm back to being unable to walk very far though whereas I had no issue when taking the Nurofen (even the regular non-codeine Nurofen). It sucks having constant pain. I've been waiting almost 2 years for an appointment at a pain clinic but I'm guessing that would end up being a waste of time too. I'm 48 and if this goes on much longer, I'm gonna struggle to stay working because by the end of the week I'm in absolute bits.

Gremlinertia

Email/call gp to recontact pain clinic, try to accelerate your appointment, as for the refusal of service, I don't know, possibly a comreg issue?

In a lot of pain myself so I truly do understand the frustration

Dempo1

Pharmacists are not there to provide counselling, their roll is to dispense Medications either prescribed or OTC when a prescription has not been supplied. People may agree or disagree but as things stand, Pharmacists are not permitted to dispense prescribed drugs without a GP or Hospital prescription.

Whilst Pharmacies may have some knowledge of a customers Medical history, previous prescriptions etc they can't be expected to dispense prescribed drugs without a prescription as a discussion at a counter is meaningless. Whilst many are of course sympathetic & will suggest an alternative that's not a controlled medicine, there are strict rules in place they have to adhere to.

I personally believe pharmacists should have more discretion but surely this would require them to have access to a patients medical history or details of any current or existing Illness & I can't see that happening any time soon. It's hard enough for a patient to get access to their own records let alone a pharmacist that has no involvement in a patients care, other than dispensing medications requested by a GP on a patients behalf.

If pharmacists were to be allowed to prescribe Medications without prescription the current model would require an overhaul, again I can't see that happening. To Answer OP main Question Pharmacist's in fact have very little power or discretion when it comes to the dispensing prescribed or Controlled medicines.

The Continental Op

OP, can't you just get Ibuprofen in Aldi, Lidl, Super value, Dunnes or Tesco?

odyssey06

https://www.boards.ie/discussion/comment/120794426#Comment_120794426

I have only seen aspirin or paracetamol on supermarket shelves here.

The Continental Op

https://www.boards.ie/discussion/comment/120794668#Comment_120794668

Never seem asprin but thought I've seen Nurofen Plus in Lidl? Will try to remember to check next time I'm in.

fits

https://www.boards.ie/discussion/comment/120794689#Comment_120794689

Definitely not. Can only be got in a pharmacy.

The Continental Op

https://www.boards.ie/discussion/comment/120794800#Comment_120794800

Fair enough must be that I see it in the UK.

martingriff

https://www.boards.ie/discussion/comment/120794426#Comment_120794426

There is a bid difference between Ibuprofen and Nurofen when it comes to pain relief which I realised again only this week when I got a bad headache/migraine

Edit its was Paracetomol and Nurofen Plus. Forget what I said

Anything that contains codeine is pharmacy only (though not prescription only).

OP, I once tore ligaments in my knee and ankle very badly and needed surgery to repair and was on crutches for months and my GP gave me a repeat prescription for solpadeine, and I didn't have to have that awkward conversation every time I needed to get them. (Can't take ibuprofen due to asthma).

It really would be worth asking your GP to give you a six month repeat prescription, (if you're paying privately) and if you are on a medical card, your doctor can give you a three month repeat prescription. If you have a long term illness, you shouldn't have the bother of getting prescriptions issued monthly.

Without a prescription, the pharmacy has to ask the questions, but the GP can resolve this issue for you.

cnocbui

Yes the pharmacy sector has too much power and influence in this country. They have successfully managed to ban the import of natural theraputics that are commonly available throught the EU and to exclude pharmaceuticals from trade within the EU. It's far worse than with alcohol as at least with that you can pay the excise whereas you can't buy a packet os aspirin online, or any other over the counter medications, even when aspirin over the counter has been unavailable for months in this country. Also the over the counter pack sizes are a nany-state joke.

In Australia, you can get Aspro Clear 300mg in pack sizes of 42, 60 - take your pick!

The equivalent here is Bayer soluble aspirin in a pack of 18. This drives up the cost. The cost of a Bayer 300mg tablet here is €0.20 - the Australian 60 pack works out at €0.136 - 47% less expensive.

Beconase (hayfever nasal spray): If you buy it over the counter here it's in pathetically small pack sizes costing a fortune: €13 for 100 sprays. You can not buy the generic equivalent - beclametasone diproprionate over the counter. That is just fucked up.

In the UK you can buy the generic over the counter in pack sizes of 200 sprays, for just 25% of the cost of paying for Beconase here.

In Australia, you can get the same Beconase brand in 200 spray pack sizes for 229% less than the cost here on a per dose basis.

You can get beclametasone on prescription here, but you need to add €50 for the doctors visit/prescription and a €7 dispensing fee!!!

https://www.irishtimes.com/news/health/drug-prices-here-among-the-highest-in-europe-1.1443937

The Continental Op

I by Paracetamol and Ibuprofen for a neighbour whenever I go to the UK. I can't remember prices as I buy a few every time I pass a Pound Store or similar but last time I dropped off 200 Paracetamol for about €6 and 200 Ibuprofen were about €10. I can also get those numbers because one shop styles themselves as a "trade" warehouse and for some reason allow you to buy up to 6 packs at a time?

If something like aspirin is "short", as a lot of common medications seem to be lately, they keep what stocks they can get for customers with prescriptions.

I haven't been able to get Piriton antihistamines for a few weeks now as it is "short" - even though its not a prescription item. Out of sheer luck I did manage to get a generic version - Hayleve - in a pharmacy I don't usually go to during the week.

https://www.boards.ie/discussion/comment/120795372#Comment_120795372

You think Pharmacists/pharmacy sector decide what medications can be imported and legally sold in an Ireland, what is the function of the HPRA then?

Perhaps it is worth looking up how medications are imported and distributed to pharmacies under license in this country, you will see that pharmacists have little control over the price disparity between here and the UK. God knows there are enough articles online explaining why medications are more expensive here than in the UK, google is your friend.

Op, pharmacists are not obliged to sell otc medications to you, and must act in the publics best interest. If that means pissing a few people off by asking them a few questions, that is a small price to pay, and is considerably safer/less dangerous than handing out medications which may be harmful if misused to everyone who asks.

Xander10

https://www.boards.ie/discussion/comment/120795457#Comment_120795457

I wouldn't want to be responsible for supplying someone with that quantity

https://www.boards.ie/discussion/comment/120795009#Comment_120795009

Repeat prescription for codeine containing med? I’ve been told that’s an absolute no-no. Have had panproctocolectomy, total knee replacement, and multiple major and extremely painful & serious surgeries, have had Trigeminal neuralgia, have MS now. Always had to attend doctor weekly as he was very keen to reduce meds as soon as possible before addiction / habituation set it. As he said I’d end up writhing in detox if my situation wasn’t carefully managed. He is very anti-codeine, as most doctors now are, and says it becomes useless in itself as a painkiller after a few weeks, and there’s rebound pain attempting to come off.

https://www.boards.ie/discussion/comment/120795457#Comment_120795457

BS.

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/956857/Appendix_4.pdf

What people generally don’t seem to understand is the dangers in medicines, especially when taken in quantities beyond those recommended. There is a fine window of toxicity regarding simple paracetamol, every year a certain number of liver transplants in UK & Ireland are carried out because of irreparable damage done to the liver, and this damage can be done in very short order by eg doubling up the dose or taking two different brand products with it. That’s why you see very small packets in the supermarkets, with warnings on them. The codeine part has its danger because of addiction if taken regularly, at least that aspect in itself is unlikely to kill you, but the paracetamol it comes with will it will if taken in increasing quantities. As for products with ibobrufen, some people are very sensitive to this otherwise effective anti-inflammatory painkiller, myself being one. I end up with severe gastric intestinal effects if I take more than one dose in a very long time, and sometimes I don’t get away with that one dose. Even if you are not especially sensitive, they pose a risk to stomach lining, so need to be used with an amount of caution.

Basically, all painkillers come with serious risks if taken in higher doses or in greater frequency than recommended, and for chronic pain it’s important to try and tackle the root source of pain, and pursue for second opinion if necessary. If surgery can safely remedy all the better, if other effective pain reducing methods can be employed they should be explored. It is horrendous being in a lot of pain, it’s very familiar territory.

The Continental Op

https://www.boards.ie/discussion/comment/120795899#Comment_120795899

Best Practice.

https://www.boards.ie/discussion/comment/120795925#Comment_120795925

Keep reading, you will get to it.

The Continental Op

https://www.boards.ie/discussion/comment/120795758#Comment_120795758

Well I wouldn't do it if Irish pharmacies weren't such a rip off.

https://www.boards.ie/discussion/comment/120795850#Comment_120795850

It was a good few years ago now, but yes, he did. I think it was 60 a month, and I can't remember if it was for three or six months. It was also available on the GMS scheme (don't know if it still is).

I can't take ibuprofen, as it triggers my asthma, so my choices of painkiller are limited, and paracetemol by itself wasn't strong enough for the injury I had, so when it got bad, I could take two solpadeine. Usually took them at night.

The Continental Op

https://www.boards.ie/discussion/comment/120795932#Comment_120795932

Read it many times before. Here's one in the press that must be obvious BS

https://www.pharmacymagazine.co.uk/latest/rps-slams-poundland-as-irresponsible-over-paracetamol-offer

I can remember the offer as I took advantage of it at the time, but you say it can't happen.

Former Former Former

https://www.boards.ie/discussion/comment/120795372#Comment_120795372

You can not buy the generic equivalent - beclametasone diproprionate over the counter.

This is unfortunate but there's nothing any pharmacist can do about it, if no generic company is willing to put it on the market. It's a byproduct of Ireland being a very small market.

Similarly, the 200-spray version only being available on prescription is nothing to do with pharmacists, they would love to be able to sell more products over the counter.

cnocbui

https://www.boards.ie/discussion/comment/120796056#Comment_120796056

Irish pharmacists enjoy the highest margins in the EU (33 per cent)

That would just be an inconvenient by-product of legislation, fotunately for pharmacists. Legislation in specialist areas such as medicine is always contributed to by specialists and professional bodies with appropriate expertise. Not our fault, it's the law, is a simplistic response a long way from the truth.

St John's Wort, 5-HTP and many other substances were not banned from import because some lawyer turned politician suddenly thought it would be a grand idea - out of the blue.

Former Former Former

https://www.boards.ie/discussion/comment/120796323#Comment_120796323

That's a whole other set of arguments and I'd be all day countering them.

St John's Wort is prescription-only because it dramatically reduces the effectiveness of a huge number of other medicines. It isn't suitable for self-medication, even if you think managing your own depression is a good idea (it's not). It's literally the definition of protecting public health, even if some people only ever want to see the conspiracy.

CIARAN_BOYLE

https://www.boards.ie/discussion/comment/120634553#Comment_120634553

Same. I had minor dental surgery a few years ago. I was told to manage pain with paracetamol and ibuprufen (with a dose that exceeded the recommended dose on the box). My local pharmacy flagged it the second time I went in that I was going through the tablets very quickly and refused to sell. I chose to get a prescription rather than fight over it or go elsewhere.

https://www.boards.ie/discussion/comment/120795850#Comment_120795850

Some doctors will prescribe it. Others won't. Different doctors will have a different view. I believe codeine can have extra effects on the colon so doctors would be more anti codeine with someone who has had colon issues before. It also helps if the doctor knows there will be an end point. I had a three month repeat prescription when waiting for a knee surgery that was scheduled in 3 months time. This is different to constant pain management for someone with long term issues.

mrslancaster

Its usually not the pharmacist asking those questions, its the counter staff in the shop which puts customers on the spot, and in most pharmacies, other customers can hear every word of private conversations about medical conditions, prescriptions, name, adress, dob, who the GP is etc when buying OTC or collecting prescriptions.

Happened to me at the till in the supermarket. I had a bottle of benilyn cough bottle and a 12 pack of panadol in a trolley full of groceries and when the checkout guy said 'just one or the other' I had no clue what he was talking about for a few seconds. So I said hold the panadol, finished paying for everything, parked my full trolley, went back around and got another 12 pack, went through the till again and hey presto! not a problem.

Its a bit daft really - panadol in a pharmacy comes in 24 pack OTC boxes but if I tried to buy two 12 pack boxes otc in a supermarket, it's not allowed. The same supermarket would happily sell 12+ bottles of alcohol or 12+ packs of cigarettes without a murmur though 🙄🙄🙄.

https://www.boards.ie/discussion/comment/120796466#Comment_120796466

I had ulcerative colitis before having entire organ removed, I knew the dangers of codeine or narcotic based meds which can cause paralysis of the colon. In an ordinary person that just leads to constipation, in someone with colitis it can lead to a fatal colon rupture. But after colectomy doctors are still reluctant for me to have it, not that I request it much at all, but I’m always warned a few days only and that other treatments may be necessary if I’ve a condition that causes enough pain to warrant them. I was also told by the surgeon who did the recent septoplasty that his female patients report very little pain after surgery and do with paracetamol whilst his male patients demand heavy duty stuff. He decided not to bother with a prescription for me as he predicted I could cope without. I did however get solpadeine for a few days from the chemist.

https://www.boards.ie/discussion/comment/120795975#Comment_120795975

I am still calling BS on your post.

Why? Because if Poundland sold you 200 paracetamol and 200 ibuprofen as you claim, they would not be breaking guidelines on best practice, they would be breaking the law. That article relates to buy-1-get-1 free offers, it does not say that you could buy 100, then get 100 free. If it did, then it wouldn’t be an article about guidelines being ignored relating to offers, it would be a much more serious offence to exceed the 100 tab limit.

Its ok if you exaggerated or don’t remember exact amounts, but you didn’t buy quadrupole the legal limit in a single transaction or in any one shop. A quick google shows complaints on Reddit and Twitter going back a few years that Poundland limit their offers to two packets, which would be 32 tabs max ( as they are not a pharmacy), boxes would be limited to 16 tabs per box, you would have had to bring 13 boxes (208) of both to the counter.

Jim_Hodge

https://www.boards.ie/discussion/comment/120795975#Comment_120795975

UK rules are quite clear

A pharmacy may sell larger packs containing up to 32 tablets or capsules under the supervision of a pharmacist. It is illegal to sell more than 100 tablets or capsules of either paracetamol or aspirin in any one retail transaction.

The Continental Op

https://www.boards.ie/discussion/comment/120797085#Comment_120797085

Yes the rules are clear, its illegal to sell more than 100 tablets, the rest are guidelines. This article is a little old buts puts it very well.

https://www.yorkpress.co.uk/news/4111289.poundland-apologies-after-breaching-regulations-on-sale-of-paracetamol/

Under guidelines dating back to 1998, stores are urged not to sell more than two packets of 16 paracetamols, and the sale of more than 100 tablets without a doctor’s prescription is illegal.

Interestingly after apologising Poundland went on to do the same again a few years later.

Other companies I can't provide links for also sell more than one or even two packets. I should be back in the UK again this month so will take a photo of the receipt if I can get more than 3 packets in one sale - expect to be able to get 6.

Edit> Another link showing that its not illegal to buy up to 100 paracetamol provided they come in packets of 16

https://petition.parliament.uk/archived/petitions/118948

however because of the GUIDLINES its rare to find anywhere that will sell more than 3 2 packs of 16.

And a BMJ article that says

A small number of discount retailers still do not adhere to the best practice guidance and MHRA remains concerned about multiple sales of analgesics in these outlets. MHRA guidance does not, however, have the force of law and so the Agency is not in a position to take statutory action to prevent such practices.

https://www.gov.uk/government/publications/advertising-investigations-september-2016/september-2016-multiple-sales-of-analgesic-containing-in-retail-outlets

The Continental Op

https://www.boards.ie/discussion/comment/120797056#Comment_120797056

Never said I could buy 100 or even 200 tablets at a time from Poundland. I certainly could buy 6 packets of paracetamol 6 weeks ago and for the last 40 years or so from one UK discount warehouse. Buying 6 at a time makes getting a couple of hundred a lot less effort. 6 packs is 96 tablets so two visits and there's your 200 less 8. tbh I had wondered why they could sell 6 packets but seems it is quite legal - see my reply above - 96 is less than the legally enforceable max of 100. The warehouse store I use also has a garage and when I buy petrol if I remember I pick up another 6 packets, normally forget so get another 100 when I visit another branch of the same warehouse or get 2 packets every time I'm in a supermarket, or near a Poundland.

Fionne

Coming back with something of an update. I got Vimovo (Naproxen/esomeprazole) from my GP on prescription. I'm not sure what I'll do when it's run out, the whole palaver of trying to get a repeat prescription is so stressful I'd almost rather be in pain than deal with it.

I was in the UK recently and went to a Boots and asked for Nurofen Plus. "32 or 24?" was the only question I was asked. It was just before I left that I even thought to do it and I wish I'd thought of it sooner and stocked up. I rarely resort to a Nurofen plus except when I can literally barely stand with pain so even the 32 pack should last me several months.

Chemist Warehouse have opened not far from me and I haven't been yet but have heard one person say they were almost €10 cheaper for their prescription. A bit of competition might not be a bad thing.