Readers Write: Helping the sick– and those in pain with morphine and cocaine

The Island Now

I recently saw a sign in a pharmacy window that they do not stock any CII or narcotic medications. How can that pharmacy serve its customers with such a policy? I tried to determine who was real and who was not when I had my own pharmacy in a rather simplistic manner.

I would call the physician’s office and ask for an ICD9 or now, an ICD10 code, which would indicate to me the condition being treated by the physician and give me a clearer picture of the patient’s needs and be able to offer better care from a pharmacy perspective.

I have seen terminally ill patients given Tylenol No.3 instead of a more potent opioid for fear of becoming a target for both the addicts and the law. It really serves no purpose to explore the source of the problems we have today.

Perhaps if the doctors had not written the original prescription in quantities that we now know to be excessive and the pharmacists had not been so quick to fill them without calling the physician and asking for the reason for such a product and such a quantity, we might have avoided some of the problems we see today. Finding a way to serve these individuals is what we should be exploring,

I was a young pharmacist alone in my own pharmacy and a nun walked in, dressed in clothing that indicated who she was and presented me with a ”written” prescription”. It contained the following: Morphine sulfate, cocaine hydrochloride, gin and honey.

The year was 1970 and even though I had already been a pharmacist for 13 years and had worked for what seemed forever in a drugstore, I was not certain what to do. I weighed the different possiblities and decided to fill the prescription.

I asked the nun to go to the nearest liquor store and buy a bottle of the least expensive gin, and then go next door to the supermarket market and buy the honey, and bring them both back to me, as neither of these was standard stocking in a “drugstore.”

Could you imagine in your wildest dream stocking morphine sulfate powder or cocaine HCl crystals today?

The man for whom the prescription was intended turned out to be a priest in a local monastery who was suffering from terminal cancer and was in severe pain and who was being treated with what we know historically as “Brompton’s Cocktail,” to relieve his pain and suffering.

Robert Twycross, a leading pain researcher and hospice physician, noted a “tendency to endow the Brompton Cocktail with almost mystical properties.

The “Encyclopedia Of Death and Dying” in a survey of teaching and general hospitals in the United Kingdom showed the mixture and its variants to be in widespread use in 1972. Elisabeth Kubler-Ross, the psychiatrist and pioneer of end of life care, became one of its supporters, as did some of the pioneers of pain medicine and palliative care in Canada.

This entire episode could not have happened today. The physician could not write a prescription since it would have to be sent electronically, nobody would stock either morphine or cocaine crystals or powder, and no pharmacist would fill it for fear of being considered a target by an addict, and the fact that medical schools, I think, probably do not teach the students how to write a compounded prescription.

Try filling that prescription and putting it through the insurance carrier for approval.

Bert Drachtman

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