The surprising way patients get drugs

The surprising way patients get drugs

Tom is diabetic, asthmatic, and broke. He’s back for a checkup.

“I take my metformin every morning with my grits,” he says, “but I don’t need no refill. I just got me some metformin XR.”

“How did you get extended release? They’re super expensive.”

“Well, my neighbor runs a tattoo shop. We live behind her store. Her doc switched her up to insulin, so she gave me her old meds—a big sackful in the alley. That’s gonna last me another year.”

Prescriptions dispensed behind a tattoo parlor? Wow. I’m constantly impressed by my patients’ ingenuity. One gal this week told me she’s on her deceased grandfather’s antidepressants. Another gets his pharmaceuticals from the farm supply store. I’m just glad to know he doesn’t have fleas.

“Are you good on your inhalers?” I ask.

“Well, the cheapest inhaler is 52 bucks. So I basically can’t afford to breathe. On Craigslist, I found some for ten bucks. I contacted the guy, and he met me at the Walmart gas station in a black Jaguar. I went to the door. He asked if I was Tom. Then he said, ‘You know this is illegal.’”

“Then what?”

“He let me in the car and he opened up a box. Each inhaler was in an individually sealed silver pouch. I took all twelve and handed him 120 bucks. Said he could use the money ‘cause him and his wife split up. He was wealthy. When his wife left him, he just ended up with the car. And the inhalers he got through her insurance. Wouldn’t a done him any good to use ’em, ‘cause he was smoking cigarettes.”

As I refill his meds — the ones he didn’t get in a back alley or from a Craigslist drug deal — he says, “You know what illegal means?” He pauses. “Illegal’s a sick bird.”

“What?” I ask.

“Illegal just means an ill eagle.”

The surprising way patients get drugs

Pamela Wible pioneered the community-designed ideal medical clinic and blogs at Ideal Medical Care. She is the author of Pet Goats and Pap Smears. To protect the patient’s privacy, a professional model has been used in this photograph.

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  • Kristy Sokoloski

    Yikes. That’s scary. But unfortunately, I have heard of some similar stories. And that includes even those that may get medicines from family members such as for anxiety too. One lady I knew mentioned that she did this type of thing. I told her that if she was ever found out that she could get in to a lot of trouble. The thing that always amazes me is how so many think that it’s ok to share medications like this when it specifically says not to share the medicine with another person but yet goes unheeded.

    • http://www.idealmedicalcare.org PamelaWibleMD

      What kind of trouble has anyone actually gotten into for this? (not including the opioid drug trade)

      • Patient Kit

        I think the biggest issue is the potential to end up with drugs that have been tampered with or faked. In theory, drugs purchased from a pharmacist at a drug store are more likely to be exactly what you think you are buying than drugs purchased via a stranger on craigslist.

      • ninguem

        See my links. Also look up the Office of the Inspector General, look for the “exclusions list” for entities barred from Medicare and Medicaid participation, and see who has got in trouble for this.

        LOTS of shady pharmacies, and more than a few wholesalers as well.

        • http://www.idealmedicalcare.org PamelaWibleMD

          But any individual patients cuffed up and taken in for buying or selling inhalers in the Walmart parking lot? I want to know what if anything has ever happened to a patient. Anyone know?

      • Kristy Sokoloski

        That’s a good question that I have wondered as well.

        And the reason that I have wondered this is because of how many people do it in spite of being told that they shouldn’t. I know I won’t do it because of the fear that they could get sick from taking something meant for me. Not sure what the legal ramification is if someone shares their medications with someone else when they are not supposed to.

        • http://www.idealmedicalcare.org PamelaWibleMD

          I asked this at a malpractice conference and at a CME to prevent illegal use of opioids and, of course, blank stares. Nobody knew. Even more worrisome is that most of the docs were clueless that patients could not afford their meds are were getting them on Craigslist and back alleys.

          The only people who thought I was not off my rocker for suggesting that patients do this were the two FPs sitting next to me.

          • Patient Kit

            I know docs are busy peeps, but that is a huge problem if most docs really are clueless about what is going on out here with peeps who can’t afford their meds — or their doctors.

    • SarahJ89

      Tons of people share meds. It’s very common.

      • SarahJ89

        That’s part of why we have all these prescription drug addicts floating around. I ended up with prescriptions for over 50 vicodin/oxycontin, unasked for and unneeded, which were prescribed in knee-jerk fashion. I could have shared or sold them easily, but did not.

        • http://www.idealmedicalcare.org PamelaWibleMD

          On the topic of prescription painkillers: Anyone notice that nice-looking young women are getting unasked for scripts, while less-attractive-looking men are not receiving their requested pain Rx? I’ve picked up on a trend here. Thoughts?

          • SarahJ89

            Trust me, fat old ladies get unwanted/unsolicited oxy and vicodin pushed at them. I would have been swimming in the things had I filled the scrips. Or rich had I filled them and sold them.

  • Patient Kit

    Considering the high prices that pharmaceutical companies are allowed to legally charge in the US, this kind of thriving illegal underground market does not surprise me at all. It may be wrong and potentially dangerous, but it’s also wrong for Big Pharma to price millions of Americans out of being able to buy the drugs they need legally. Think of that huge segment of the population as “what the market can’t bear.”

    • http://www.idealmedicalcare.org PamelaWibleMD

      Yep. The will to live is strong. If people can’t get meds legally, they will go the illegal route. Imagine getting priced out of your asthma inhaler?

      • Lisa

        It is scary.

        Are diabetic medications and drugs to treat asthma (inhalers) sold at a high price because of the nature of the demand, ie if you need them, you need them?

        • SarahJ89

          It’s a really sad thing to see an uninsured diabetic try to take care of his/her self. Really sad.

      • Deceased MD

        And Pam, who is that dude in the picture?

        • http://www.idealmedicalcare.org PamelaWibleMD

          Move-Around-Mike is his name. He says he likes to move around. Just met him on the street corner.

          • Deceased MD

            That is anazing. He did not seem concerned that his pic was taken and that he was doing anything wrong? Is this common to find on the streets where you live?

          • ninguem

            “Is this common to find on the streets where you live?”

            Deceased………it’s like this.

            “The annual meeting of the Lane County Medical Society will come to order. Who has the caduceus?”

            http://www.jqjacobs.net/photos/fair/fair_trail.jpg

          • Deceased MD

            Now that’s hilarious Ninguem!

          • Patient Kit

            I assumed that Move Around Mike is just a “model” who agreed to be photographed to illustrate Dr Wible’s post. If he is a real Ill Legal asthma inhaler dealer, I’d go with the “model” cover if I was Move Around Mike. If asked or accused, he should just say “I’m not a real Ill Legal inhaler dealer. I just play one on KevinMD.” :-p
            But seriously, if these peeps are advertising on craigsllist, they’re findable if any authority is looking for them.

          • Deceased MD

            good point. But compared to the big guns these are small misdemeanors that no one has the manpower to enforce.

          • Patient Kit

            True. Still, there is plenty of history of the powers that be going after the easy lowhanging fruit and never getting close to the hard-to-get big guns.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Some inhalers for sale on Craigslist:

            elpaso.en.craigslist.org/emq/4327751390.html

          • ninguem

            Well now.

            You can buy drugs illegally on Craigslist.

            Who knew?

            And to think all this time, I thought Craigslist was just for illicit sexual liaisons.

          • ninguem

            i mean i’m just sayin’

          • http://www.idealmedicalcare.org PamelaWibleMD

            Common that people are friendly in Eugene, Oregon. Most people are carrying these signs though:

          • ninguem

            What’s underneath the sign?

          • http://www.idealmedicalcare.org PamelaWibleMD

            Your post ninguem.

          • ninguem

            So……..is this the street corner where you prescribe the love drug?

          • http://www.idealmedicalcare.org PamelaWibleMD

            Hahaha! No. I prescribe the love drug everywhere.

        • SarahJ89

          Oh god, she always has the greatest pictures.

      • SarahJ89

        Pamela,
        Sadly, it’s not hard to imagine at all. Have you priced those things??? I stopped bothering with them, partly due to the ridiculous price, partly due to the incredibly uncomfortable side effects combined with the fact they didn’t seem to do anything. Except cost like crazy.

    • Lisa

      Many of the drugs I’ve taken are available as generics, and they quite were inexpensive. You do have to differentiate between non generic drugs and generic drugs in this discussion.

      • Patient Kit

        Agreed. I’m a big fan of generic drugs. Whenever generic is an option, I get generic.

        • http://www.idealmedicalcare.org PamelaWibleMD

          No such thing as a cheap generic asthma inhaler. Inhalers were cheap, but they changed the formulations and now they are all over 50 bucks.

          • ninguem

            What they changed is the propellant, which caused the inhaler to be considered a “new” drug, puts it on patent, with the price gouging that goes with that.

            That was ozone layer/global warming stuff. I find it hard to believe that the propellant released by asthma inhalers could cause significant planetary climate change, but it was changed along with all the other aerosols and refrigerants.

          • Patient Kit

            Wow! If I’m understanding you correctly there are currently no generic inhaler drugs for asthma? None? Because the new method of delivery put them all back under patent? If so, that is outrageous! How much does Big Pharma sell these exact same inhalers for in other countries?

          • ninguem

            Look at colchicine and the new drug Colcrys.

            A pharmaceutical company found a way to patent a drug that was known to the ancient Egyptians, that has existed in the USA for a century or more, basically a generic pill.

            They found a way to take that same pill, get a patent on it, litigate the generic manufacturers out of the market. and a drug that used to be five cents a pill, is now five dollars a pill.

            And they say doctors are greedy.

          • Patient Kit

            I’m not familiar with that drug or what it’s used for but I’ve seen it cited here at SZ as another example of the greed of the pharmaceutical companies. This business of taking inexpensive generic drugs backwards and putting them back under patent (and out of reach for many people) is just an obscene abuse of power. I realize that Big Pharma’s lobby is uber powerful, but is there nobody who can go up against them? Not even on something like this? Where is the government, presumably Big Pharma’s biggest customer, on this? If I sound angry, it’s because I am. I never thought most docs are greedy but Big Pharma’s level of greed is evil.
            >:-(

          • Lisa

            Big pharma is greedy for sure; so is corporate medicine – insurance and corportations that own hospitals.

            The profit motive should be taken out of medicine, plain and simple in my opinion.

          • Patient Kit

            No disagreement from me on this. There is plenty of greed in our system. I’m just focusing on Big Pharma at the moment in this thread because that’s what this thread is about. But hospital corporations and insurance companies are equally greedy. And the greed just seems to keep escalating.

            In the short time I’ve been posting here on KMD, I think I’ve been very clear that I’m all for a single payer system in this country. So, we’re in agreement about taking the profit motive out of Big Health. Healthcare should not be, first and foremost, a big business with profit being it’s main reason for existence.

          • http://www.idealmedicalcare.org PamelaWibleMD

            The cruelest of all price gouging is with the pill used for Death With Dignity (physician-assisted suicide). Should be 5 cents a pill. It’s $600. So poor people can’t afford to die. I will post the relevant chapter excerpt from my book below:

          • http://www.idealmedicalcare.org PamelaWibleMD

            Essentially I write an Rx for 10 grams of Seconal for a 90-pound man who is dying and had not been off the couch in a month. They are poor. Use an outhouse. Living off the grid. He had planned to shoot himself, but asked for the “suicide pill.” Wife went to pharmacy and it was $637 for a generic that should be pennies a pill. With her Oregon Rx Discount Card they dropped the price to $550.
            Coud not afford to die.

          • ninguem

            I’ve never written a “death with dignity” drug.

            What are you allowed to prescribe?

            There’s probably any of a number of medications that would work, especially in combination and prescribed to gross excess.

            But I suppose there is a certain administrative restriction.

            What is “allowed”?

            I don’t think I’ve prescribed secobarbital for any purpose.

          • http://www.idealmedicalcare.org PamelaWibleMD

            I had never prescribed it. But it has been on the market of like 60 years. They use it to put down farm animas sometimes. I bet not at $1000 an animal. Vets gets better deal on this stuff. Any vets out there want to chime in on pet Rx price gouging?

          • eqvet2015

            Regarding euthanasia, pentobarbital +/- phenytoin is the most common euthanasia drug used, but pets are overwhelmingly euthanized by IV injection, and prices for parenteral preparations do not necessarily correlate well with prices for oral preparations. I don’t know what the different brands cost, or for that matter how much they’ve changed in the last 5 years, but when I was helping with inventory at a practice before college, it was about $80/100 cc bottle of Beuthanasia, which was dosed at 1 cc/10 lb, so a cat would cost 80c while a horse would cost $80. Certainly not hundreds of dollars.

            Regarding price gouging, a number of drugs that have been around for ages have gone on back-order and, if/when they were reintroduced, the price was increased by an order of magnitude. Off the top of my head, most ophthalmic ointments, doxycycline, and metronidazole have all been affected in the past few years.

          • SarahJ89

            I raise poultry and my day job is working with farmers. You can get antibiotics easily at the feed store. Not a wide variety, but still… it’s good to know about.

          • ninguem

            No, don’t ever take animal medicines.

            This is what will happen to you.

            http://www.youtube.com/watch?v=wXeV5cqb_3Y

          • http://www.idealmedicalcare.org PamelaWibleMD

            Looks like 80% of the time secobarbital is used. Second-line drug is pentobarbital. See below:

            http://www.medscape.com/viewarticle/742070_3

          • http://www.idealmedicalcare.org PamelaWibleMD

            Outrageous. Yes. With the cheapest overpriced inhaler ($52) you pay $1.73 per day to breath. With $10 each on Craigslist, you pay 33 cents per day to breath.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Yep. CFCs. Did the price or refrigerators go up 400%? No. Did the price of hairspray go up 400%? No. Just asthma inhalers. Here’s why:

            http://www.motherjones.com/kevin-drum/2013/10/heres-why-your-asthma-inhaler-costs-so-damn-much

          • Patient Kit

            Wow! I had no idea that there are no asthma inhalers under $50 available in the US. See a more detailed expression of my outrage in my response just below. Is this true in Canada too? Or are the same inhalers less expensive there?

  • Lisa

    Several thoughts:

    1) My son was uninsured for a while; he found a wide variation in price for the drugs he was taking, depending on the pharmacy he got them at. He also checked on-line prices, which in some cases were good. He never considered looking for the drugs in the black market.

    2) I’ve had leftover drugs when my doctor changed my script: It seems wasteful to throw them away or take them to a drug disposal program (keep them out of the land fill or the water supply and all of that). If I knew other folks who take the same drug, of course I’d offer it to them.

    3) What really worries me about people buying drugs on the black market is the use of antibiotics. That could lead to all kinds of potential for problems, including increased drug resistant bacteria. That is already a problem due to the over use of the drugs.

    • Patient Kit

      1) When I was without insurance for a few months last year (between losing one and qualifying for the other), I started shopping around to get a sense of what my options would be if I didn’t get any new insurance (a position I could find myself in again soon) and I found the same thing — huge differences in prices at various stores. For example, Costco was much cheaper than Walgreens. There are also a number of Rx discount cards around, both by membership fee at some stores and free . I got two of the free cards, one through NY state and another through a nonprofit, brought them to the store to check them out and they would have worked. So, yes, it pays to shop around.

      2) Friends offered to share some of their unneeded drugs to help cover the gap for me if I needed it. And I would do the same for others when I can. We’re all just trying to survive out here. I’d only accept Rx drugs from peeps I trust though. The stranger via craigslist route is too scary.

      3). Generic amoxicillen is available OTC in Mexico. When I was spending time down there (a few years back (before my whole life temporarily fell apart), I always picked a bottle up just in case. But I rarely used it in Mexico or when I brought it back to the US. I’m sure I have a few bottles of unused way past it’s date amoxicillen around somewhere.

      • http://clearhealthcosts.com/ Jeanne (clearhealthcosts)

        This post is amazing. Thanks, Pamela Wible. We’ve heard a lot of scary stories about people trying to pay for their medications.

        Pricing can be really random. You can find yourself paying more for your meds if you invoke your insurance than you would if you pay cash — that is, the co-pay can be higher than the price of the meds at certain pharmacies. Also, the RX discount cards often don’t work. And! Generics are not always cheaper.

        We collected some resources on this page:

        http://clearhealthcosts.com/prescriptions/

        While we concentrate mostly on the prices of procedures, we compiled this as a resource, and hope others will find it useful.

        • Patient Kit

          Thank you for the link to your site, Jeanne. It looks interesting and useful and I’ve bookmarked it for future reference.

          Re the pharmacy discount cards that I mentioned, the one I got and checked out at Walgreens in Brooklyn was PS Card and, had I needed to go that way, it would have given me a significant discount there.. But Costco was way cheaper than Walgreens+ PS Card. I don’t remember whether I tried to use the PS Card at Costco. I just remember being so shocked that the two retailer’s prices on the same drug could be so different. I think it was >$100 different. This was for a common maintenance med unrelated to my ovarian cancer. The other card was, I think, from the city, not the state — BigAppleRx. Thankfully, this was only consumer research I was doing and I never had to use the cards because new insurance kicked in. But I could be between insurance again soon, so it’s good to know that it pays to shop around.

          • http://clearhealthcosts.com/ Jeanne (clearhealthcosts)

            Thanks, yes, we hear a lot that Costco is the least expensive — and also that you don’t have to have a Costco card to use their pharmacies.

            On the other hand, we also hear that prices bounce around a lot and you can’t count on Costco being cheaper; in fact, my local indy here in the NYC suburbs approaches Costco sometimes in price.

            If you use all those resources for your common meds, your hair will stand on end at the price variations!

          • Patient Kit

            Costco has a reputation for treating it’s employees well, so it doesn’t surprise me that they allow customers without memberships to use their pharmacy. The one time I used them, my meds were very inexpensive and I was treated very kindly. At the time, I was between insurance plans and scrambling because I had a likely diagnosis of ovarian cancer (which surgery/biopsy soon confirmed). When I called the Costco pharmacy to price the drugs I needed, the pharmacist listened to my story, told me to come in and just tell them at the door that I was there for the pharmacy. When I got there, he remembered me and was very empathetic to me and my situation. It was a very pleasant experience. This was Costco in Sunset Park, Brooklyn.

      • SarahJ89

        Tetracycline is readily available in your local feed and grain store.

        • Patient Kit

          LOL!, I’m not sure we have any local feed and grain stores here in Brooklyn, NY. :-p

        • http://www.idealmedicalcare.org PamelaWibleMD

          Aha! I knew it though I just went in to see what drugs I could buy there. I left with a baby chick.

          • SarahJ89

            OMG, how cool is that. I’ve raised poultry for 35 years, have given workshops and work on a farm. You probably have local resources, but do feel free to call on me if you have any questions. duckladynh AT yahoo DOT com.

    • http://www.idealmedicalcare.org PamelaWibleMD

      1) Yes. Prices vary wildly. Get generic when possible. Get Rx on Walmart or other discount pharmacy for $4/mo if on generic list.
      You do NOT have to use your insurance. Rx co-pay could be more than just buying for $4 uninsured. Many states have Rx discount cards. In Oregon the card will get you 40% your drugs.

      2) Agree. It is wasteful! Many docs will re-use drugs that patients drop off (ill eagle) and expired meds (ill eagle) and will write monthly scrips for higher amounts (ill eagle) so patients do not have multiple Rx co-pays. Doctors really are trying to help patients even if the have to break the law to do it.

      3) Yes. Do not ignore side effects, Can be lethal. I will never forget the 16 year-old boy with aplastic anemia (bone marrow failure) as a result of taking an OTC antibiotic, Chloramphenical, from Mexico.

  • Deceased MD

    The question is why do we put up with this? A generic that was pennies on the dollar now escalates to 50 X the cost? Meanwhile there is no negotiating prices for Medicare prescriptions.

    • http://www.idealmedicalcare.org PamelaWibleMD

      Why do we put up with this? What, if anything, CAN be done?

      • ninguem

        The quinine thing is the same as colchicine. In fact, if I remember correctly, it may well be the same company, URL Pharma, or some subsidiary (Mutual), or some entity that has taken over, Sun Pharma, or Takeda.

        Hippocrates could have told you that colchicine worked.

        A Peruvian peasant curandero could have told you that Quinine worked. People taking it as an antimalarial……..and in the day that included people as far north as Eugene, Oregon……also knew that Quinine helped nocturnal leg cramps. They could have told you that, a hundred years ago.

        So, Quinine grandfathered in as an antimalarial, and continued “off-label” use for nocturnal leg cramps. There was no research recognized by the FDA, proving its effectiveness.

        Over the decades, I’ve seen Quinine pulled off the market for lack of research to efficacy.

        As soon as it gets pulled off the market, the people who benefit from the drug raise a fuss, and it goes back on the market.

        Again, the FDA gave companies market exclusivity in return for the research. It was done, some company has the “patent”, or “exclusivity” or whatever they’re calling it, they’re raking in money selling a generic at some order of magnitude higher price. They “proved” what a Peruvian peasant or an Oregon covered-wagon pioneer could have told you.

        Here’s still another article about URL. Basically, they came into existence to take advantage of this FDA program.

        They took the money and ran.

        http://www.post-gazette.com/business/businessnews/2013/03/03/URL-Pharma-may-no-longer-be-cash-cow-in-Philadelphia/stories/201303030209

        • SarahJ89

          When I was a young woman you could buy it (and paragoric–tincture of opium) over the counter. My roommate took quinine in an effort to induce an abortion (illegal in those days, which is why my other friend is not able to be here–she died). It didn’t work.

  • Lisa

    Other governments (Most European countries & Canada) negotiate prices with drug companies. Heaven forbid that our government gets involved with that. Sarcasm fully intended.

  • http://www.idealmedicalcare.org PamelaWibleMD

    I feel so naive. Very scary! Is this common knowledge? Who else is familiar with this?

    • Deceased MD

      I think that’s the idea. LOL. (That no one knows about it). Just as I was thinking they could not go any lower Pam, they just did.

      • http://www.idealmedicalcare.org PamelaWibleMD

        A few bad apples? This can not be that common. Can it?

        • Deceased MD

          I don’t really know. We went to medical school. I think I missed that day when they were talking about pharmaceutical fraud. But in a way it is not surprising given the high price of pharmaceuticals, it sounds like they are basically turning into street drugs and the new drug lords are called Pharmacy warehouse managers I guess?

          • http://www.idealmedicalcare.org PamelaWibleMD

            What kind of education beyond high school do you need to be a Pharmacy Warehouse Manager? Will a G.E.D do the trick?

          • Deceased MD

            LOL. I think they are suppose to have a college degree but who knows in this world. I had the bad fortune to go on a recent vacation and stay at a hotel with 40 EHR consultants–most from Alabama. I assumed they had a degree in Computer Science. The first guy drove a truck of bottled water in the mid west before this and the second guy chatted up about his rottweiler biting his brother in law’s arm off after br-in-law came out of prison.The finale was the hot tub where the woman sitting next to me told me that she was here to “teach doctors”. Seriously. SO nothing would surprise me Pam if they got these pharmacy guys from the cartel.LOL. oh and all of this in a 4 star hotel being of course paid by the EHR company.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Life is starting to finally make sense – in a weird way . . . Thanks Deceased MD!

          • Deceased MD

            LOL. Why? Have you run into idiot types like this?

  • Patient Kit

    Thank you for the very interesting background on colchicine. So, what I hear you telling me is that URL Pharma took a drug that docs knew about since ancient Egypt and did some research to turn it into an evidence-based medicine? And now URL Pharma gets to profit massively from doing that? Where is the outrage? I mean, besides yours and mine and others here at KMD. Where is the massive outrage?

    • http://www.idealmedicalcare.org PamelaWibleMD

      1) People who are most impacted by this are just trying to get their inhalers in back alleys. If you are short of breath and short on funds, you do not have a lot of time for political action.

      2) People who are not short on funds or having urgent medical needs for which they are looking for black market drugs are mostly unaware of what patients are doing just to get by each moth (paying > $2 per day just to breath)

      3) Doctors who may be the other group aware of Pharma price gouging are so overextended by their workload and other issues (see any number of KMD posts on problems in the medical field) that I am not certain they can take this on in any meaningful way.

      Any ideas here?

      • Patient Kit

        Yes. We need a good filmmaker to take on these pharma issues and make a movie as good as Dallas Buyers Club about them. Movies are one way that lots of peeps learn about outrageous stuff outside of their own experience. Never underestimate the power of a good movie.

      • ninguem

        I E-mailed the Wall Street Journal and spent an hour on the phone with a reporter, lots of E-mail exchanges, and dropped the name of a few prominent rheumatologists to quote for the record. Quote me for the record, I suppose, but who cares about some small-town FP?

        The reporter wrote a nice story about it.

        Remember, the pharmaceutical companies did not do this on their own.

        It’s like the Tea Party versus Occupy Wall Street.

        Tea Party: The problem is Government is in bed with Big Business, and Government is the bad guy.

        Occupy Wall Street: The problem is Government is in bed with Big Business, and Big Business is the bad guy.

        No, the problem is The problem is Government is in bed with Big Business, and they’re both just as bad, and should not be colluding at all.

        The Colcrys thing is just another example of crony capitalism, with the government picking winners, and using “lawfare” to drive honest healthy competition out of the marketplace.

        • Deceased MD

          We’d love to read the story. Do you think the cases of fraud you reported are more an issue for medicaid type scandals or happening across the board.

          • ninguem

            Search Colcrys in the Wall Street Journal, there’s lots of articles, I wasn’t the only one. I just mentioned it was a story of crony capitalism, government picking winners, “lawfare”, and the distortion of a free market, causing the price of a drug to go up over a hundredfold.

            Somebody in their editorial staff was intrigued enough to send someone my way

            I’ve said for a long time, you learn a lot of medicine reading the Wall Street Journal.

            The big fine to Mylan for jacking up the price of generics, back in the 1990′s. All the hype I got in med school over the superiority of levothyroxine over natural thyroid, was based on zero research. Big fine to the thyroid drug makers. Levothyroxine is in the top five most widely sold prescription drug in the USA and the developed world generally. The Colcrys thing. I could go on and on.

            I’m a mutual fund buy-and-hold guy, so I just scan the financial data page. When I see an article warning investors that some healthcare-related firm is going to take a fifty million dollar hit on profits, therefore do your stock analysis with this in mind, I look to see why they’re getting hit, it’s usually mentioned.

            When the hit is because of a fine for some sort of misdeed, and a regulatory agency has imposed a fine, I like to read what they did, and I very often learn something that hadn’t been mentioned in the professional journals yet.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Does this mean I may finally find out who you are in real life, ninguem?

          • ninguem

            I’m really just a virus on Kevin Pho’s server.

          • Deceased MD

            But a very nice one at that!

          • ninguem

            I may be just a virus today, but I have dreams.

            Some day I’m going to be a hologram on Deep Space Nine.

            images2.fanpop.com/image/polls/420000/420989_1271353141748_full.jpg

          • Deceased MD

            Brilliant. You seem like a resourceful doc. Pretty soon you can give up your day job with stock tips like that. I know the Colcrys scam has been at least mentioned in the NY Times albeit briefly so I bet you had a new twist to your story.
            I was telling Pam I was in a hotel on vacation that was ruined by 40 EHR consultants. But the finale was the Pharmaceutical company types that were discussing writing a program to best determine the cost of their new drug using various parameters. They took over the restaurant I hoped to have lunch in. Bad enough they are taking over but can’t even take a vacation without them taking over.

          • SarahJ89

            Gak. Way to lose weight quickly. “Pass the emesis basin. The EHR folks are here!”

          • Deceased MD

            LOL Exactly how I felt.

          • SarahJ89

            There are intermittent (and suspicious looking) shortages of natural thyroid from time to time. I’m lucky in that my hypo is controlled by levothyroxin–and an NP smart enough to know my THS needs to be around 1.0, NOT just within “normal” range. The feeling among many people who rely on the natural thyroid is that there is a movement to get rid of it to sell more levo. What a drag for people who rely on it

    • ninguem

      Where was the massive outrage?

      In the gout support groups, the support groups for Behçet’s disease and Familial Mediterranean Fever.

      In the medical specialty organizations.
      http://www.the-rheumatologist.org/details/article/865591/Colcrys_Approval_Triggers_Questions.html

      But we’re just greedy doctors, the government ignores us.

      Remember, the drug company did not roll tanks down the street and force this at gunpoint.

      This was done with the full cooperation of our government.

      Both sides are just as bad with this. Right and left are equally dirty on this one.

  • http://www.idealmedicalcare.org PamelaWibleMD

    My guy above who needed the suicide pill was dying of gout-related kidney failure and certainly could not afford the colchicine.

    Question: I thought “they” were not allowed to patent natural medications. They have to alter the chemical structure somehow to create something “new-and-improved.” And charge the “new-and-improved” price, of course. Right?

    • Deceased MD

      On the side, it’s interesting because in the news, prisons don’t have access to death meds so are postponing executions. What a society we live in.

  • Patient Kit

    Is this mostly mom & pop independent pharmacies? I’m guessing that if any of the big three (CVS, Rite Aid, Walgreens) have been caught doing this, it would be big news, if for no other reason than they are big public companies with investors who would be outraged if stock prices plummeted. And if it is mostly independents involved in these drug resell schemes, do they try to justify it by saying they are struggling to survive against the big three? Tangled, tangled webs.

    • http://www.idealmedicalcare.org PamelaWibleMD

      Wholesale warehouses that sell to pharmacies? Or is it just smaller pharmacies? I am also very curious.

    • ninguem

      Mom and pop pharmacies.

      Go into the OIG exclusions database you can look them up yourself.

      Or Google search some string like “Pharmacy charged reselling prescription drugs” or similar string. You’ll get LOTS of hits.

      What has CVS done? Looky here:
      http://en.wikipedia.org/wiki/CVS_Pharmacy

      Walgreen’s just as bad
      http://en.wikipedia.org/wiki/Walgreens

      Rite-Aid had some accounting scandals back in the 1990′s that got at least one senior executive some jail time.
      http://en.wikipedia.org/wiki/Rite-Aid

      But it’s hard to beat CVS and Walgreens for big-time controlled drug diversion and tens of millions of dollars in fines.

      The Medicaid recipient reselling to the pharmacist who then resells the drug, same pill might be sold half a dozen times. As far as I know, that’s usually the small chains or independent pharmacies.

      http://www.gao.gov/assets/220/218249.pdf

      http://www.fbi.gov/newyork/press-releases/2013/manhattan-u.s.-attorney-announces-charges-against-bronx-pharmacy-owner-for-participating-in-medicaid-fraud-scheme-involving-the-diversion-of-prescription-drugs

      http://www.painpolicy.wisc.edu/sites/www.painpolicy.wisc.edu/files/gao92.pdf

      http://www.nbcnewyork.com/news/local/Medicaid-Fraud-Prescription-Arrests-FBI-Charge-Health-Care-162713966.html

      I mean it, there’s LOTS of this going on.

      • Patient Kit

        Just to clarify, I definitely don’t think the big 3 are any angels. I wasn’t even thrilled about the CVS-Caremark merger let alone all the other stuff CVS has done. I remember a couple of years ago reading about one of the big 3 (I forget which) selling outdated baby formula and OTC drugs in poor underserved neighborhoods. I just wondered whether any of the big 3 had been caught involved with the drug reselling schemes.

        It really is disheartening how even the worst scandals don’t seem to make much difference to a company’s wellbeing. I don’t know whether the public isn’t paying attention or is just overwhelmed and desensitized because there is so much bad corporate behavior.

        It’s nice to have a conversation with peeps who are sincerely angry about this stuff. I appreciate your anger.

        • SarahJ89

          Most of the public (that would be us, I suppose) are too busy trying to survive paycheck to paycheck to pay much attention.

      • SarahJ89

        Don’t forget double billing. I had a pharmacist double billing Medicaid when I was a welfare worker.

        People complain about clients defrauding welfare. Let me tell you the middle and upper class have their hands in the cookie jar up to their eyebrows. My clients’ access to money was so limited. A crooked nursing home administrator (in cahoots with a county commissioner), pharmacist, attorney draining a conservatorship, doctor (rarer)–those folks could steal rings around any client I ever saw.

    • SarahJ89

      My neighbours own a family pharmacy. I naively thought someone literally was minding the store. Ha! The entire family has serious substance abuse issues, the (not a blood relative) pharmacist was swapping drugs for blow jobs with a customer, the manager was dealing cocaine from her parents’ home in my neighbourhood. I was amazed, really. Oddly, they fired one of the sisters who became an oxy addict due to an untreated shoulder injury (no insurance). I think her crime had more to do with dysfunctional family dynamics than her actual crime.

      They’ve sold the place, but it sure was interesting to watch. Much better than television.

      • Patient Kit

        A popular mom & pop pharmacy in my Brooklyn neighborhood was raided and investigated for illegal steroid and growth hormone trafficking a few years ago. The owner/pharmacist was soon found dead from a gunshot to the head. It was ruled a suicide but rumor has it that he was shot execution style. The store is still open and operating. Under a new owner.

        • http://www.idealmedicalcare.org PamelaWibleMD

          Ummmm . . . anyone writing these stories?

          • Patient Kit

            The Brooklyn mom & pop that I mentioned made the news. Besides extensive local (Brooklyn) paper coverage both the NY Times and NY Daily News wrote about it and, I’m sure, others. In addition to the now dead pharmacist, there was a corrupt local doctor who wrote many illegal Rxs and sent his customer’s to this pharmacy. Not only were athletes customers but 19 bodybuilding NYPD officers were apparently steroids customers at the store. The store was named in MLB’s steroids investigation. To top it all off, the store has a history of connection to the Gambino crime family. Yep. It made the news. And yet the pharmacy is still open. Under new ownership. It’s a very old-timey mom & pop store, almost quaint. Like you fell into an old James Stewart movie like It’s a Wonderful Life. Accept for, you know, the illegal steroids business and the mob connections.

      • http://www.idealmedicalcare.org PamelaWibleMD

        OMG. I am so naive.

      • ninguem

        I’m sure the pharmacist didn’t think of them as blow jobs.

        They were refills.

  • http://www.idealmedicalcare.org PamelaWibleMD

    Disclaimer: Completely off topic, but very funny. Just happened today:

    • SarahJ89

      On the other hand… it might have been a pet mole.

  • Payne Hertz

    You can buy albuterol inhalers (name brand Ventolin) for $20.00 from Canada. Combivent is $24.00. That’s about what they cost years ago before the price gouging.

    I have a similar problem with quinine. I get it from CanadianMedsUSA which is a reliable source (actually an American company that gets meds from Canada, New Zealand, UK and Israel.) It is a fraction of the cost of the name-brand Qualaquin which is another FDA-engineered rip-off.

    See if you can get your doctor to prescribe a bunch of them at once to make it worth your while as far as shipping/hassle factor. I have a rheumatologist who prescribes me a year’s worth of quinine at once but since I don’t use them every day, it lasts a long time. I have now laid in a 2-year stockpile in case they pull the plug on Canadian drugs.

    • SarahJ89

      I keep my levo in the freezer. Storage temperature is an issue with thyroid meds. After being undiagnosed for 25 years, I’m totally paranoid about being without it.

  • Dave

    I’ve ordered my own meds from India for many years now and never had any problems. Prices are great – inhalers $2-4 to use an example from this piece, so even undercutting the guy in the Jag. Other drugs a fraction of US prices and often only a fraction of my copay. I often recommend this route to patients who have difficulty paying for medications that are legal to import for personal use (ie. non-scheduled).

    • http://www.idealmedicalcare.org PamelaWibleMD

      Are you a Doc Dave? And wow! Can’t beat $2 for an inhaler–unless getting free from a relative.

    • SarahJ89

      So… how does one find a reputable vendor overseas? I live close enough to Canada so I’d take a road trip to find a pharmacy in person if I needed to. But if I wanted to buy elsewhere or didn’t live this close to a border, how would I figure out who’s a scammer and who runs a legit pharmacy???

      • http://www.idealmedicalcare.org PamelaWibleMD

        Word of mouth. I find out from my patients. Then I let other patients know reputable sites to fill their Rx.

        • ethanspapa

          I found a wonderful hero,like yourself Pam, at Ma. General .When the suits would come in with samples of drugs the sales people were pushing. She said she would prescribe them but wanted lots of samples to give her patients that couldn’t afford them.She wanted her patients to get samples for the ones who didn’t have the money to pay for it.
          My eyes popped out when I saw her supply room A special place in heaven for u-2

  • ninguem

    By the way, Metformin 500 mg extended-release is on the four dollar list at Wal-Mart, and usually the same price at Freddy’s and the usual competition in the area.

    It shouldn’t be super-expensive, though that’s always relative.

    • http://www.idealmedicalcare.org PamelaWibleMD

      Good to know. Last I checked (may have been years ago) it was really expensive.

  • http://www.idealmedicalcare.org PamelaWibleMD

    I hate to say this but me too. Who wouldn’t? Especially if the meds are in original wrapper. The problem is that rescue medicines that are needed for life-threatening conditions would also have life-threatening results if they were counterfeit.

  • http://www.idealmedicalcare.org PamelaWibleMD

    See disclaimer at the bottom of the article: “To protect the patient’s privacy, a professional model has been used in this photograph.” The patient was willing to be in a photo. My decision not to have him in the photo.

  • Deceased MD

    Now there is a warm and fuzzy story. I like it! So delighted he made out so well!

  • Daniel Lang

    Pam, as a read your article and the comments what struck me is the biggest culprit in the drug/health problem over and over again is the pharmeceutical industry. 60% of all drug fatalities year to year are pharmaceuticals (50/50 intentional/unintentional). 50% of the growing heroin addiction problem in this country has its source in first a person being addicted to pharmeceutical opiates. If one wants to talk about a gateway drug, pharmeceutical opiates need no study for a conclusion to be made. Based on the data (we like data-driven decisions) the real war on drugs should be against the so-called legitimate pharmaceutical companies. Our first step should be the elimination of the prohibition of marijuana (so research can be done) and moving it from a criminal issue to a health problem. As a health problem it needs to be saturated in information and education. Of course we do such a poor job with alcohol why would we think we could address the health problem of drug use and abuse. I strongly recommend supporting the organization Law Enforcement Against Prohibition (LEAP).

    • SarahJ89

      With all due respect, the doctors overprescribing serious pain killers need to look in the mirror also.

  • Daniel Lang

    Pam, perhaps a new title of your article could be “The Illegal Ways Patients Obtain Legal Drugs”.

  • SarahJ89

    I have a friend with no insurance. She had Lyme disease. I did not. What I had was a doctor who had become infatuated with alternative treatments and the Disease of the Week. He is a really nice person, but prone to trendiness. He insisted I had Lyme, which I knew I did not have (I had hypothyroidism–treated successfully later by a nurse practitioner–but apparently that’s not very trendy).

    What to do? My friend was ill, I had a prescription for doxy which I had no intention of filling. I filled it, gave her the doxy and viola! she got better. She was lucky. But our health care really shouldn’t depend on sheer, blind luck, should it?

    • http://www.idealmedicalcare.org PamelaWibleMD

      Oh wow! Practicing without a license.

      • SarahJ89

        Bring out the dancing handcuffs. I’m just glad my fried got better. The difference was stark.

  • http://www.idealmedicalcare.org PamelaWibleMD

    1) Patient came in because he needed some other Rx too (besides the ones he got on the street).

    2) No easy answer to the rest of the affordability issue. In a humane society haves need to share with the have-nots (enforced or voluntary). Or raise the minimum wage so that everyone can have what they need without requiring handouts from others. I hope I have not opened a can of worms here.

  • http://www.idealmedicalcare.org PamelaWibleMD

    Do you recommend?

  • http://www.idealmedicalcare.org PamelaWibleMD

    And where are these underground recycling centers?

  • Vikas Desai

    listen this country charges hundreds of dollars for the biggest BS branded drug of all time. Albuterol…..with asthma rates climbing from poor air quality and climate change plus all the smokers and smog the need for inhalers is as great as ever, the best part is these people who sell and buy this stuff get buried in jail for trying to survive while big business continues to thrive, we sit here and we watch and there is nothing we can do…..

  • Vikas Desai

    BTW “Ill Eagle” is pure gold!!!

  • ethanspapa

    I always found taking a steamy shower, with my little guy, when he had a low grade temp and a croupy cough, would loosen up the mucous. About ten minutes into the shower, my little guy would start breaking the phlegm up,watch his nose run like a waterfall and then whoop , barfed on my shoulder. Plus it brought his fever down. They don’t like the tepid shower when they have a fever. Obviously it feels cold to them.
    A 1/2 hour later, mom or dad is in the rocking chair,the little guy was sleeping. Put my ear to his back and listened to his breathing sounds. It usually worked . If it did keep up I would take him to a sick visit but not until I tried the things i know that usually work. Saves millions in health care costs. Instead of getting all stressed out over a simple.virus and running to the ER
    A temp of 103″ is pretty normal for a little guy.

  • SarahJ89

    It was funny and moving, had excellent acting and yes, did show another perspective on obtaining drugs.

  • Dingus

    I think it’s beautiful that there is a MD out there that actually recognizes this and is nonjudgmental about it. As an uninsured Ehlers-Danlos patient I thank you for existing. We need more doctors who care about the human beings under their care.

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