When I entered a tiny pharmacy 11 miles outside Jackson, Miss., in 2009, the pharmacist, Raymond Bauer, was distraught. Patients were coming “out of the woodwork” to fill opioid prescriptions written in other states. Mr. Bauer feared he was caught in a drug ring. “I’m getting prescriptions from clinics from Houston, Texas,” he said. “I’ve got people coming to this little podunk town from Louisiana by the dozens for thousands of units of hardened narcotics: oxycodone, other stuff, too.”
Mr. Bauer did everything he could to confirm that the prescriptions were legitimate. He called doctors to verify that they had written them. They had. He called the Texas Medical Board, the organization that licenses and disciplines physicians to check on the doctors’ standing, and eagerly awaited a response. “I’m hoping that the board says, ‘These guys are all clear.’” In the meantime, he had no idea what to do.
Pharmacists were among the first health care professionals to see signs of America’s impending opioid crisis. Years before soaring overdose rates made national news, pharmacists like Mr. Bauer faced an influx of patients who asked for early refills on painkillers, traveled long distances from their homes and paid in cash — all red flags for potential drug misuse. Patients claimed their filled opioid prescriptions were mysteriously lost or stolen, problems rarely seen with blood pressure or thyroid medication.
A more inconspicuous arm of the health care system than doctors and nurses, pharmacists are the ultimate gatekeepers to medications and devices. Some of these medications, like painkillers, testosterone for gender-affirming care and the abortion medication mifepristone, have become politically fraught. Ethically obligated to put patients first, pharmacists can refuse to dispense medications that they deem medically inappropriate — they are responsible for catching deadly medical errors like wrong drugs, incorrect doses or potentially dangerous drug interactions.
Pharmacists are trained to think in terms of medicine, but the opioid crisis pushed them to think in terms of crime. I spent a decade interviewing 170 pharmacists across the nation for my book on the opioid crisis. When I began my research in 2009, most pharmacists told me they resisted monitoring patients for criminal activity. Even though it was part of their job, they lacked proper training.
Today, however, pharmacists regularly police patients by reframing enforcement practices as care. One pharmacist told me that he now views his role as that of a gatekeeper, tasked with making sure patients are not misusing or selling drugs.
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