poison pill bottle

When was the last time you talked to a pharmacist? If you get your medicine through the mail or at a chain drugstore, the chances are good that you did not speak directly with a health professional. Instead, you probably interacted with a pharmacy technician. That means you missed out on the pharmacy safety net that is supposed to catch you if your doctor makes a mistake.

Why the Pharmacy Safety Net is Vital:

When we think of safety nets we imagine trapeze artists flying through the air or tightrope walkers teetering high above a crowd. Human beings make mistakes, so it is good to have something in place to catch you if you mess up.

There was a time when physicians relied upon their memories to keep from prescribing incompatible medicines. When they had time, they might look up a potential interaction in a drug reference book. The pharmacist was supposed to provide a safety net, catching any errors that might slip through.

Relying on memory or checking printed books isn’t feasible any more. For one thing, the human brain cannot keep track of so many permutations and combinations. And few health professionals have time to consult fat reference books. That is why computers have been considered so valuable in catching prescribing errors or checking for drug interactions.

There is one huge problem with this modern technology. It still relies upon humans to act upon the information that computers provide. Far too often, health care providers skip that step.

Doctors frequently override drug interaction warnings that crop up while they are completing an electronic prescription. One insider told us that it happens 80 to 90 percent of the time a doctor writes a prescription. That’s because there are so many warnings physicians have trouble determining which ones are truly worrisome and which are merely a distraction. Many probably rely upon pharmacists to be their safety net.

The Pharmacy Safety Net Has Huge Holes:

Sadly, a new study published in the Chicago Tribune reveals that the pharmacy safety net has huge holes in it.
Two professors of pharmacy advised the Chicago Tribune reporters on their investigation. The journalists took actual prescriptions for pairs of drugs to 255 pharmacies in the Chicago area and recorded whether they got appropriate warnings about possible interactions.

The results were chilling. Life-threatening combinations such as the gout drug colchicine and the blood pressure pill verapamil should not have been dispensed together. Patients should have been warned of the possibility of an unplanned pregnancy while taking the antifungal drug griseofulvin with a birth control pill. But half of the pharmacies failed to offer warnings.

One reader reacted to this story:

“This is unbelievable. Since my wife started taking so many drugs I asked my pharmacist how they could keep track of all the interactions. He said that the computer did that for them. I assume all software is available to all stores, so how did this happen? Just not buying the software?”

All drugstores have software in place to catch dangerous interactions. But like doctors, pharmacists get too many warnings and suffer “alert fatigue.” Prioritizing which ones are important and which ones are simply a nuisance becomes difficult. Psychologists call this desensitization.

If you remember the Aesop fable about The Boy Who Cried Wolf, you know what that means. The shepherd boy thought he would amuse himself by crying out “Wolf, Wolf,” to see what the villagers would do. They came running, but it was a false alarm. He did it again a few days later and again the villagers came, only to discover that he was fooling them. When the boy cried “Wolf, Wolf,” the third time, they ignored him and the wolf got the boy’s sheep.

Pharmacists eventually get used to ignoring many alerts about dangerous interactions. Part of the reason is that they are working so fast to fill hundreds of prescriptions a day that they have no time to a) contact the prescribing physician b) deal with every alert that comes up on the computer or c) counsel every patient that there could be a potential interaction.

One Pharmacist Shares His Experience:

“I’m a retired chain store pharmacist. In my opinion, the Chicago Tribune investigation is a huge public relations disaster for the major chains. One would hope that the dismal results of this investigation would shame the chains into making major changes. But I predict that will NOT happen.

“In my opinion, the root cause of pharmacy mistakes (including overriding significant drug interactions) is understaffing. Understaffing forces employees to work at maximum output for their entire shift. That increases the productivity of pharmacists and techs but it also causes a huge increase in pharmacy mistakes.

“The Chicago Tribune had a follow-up article with responses to the investigation from four of the major chains. Most of the chains said that they would increase training in drug interactions and update their Policy and Procedure manuals to state that pharmacists must call the prescriber in cases of serious drug interactions.

“None of the chains said they would address the heart of the problem by increasing staffing in the pharmacy. Increased staffing would hurt the chains’ bottom lines.

“In my opinion, the big chains have made the cold calculation that it is more profitable to have pharmacists sling out pills at lightning speed, and then compensate any customers harmed by mistakes, rather than have adequate staffing for the safe filling of prescriptions. The main thing that the chains care about is how fast prescriptions are filled. Quantity is far more important than quality.

“About 20 years ago, US News & World Report did a cover story investigation that was quite similar to the Chicago Tribune’s investigation. The USN&WR cover story was titled “Danger At The Drugstore.” That cover story was embarrassing when it was published but, predictably, it had no lasting effect.

“In my opinion, pharmacy mistakes (dispensing the wrong drug, the wrong dose, the wrong directions, and dispensing drugs that interact) will continue unabated until state boards of pharmacy get the backbone to stand up to the massive legal and political clout of the mighty drug chains.

“The state boards of pharmacy need to fulfill their duty to protect the public safety by mandating adequate staffing levels in drugstores. Unfortunately, the huge drug chains lobby state legislatures to prevent state boards of pharmacy from requiring safe pharmacy staffing.

“The public should demand safe staffing levels in pharmacies but I don’t see that happening any time soon. The public has a hard time believing that things are as bad as pharmacists know they are. Pharmacies must be adequately staffed to protect the public from serious pharmacy mistakes.”

Create Your Own Pharmacy Safety Net:

Larry M. shares a sad story:

“Only 50% errors? I am not surprised at all.

“My late wife filled and refilled prescriptions for Ultram (tramidol) and anti-seizure medication several times without ever hearing a word of caution. Eight doctors missed it, too.

“When I finally discovered that Ultram was causing the seizures (black box warning) in 1996 by using our brand-new broadband internet and took the pharmacist to task, he stated that it wasn’t his job to review medications.

“The eight doctors? They just shook their heads and mumbled “Sorry.” One had to be coerced to file with the FDA.”

“It was only a year of her life lost.”

What can you do to protect yourself? Anyone who is taking more than one medication needs to ask every health professional (prescribers and dispensers) to double-check for possible incompatibilities. To help with that process we offer our free Drug Safety Questionnaire at www.PeoplesPharmacy.com. Physicians and pharmacists should take the time to fill out the answers and protect patients from potentially life-threatening combinations.

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  1. Linda
    Kittery Point, ME

    I must say that we are fortunate to have the Pharmacist at Walmart in Newington, NH, come to the counter to talk with patients whenever we are prescribed a new medication. She does not rush you either. This is one of the many reasons that I continue to purchase my medications there.

  2. Karin
    Schaumburg IL

    I think that all health care fields tend to be very busy and understaffed. I was a veterinary technician for thirty years and surgery was consistently overbooked and understaffed.

    And , Joe, I think you owe pharmacy techs an apology for your backhanded disrespect.

    • Joe Graedon


      Pharmacy technicians are nice people who work very hard. I have interacted with many and they do their jobs with professionalism.

      Let’s compare techs with pharmacists:

      Most pharmacists now receive a Doctor of Pharmacy (PharmD) degree. That means they spend two to four years in an undergraduate college program plus an additional four years in pharmacy school. They must past licensure exams and maintain continuing education requirements. The training is rigorous and expensive. The average pharmacist is well compensated for this training. Many now receive over $100,000 a year, not counting bonuses. The average hourly wage is $55/hour or more.

      There are no standard training requirements for pharmacy techs. Many chains have their own in-house training programs that vary in quality. In some states a tech does not have to have a high school diploma. Bottom line, pharmacy techs are not uniformly trained or certified. Salaries generally range from $10 to $16 per hour.

      Most customers do not realize that the person who hands them their prescription knows very little about the medicine that is being dispensed. As for decision making about drug interactions, this is clearly not part of the training process. Asking a pharmacy tech whether you could take two different medications at the same time would be a mistake because the technician does not have the background to answer.

      We do not mean to denigrate the role of the technician. We only wish that schools of pharmacy would create programs for these individuals that is rigorous. State Boards of Pharmacy should have certification and licensure exams and technicians should be paid a fair wage.

  3. Doug

    Thanks for this informative article, especially as I fill my prescriptions at one of the major chains. I always ask my provider if any new prescription will interact with my current medication. I also check for possible interactions on sites like drugs.com, but wonder how accurate that information is. Do you have any information about their accuracy/reliability, or if one site is more reliable than others? Thanks.

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