Where's the Pharmacist?

   The world was stunned by the sudden death of Prince on Thursday. During the next few days there was speculation as to why  this 57 year old man would be dead. One of the things I read was an article talking about how he had overdosed on the opioid pain medication Percocet a few days prior to his death.
  There were comments at the end of the article and several of them blamed "Big Pharma" which pushes drugs to make money. This is a variation on a comment that I see quite often. I get a little angry when I see it. As a pharmacist I don't think the problem is big drug companies pushing drugs on people. It's not that simple.
   Whenever I hear of cases where celebrities have overdosed on a prescription drugs, I wonder how the person got the drug. Where was the pharmacist? Where was the prescriber? This is an important question. The law is that prescription medication cannot be given to someone unless there is an order from a provider licensed to do so.
  The reason for this is that drugs have risks and benefits. Some drugs are only safe under certain conditions. That why it requires a prescriber to write an order for a medication and a pharmacist to dispense it and why both professions require years of schooling. There are interactions and other things that would be impossible for an average person to consider.
  I have long believed that we as a society don't really know how to use drugs. Now that we have insurance and medications are easier to obtain,we tend to take them for granted. We tend to look for a pill to cure something. That's not how it works.
  In older times, when many of the medications we have now did not exist, other treatments were used. For instance when I was a kid pinkeye was treated with boric acid eye washes and a few days home from school. There were plasters and steam and other things that people used to cope with common illnesses. Not all of them were effective.
  When more medication came onto the market and laws were put in place to assure safety, efficacy and that standard manufacturing practices, people still used home remedies. That was partly because medications were expensive so they were reserved as a last resort.
  Once people had insurance and cost was not a prohibiting factor, people went to the doctor more and used more medication. I believe that direct to consumer advertising of prescription drugs made this problem worse. That is when we as a society started using drugs improperly. One phrase I read was "better living through chemistry"
  There are some illnesses and conditions that can be cured or controlled with medication. There are a lot more that require both medication and lifestyle changes or non drug therapies. For instance, a person with high cholesterol who takes atorvastatin still has to follow a low fat diet. The purpose of the drug is not to allow you to continue an unhealthy lifestyle. The purpose of the drug is to work with lifestyle changes to prevent things like stokes or heart attacks.
  I have read several studies that prove that antidepressant medications alone do not adequately control depressive symptoms in most patients. Other things like exercise, diet, socialization and seeing a counselor or therapist have to be used along with the medication.
  I'm also frustrated with the "if one is good, two is better" attitude. The reason why we put directions on any medication is because when used as directed, a medication relatively safe. Choosing to ignore the directions can  make a medication unsafe. If someone overdoses it's not because "Big Pharma" made the drug. It's because someone did not follow the directions or heed the warnings.
  I wonder how some celebrities who have overdosed seem to have large quantities of medication on hand. If I saw someone getting some of the amounts of medication I've heard reported red flags would go up immediately. I believe any responsible healthcare professional would see the same. Given the amount of people that tend to be around most celebrities, I'm surprised that no one notices. If I saw someone with several bottles of the same medications prescribed by different doctors, I would be concerned. I don't understand how no one notices until it is too late.
   I remembering reading that the two groups who get the worst health care are the very poor and the very rich. This is a sad thought. In our country no one should get inadequate health care no matter who they are......