"No opioids for you!" - (4/23/2019)

By Dr. Ron Gasbarro

As pharmacists go, Saul was perhaps the grumpiest guy in the profession. Get him too early in the day or just before closing and he could very well bite off your head! “No, I cannot fill this prescription today,” he barked at Mrs. Cohen. “Tomorrow, yes. Today, no. No exceptions!” While Saul was a stickler for doing things by the book, he had a laser-focused distaste for “the druggies.” The druggies were people who were chronically on narcotics. To Saul, they were pushy, whiny, and an imposition.

For example, Mr. Flanagan came in with a new prescription for his wife’s hydrocodone, a narcotic she takes for her cancer pain. Typically, Mr. Flanagan is punctual with regard to his wife’s medication. However, in the last week, she has been taking more as her condition has deteriorated. He even had a new prescription to cover the increase in medication. Yet, Saul balked at filling the new prescription because it would involve getting into a hassle with the insurance company – and it was Friday night so the doctor could not be reached for an emergency supply. Mr. Flanagan even offered to pay cash for the narcotic. “She is using too much of this drug!” Saul bellowed. “No can do. Rules are rules!”   

Then, Chris, 35, came into the store for his usual prescription for oxycodone. “I got back pain,” Chris once told Saul. Yet, Saul judged the man as being an addict and gave him all sorts of reasons to leave. “I am out of this until Wednesday.” “Your insurance gave it a thumbs-down.” “I was just about to close the store.” Chris never understood why Saul disliked him, but he had enough pills until Saul said he would fill the new prescription. 

Is it illegal for a pharmacist to refuse to fill a prescription? Some states allow a pharmacist to refuse to fill a prescription for a contraceptive based on the pharmacist’s moral views. Yet, that pharmacist must ensure that the patient can obtain the medication somewhere else. In terms of controlled substances, such as a narcotic, the pharmacist has a legal duty to prevent the illegal use and diversion of controlled substances. If a prescription is thought to be forged, used for addiction, or is medically unnecessary, the pharmacist has a legally protected right to refuse the fill. Also, as a means to combat the opioid epidemic, many establishments legally constrain pharmacists in terms of when they are allowed to refill controlled substances. For example, in New York State and in some national chain stores, the patient cannot have more than a 7-day supply before the pharmacist refills a narcotic medication. 

The prescriptions of Saul’s patients are legal and there is nothing in their history that should arouse suspicion. This, then, becomes an ethical issue. Are these patients addicts? Addiction is drug-seeking behavior, usually for non-medical reasons. Chris does have back pain. However, if he uses the drug the way it is prescribed and does not attempt to overstep his bounds, then he is within his legal right to obtain the drug at the specified time. As for Mrs. Flanagan, by interrupting her medication, she could be in physical jeopardy. Not only would her pain increase, but she could also go into withdrawal, with the symptoms that accompany it, such as abdominal cramping, severe nausea, diarrhea, and vomiting. 

Saul’s actions are not those of an empathetic pharmacist who claims to be doing the right thing. He needs to reflect on his practicing philosophy or step aside and let other professionals do his job. As for Saul’s patients, perhaps finding a different pharmacy would be the more sensible and less frustrating way to go.

Ron Gasbarro, PharmD, is a registered pharmacist, medical writer, and principal at Read more at

Show All News Headlines

Click Here For HowToTakePills© Archive