REPORTED BY
NORMAN J CLEMENT RPH., DDS, NORMAN L.CLEMENT PHARM-TECH, MALACHI F. MACKANDAL PHARMD, BELINDA BROWN-PARKER, IN THE SPIRIT OF JOSEPH SOLVO ESQ., IN THE SPIRIT OF REV. C.T. VIVIAN, JELANI ZIMBABWE CLEMENT, BS., MBA., IN THE SPIRIT OF ERLIN CLEMENT SR., WILLIE GUINYARD BS., JOSEPH WEBSTER MD., MBA, BEVERLY C. PRINCE MD., FACS., LEROY BAYLOR, JAY K. JOSHI MD., MBA, ADRIENNE EDMUNDSON, ESTER HYATT PH.D., WALTER L. SMITH BS., IN THE SPIRIT OF BRAHM FISHER ESQ., MICHELE ALEXANDER MD., CUDJOE WILDING BS, MARTIN NDJOU, BS., RPH., IN THE SPIRIT OF DEBRA LYNN SHEPHERD, BERES E. MUSCHETT, STRATEGIC ADVISORS
BY
WALTER WRENN MD
AND
JOSEPH WEBSTER MD
I recently had a conversation with a pharmacist who questioned my treatment of my patient. The patient was prescribed Suboxone 8-2 mg 24 mg daily and Alprazolam 2 mg TID. At the same time, I agree that part of a pharmacist’s responsibility is to watch out for drug interactions, I found this dangerous.
He asked me when I was going to reduce the medication. That question implies that this pharmacist erroneously believes that this medication should be reduced and eventually stopped an opinion also shared by many of my physician colleagues.
Yet, another opinion concerning pharmacist behavior also shared by my physician colleagues is that Suboxone should not be given with a benzodiazepine. Again no clinical trials to support this opinion.
My experience prescribing this combination is over ten years shows No Adverse Events (NAE). As a matter of fact a world literature search records only five deaths from this combination, but they occurred because of intravenous injection.
LESSONS TO THE PHARMD PHYSICIAN WANT TO BE
The interference into the Physician-Patient relations is a dangerous practice in medicine being promoted by the Drug Enforcement Administration (DEA) in which the American Medical Association (AMA) has had to issued several real concerns stating:
“ The American Medical Association strongly supports a pharmacist carrying out his or her corresponding responsibility under state and federal law, but the past few years are rife with examples of patients facing what amounts to interrogations at the pharmacy counter as well as denial of legitimate medications”
“The AMA continues to support physicians’ use of effective PDMPs and offers new caution based on physicians’ and patients’ experience since the publication of the CDC Guideline in 2016. We continue to urge CDC to recognize that PDMP data is only one type of information to help guide a physician’s clinical decisions.”
“Moreover, it is only one piece of data available to pharmacists and any other authorized user of a state PDMP. Yet, PDMPs have been used to inappropriately tag physicians as “inappropriate prescribers” by pharmacy chains and patients as “doctor shoppers” by some pharmacists. The AMA does not support illegal activity, but a PDMP report, by itself, is almost always insufficient to identify illegal behavior.“
CRIMINALIZING NARCOTIC PRESCRIPTIONS BY PHARMACIST: MOTORCYCLE DEALER
THE PHARMACISTS ROLE IS NOT TO INTERROGATE THE PATIENT OR WITHHOLD TREATMENT
JOSEPH L.WEBSTER, SR., MD, MBA, FACP, BS. PHARMACY:
“The respective regulatory bodies, including the various “Boards” of Pharmacy, Medicine, Dentistry, Nursing, etc., clearly outline the ‘scope of practice’ for each of those disciplines.
The orderly flow of a prescription “from” the doctor to the patient – via the Pharmacist – clearly outlines where the ‘diagnosis’ has to come from. It is statutorily the purview of the pharmacist to ‘inspect and assure’ that the drug that is being given is safe and has no known incompatibilities with the patient and its holistic environment.
It is not the purview, nor is the pharmacist trained to ‘challenge the physician’s diagnosis and do so verbally or otherwise with the patient. It erodes the ‘doctor-patient relationship and destroys the ‘confidence’ of the patient in their physician. At the very least, it is ‘unethical’ and may very well be a HIPPA violation and beneath the standard of care as a pharmacist.”
THE PHARMACISTS HAS ABSOLUTELY NO QUALIFICATION OR TRAINING TO OFFER A SECOND OPINION WITHOUT HAVING ALL THE CLINICAL DATA AND FACTS
All of the clinical data and my personal experience and a study by Dr. Agnoli et al. showed that when patients are tapered off of Suboxone. Within two years, there was a 100 percent relapse. Tapering and stopping Methadone is not done. Even though there is no study, I am sure the reason is the relapse rate. If health care individuals like Pharmacists understood that this is an opiate receptor problem, not a behavioral problem and that opiate addiction is a chronic disease, treatment would change.
As a matter of fact, nicotine addiction is caused by activating nicotine receptors in individuals, just like opiate addiction is caused by activating opiate receptors in individuals. Nicotine is legal, causing 450,000 deaths a year. Opiates arc illegal, causing 78.000 deaths a year.
Dangerous conclusions by Pharmacists based on unscientific data and facts which seriously flawed threaten all of healthcare.
FOR NOW, YOU ARE WITHIN
THE NORMS
