By David Stanley

The number of deaths attributed to misuse of prescription drugs, both intentional and accidental, is on the rise across the country, making the pharmacist's role of ensuring these drugs are used correctly more important than ever. That's why my job as a pharmacist is not only to fill your prescriptions accurately, but also not to fill them in certain cases.

The biggest problem by far comes from the abuse of narcotic painkillers [1]. Some of the problems I see are unintentional. Most of the time though, a problem with a narcotic prescription is not a mistake. I get fake prescriptions, forgeries, and other kinds of fraud so often that I stopped being surprised by them long ago. Once, I even had a customer who was so desperate that he offered to give me a broken down lawnmower he found outside the store if I would slip him a couple Vicodin. Of course, I didn't.

Sadly, fraud and forgery will be a fact of pharmacy life as long as some of the drugs we sell have the potential for abuse and addiction.
Pharmacists and other health care professionals are required--both legally and ethically--to make sure any meds leaving the pharmacy are for legitimate medical need only. These efforts are necessary to prevent abuse and addiction, but they can make life more difficult for people who suffer from chronic pain and need to the medications to treat their condition.

If you are on long-term narcotic therapy, here are some steps you can take to get the pain relief you need without accidentally raising "red flags" with your doctor or pharmacist.

Don't adjust your drug regimen on your own
It may seem like common sense that if you are in pain, you should take more pain relievers. But there are good reasons not to do this. Because of their addictive nature and potential for abuse, narcotic pain relievers cannot be refilled early without a specific authorization from the prescriber. This means you will have no medicine at all if you go through your supply too soon.

Also, many popular pain relievers--such as Darvocet, Vicodin, and Lortab--are combinations of narcotic pain relievers and Tylenol. Taking more of these meds than prescribed can easily lead to an acetaminophen overdose, putting you at risk for liver damage.
If your pain medicine is not working, let your doctor know. There are almost always other options, from stronger meds to higher dosages with less acetaminophen. You shouldn't have to take more pills than prescribed to control your pain.

Don't try to get multiple prescriptions from different doctors
"Doctor shopping [2]" is a telltale sign of illegitimate prescriptions, and it will set off red flags at the drugstore. If I think a customer might be up to this the way Rush Limbaugh was [3], nothing will be filled until each doctor is contacted and made aware of the situation. Most of the time the doctor will cancel the prescription. In extreme cases, a pharmacy would ban the customer from the store and possibly contact the police.

Again, tell your doctor if the painkiller prescription she's written isn't doing the job. As with taking more medication than prescribed, you shouldn't have to seek help from another provider to get the pain relief you need.

Do find a new doctor if necessary
There is a difference between "doctor shopping" and making a decision not to suffer needlessly. If your doctor won't treat your chronic pain, then it is just as appropriate to end your relationship and find another as it would be if he wasn’t treating your high blood pressure. Some doctors--and patients--are wary of using powerful narcotics and want to stop them as soon as possible.

Addiction is real, but so is pain, and pain is not always short-term. Long-term use of narcotic pain relievers is not a sign of addiction or abuse any more than long-term use of blood pressure or diabetes medicine. The key to pain management is your relationship with your healthcare providers. A good, honest, and open one is a big step to getting--and keeping--chronic pain under control.

As your pharmacist, I'm here to help. This means I'll get you your medications and explain how they work and how to use them. But it also means I'll only sell you the medicines you should have, when you should have them, and in the dose your doctor says you need.

David Stanley is a freelance writer who has worked as a community pharmacist for 15 years. He can be reached at dmsrph at gmail dot com.