# Problem with Base Pharmacy/Pharmacist



## rocksteady (13 Nov 2012)

Here is the situation:
-CF member goes into a base pharmacy and requests a bottle of tylenol.  
-Very young looking Capt behind the desk asks what it is for.  
-CF member: "Well I'm all out and I like to have some on hand in case I get a headache."  
-Capt replies "We don't dispense over the counter meds unless the person has a medical condition at the time they are requesting the meds.  If we dipense meds when they aren't needed people stock up and take them home to their families and that costs tax payers alot of money"
-CF member: "So if I come here and tell you I have a headache and request tylenol you will dispense the meds?"
-Capt: "Yes"
-CF member "Good to know"

Note: This person has no medical history that would put them in conflict with using tylenol, no allergies and they rarely frequent the pharmacy for anything let alone abuse any type of meds.

According to the SOP they are suppose to dispense OTC meds to treat a condition.  However, if the person is a shift worker or someone that works when the pharmacy is not open they will not have access to simple medications such as tylenol.  Is this right for the pharmacist to do this?  I have never heard of this on a CF base.  According to the individual that this happened to, this is exactly what happened.


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## ModlrMike (13 Nov 2012)

I'm not positive, but I don't think OTC meds are covered by the Spectrum of Care any more. It has been that way for many years. OTC meds are no longer covered by any provincial formulary either (with the execption of NIMB). We provide them on ops because there's no other source, but at home - not so much.

What's to stop the member from picking some Tylenol up when they next go the the grocery store?


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## rocksteady (13 Nov 2012)

Well it is my understanding that OTC meds are an entitlement to CF members according to another pharmacy officer so why should you have to pay for something if it is a benefit of your employment would be my argument.


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## rocksteady (13 Nov 2012)

ModlrMike said:
			
		

> You understand incorrectly.



Well if they are not an entitlement than why would they be dispensed free of charge?


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## ModlrMike (13 Nov 2012)

rocksteady said:
			
		

> Well if they are not an entitlement than why would they be dispensed free of charge?



I meant to say that you understand incorrectly that they're an entitlement. Being covered by the CF and having an entitlement are two different things. The Pharmacist was correct - unless the member has a condition that needs treatment there's no scope to dispense the meds.


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## PMedMoe (13 Nov 2012)

According to the CFHS page:



> Drug Benefits. Drugs in the CF Drug Benefit List, when prescribed by an authorized health care provider



And if you search the Benefit List, acetaminophen is indeed there.

My guess is that this particular Pharm O is going by the "when prescribed by an authorized health care provider" bit.  I've never had an OTC request turned down.


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## Bruce Monkhouse (13 Nov 2012)

I'm thinking just so one can have a bottle around is pretty ridiculous......


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## rocksteady (13 Nov 2012)

Bruce Monkhouse said:
			
		

> I'm thinking just so one can have a bottle around is pretty ridiculous......



Do you (or did you ever) have military kit or supplies around just in case you needed it?  Everyone deso. Maybe instead of giving a whole bottle they could just give you like 5 pills or so.  Would cut down on costs and also allow members to have a small supply on hand if the pharmacy is not open when they need it.

Because if the member goes to sick parade than that actually costs alot more than just simply giving them the small quantity of meds.


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## PMedMoe (13 Nov 2012)

rocksteady said:
			
		

> Because if the member goes to sick parade than that actually costs alot more than just simply giving them the small quantity of meds.



Maybe in that person's lost time at work, but the doctors, nurses, PAs and Med Techs are there whether one goes to sick parade or not.....


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## George Wallace (13 Nov 2012)

I know that we have had the luxury of being in a stuffy office above our UMS and they were kind enough to give us a bottle of Tylenol for the office; but don't you think that all this fuss for a bottle of Tylenol is a bit much, when you can simply go to any large grocery store or Drugstore and buy some cheaply, at your leisure.  No doubt you have some at home that you can throw in your pocket for emergencies.


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## rocksteady (13 Nov 2012)

PMedMoe said:
			
		

> Maybe in that person's lost time at work, but the doctors, nurses, PAs and Med Techs are there whether one goes to sick parade or not.....



I guess I was referring to the "man hours" used to treat that person which could have been used to do something else productive.


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## Fishbone Jones (13 Nov 2012)

rocksteady said:
			
		

> Well it is my understanding that OTC meds are an entitlement to CF members according to another pharmacy officer so why should you have to pay for something if it is a benefit of your employment would be my argument.



Show me where it says that.


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## Armymedic (13 Nov 2012)

rocksteady said:
			
		

> According to the SOP they are suppose to dispense OTC meds to treat a condition.  However, if the person is a shift worker or someone that works when the pharmacy is not open they will not have access to simple medications such as tylenol.  Is this right for the pharmacist to do this?  I have never heard of this on a CF base.  According to the individual that this happened to, this is exactly what happened.



The events, according to your source of information, happened as they should.

BTW a headache is not a condition. It is a symptom. Therefore nobody should have Acetaminophen provided to them for "just a headache". 

As far as shift work....this is why both medical and dental hold sick parade. This is when military members are to report when they are sick, regardless of their time of duty (24/7/365 remember?)

And finally; Acetaminophen is not a "simple medication" as it is the most commonly misused drug, causing the largest number of deaths due to accidental overdose.


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## Armymedic (13 Nov 2012)

rocksteady said:
			
		

> Well it is my understanding that OTC meds are an entitlement to CF members according to another pharmacy officer so why should you have to pay for something if it is a benefit of your employment would be my argument.



It is covered under the CF medical spectrum of care. It is not a benefit:
http://www.forces.gc.ca/health-sante/pub/soc-gds/cema-gaaa-eng.asp#cov-gar

Coverage

Within the limits provided in this document, CF members and other eligible persons will be:

    1. provided comprehensive coverage, whether serving in Canada or abroad, including:
        a. hospitalization and physician services;
        b. supplemental health benefits including drugs and health practitioner's benefits;
        c. occupational health services; and
        d. dental services.
    2. excluded from any deductible fees or co-payments for care and services provided by or authorized by the CF;
    3. provided emergency health services from the nearest appropriate military or civilian treatment facility; and
    4. responsible for all costs related to health care services not authorized, or for services from sources other than those designated and authorized by the senior Health Services authority. In addition, payment will not be made for treatments or therapies if they are deemed to be:
        a.controversial;
        b. not scientifically founded or proven;
        c. not medically beneficial; or
        d. provided solely for cosmetic purposes.

Limitation: Health Services Outside Canada. Eligible persons residing in Canada will not be entitled to routine health services outside Canada.


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## brihard (13 Nov 2012)

Rider Pride said:
			
		

> And finally; Acetaminophen is not a "simple medication" as it is the most commonly misused drug, causing the largest number of deaths due to accidental overdose.



Wow, for real? I had no clue that was the case. In what circumstances is Acetaminophen killing people?

I'm not questioning you- I'm genuinely startled by this and quite curious.


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## ModlrMike (13 Nov 2012)

Brihard said:
			
		

> Wow, for real? I had no clue that was the case. In what circumstances is Acetaminophen killing people?
> 
> I'm not questioning you- I'm genuinely startled by this and quite curious.



In the last year we've had 3 Tylenol associated deaths come through the ER. Most folks think the drug is innocuous and frequently take more than the recommended dose. The maximum daily dose is 4 grams, or 2 extra strength four times daily. I've treated folks who've taken that many is as little as two hours. Then there's the Tylenol #3 abuse problem.

Tylenol is also the most commonly used drug in suicide. Virtually every household has some, and usually in large quantity.


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## medicineman (13 Nov 2012)

Lots of people take products that have acetaminophen in them without looking at the bottles, then take handsfull of Tylenol Arthritis or Extra Strength, then wreck their livers by taking too much.  Happens all the time.  I spend an awful lot of time counselling people to make sure they don't exceed the max dose.

To the OP, CF members aren't really supposed to self-medicate, especially one's in certain specialist trades - that's why someone is supposed to assess them before handing out pills for "just in case" reasons.  You'd be surprised how many people I've assessed because a pharmacist's Spidey Sense started tingling and there was something wrong...all because they wanted an antacid or tylenol or advil.

MM


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## Armymedic (13 Nov 2012)

Brihard,
Acetaminophen is toxic to the liver.

If your family medicine cabinet has any cold, flu or pain relief medication in it, look under the small print for the active ingredients. Bet dollars to donuts it has acetaminophen in it.

The max daily dose of Acetaminophen is 4000 mg. Extra strength Tylenol is 500 mg tablets. Take 2 pills 4 times a day you have reached daily safe max dose. Add in a drink of Neocitron (1000mg) and perhaps a mouthful of nighttime cold and flu liquid (500-750mg per 15 ml) and you now have what is considered a harmful dose. Do that over 3-4 days, and you may have a fatal dose.

Easy as that.

Edit to add: all Medicinal chemicals (as we call them:"drugs") are by another measure poisons. At dosages of X mg/kg they provide a helpful and desired medicinal effect. At dosages of Y mg/kg they are become harmful where the adverse effects outweight the helpful effects. At Z mg/kg they are lethal.

There is no "safe drug".


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## medicineman (13 Nov 2012)

Rider Pride said:
			
		

> Edit to add: all Medicinal chemicals (as we call them:"drugs") are by another measure poisons. At dosages of X mg/kg they provide a helpful and desired medicinal effect. At dosages of Y mg/kg they are become harmful where the adverse effects outweight the helpful effects. At Z mg/kg they are lethal.
> 
> There is no "safe drug".



I'd go one step further and quote Paracelsus " All substances are poisons; there are no substances that aren't poisons; the right dose differentiates the poison..."

In plain English - anything that goes into you is potentially harmful...even the good things.  As the other saying goes, you can get too much of a good thing  :nod:

MM


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## CombatDoc (15 Nov 2012)

ModlrMike said:
			
		

> I'm not positive, but I don't think OTC meds are covered by the Spectrum of Care any more. It has been that way for many years. OTC meds are no longer covered by any provincial formulary either (with the execption of NIMB).


Just to clarify - OTC medications are still covered under the CF Spectrum of Care, both in garrison and during deployment.


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## TN2IC (16 Nov 2012)

Just wondering is there a "e-list" of these OTC that the pharmacy will have on hand? I just found out the one here has Epsom salt for my feet. Great stuff.


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## PuckChaser (16 Nov 2012)

Kingston has a handy form for OTC meds, just hand it in to the Pharm O/Pharmacist there and wait in line. Got a whole bottle of Ibuprofin today with no issue, although I did explain it was for pain management post surgery so I can stop taking the hard stuff.


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## Indig (17 Nov 2012)

Macey said:
			
		

> Just wondering is there a "e-list" of these OTC that the pharmacy will have on hand? I just found out the one here has Epsom salt for my feet. Great stuff.


Canadian Forces Drug Benefit List:
http://hrapp.forces.gc.ca/bl-lm/default-eng.asp

Many caveats:  
1) This is the list of pre-approved drugs in the system - this is not what you are entitled to, nor is it a list of what each pharmacy stocks.  Just because the CF stocks sniper rifles doesn't mean I can walk in and get one. 
2) This list isn't always 100% accurate/updated.
3) There are certain drugs that can be covered under special circumstances - your doc/pharm will tell you more if it applies.
4) Base pharmacist(s) are the point of contact for what drugs you get or don't get - if they tell you no, it means no.

To answer your question though:  each pharmacy determines their own stocks based on the demands of the supported personnel and the local physicians.  They also determine their own SOPs for how you can request OTCs (e.g. a short-staffed pharmacy will make you go to sick parade for assessment).  That being said, if you find a common OTC on the benefit list, they likely have it.  If not, they may be willing to order it in for you if its reasonable and you're very very nice about it.


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