When pharmacists don't do their jobs, patients die
By Mike Wokasch

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Pharmacists are the last line of defense in for the safe use of prescription drugs. They are often the last check against prescribing errors or potential complications — e.g., drug interactions — from taking a prescribed drug. They also make sure drugs will be available when we need them, while maintaining the integrity of the supply chain by guarding against nefarious infiltration or other compromises to the safe distribution of prescription drugs.

INDUSTRY PULSE

What is the biggest concern in the pharmaceutical industry?
  • 1. Medication errors
  • 2. Cheap drugs
  • 3. Compounding pharmacies
  • 4. Drug shortages
  • 5. Drug abuse (narcotics)

I no longer practice pharmacy — that's in the best interest of patient safety — but I will never forget being taught in pharmacy school at the University of Minnesota that as healthcare professionals, patient health and well-being were our priority. Our responsibilities went well beyond being able to count by fives to get the right drug into the right container in the right amount for the right patient. We were reminded repeatedly there was no room for error in fulfilling our responsibilities. Even 99 percent is not good enough, because that 1 percent mistake could kill somebody.

Unfortunately, patients are dying because some pharmacists are not doing their jobs. Here are some pharmacist actions and behaviors that have contributed to patient mortality.

Medication errors

Medication errors occur when pharmacists dispense the wrong drug — including drugs to patients with documented allergy or known adverse reaction to the drug — the wrong dose, or a combination of drugs that can adversely interact with each other. Physicians make mistakes in prescribing, but it is the responsibility of the pharmacist to review and assess the prescription to avoid potentially doing harm to the patient.

This may require contacting the prescribing physician to discuss potential hazards and confirm the treatment plan. If the pharmacist doesn't catch an error, the patient probably won't catch it, and there is no other safety net except perhaps an observant caregiver in some cases. Best estimates are that deaths from medication errors are in the tens of thousands if not hundreds of thousands per year in the U.S.

In search of cheap drugs

There is nothing wrong with trying to get the best price possible for a drug. When pharmacists go outside the normal distribution channels, however, they expose patients to products from unverifiable sources, potentially counterfeit drugs, drugs that may have been exposed to deleterious storage conditions and dubious manufacturing processes.

Some pharmacists might suggest they do this to help patients keep drug costs down but how many take this risky route to improve their own profitability. We will probably never know the harm done and death toll from prescription drugs sourced from outside the traditional supply chain.

Compounding as a manufacturer

Compounding is not the issue. When done without regard for patient safety, however, and on a scale that no longer ensures consistency or sterility, it becomes hazardous. The serious nature of compounding mishaps is exemplified by the allegations against the New England Compounding Center (NECC). As many as 50 deaths are associated with fungal contamination of purportedly sterile products compounded by the NECC — a pharmacist-run company, with compounding supervised by pharmacists and regulated by pharmacists on the Massachusetts State Board of Pharmacy.

This is not an isolated case of a single pharmacist making a mistake but rather layers of pharmacists not doing their jobs to safeguard public health. Moreover, let us not forget the pharmacists who purchased these products knowing the products were coming from a nontraditional "manufacturer" and purchased outside normal distribution channels.

Drug shortages

Pharmacists have played a major insidious role in the drug shortages over the past couple of years. By demanding profit-eroding, lower and lower prices, pharmacists have reduced or eliminated the financial incentives and feasibility for generic drug manufacturers to continue producing hundreds of critical medicines. Many of these drugs, although they are generic, are not inexpensive to manufacture. This is especially true for sterile injectable drugs.

Unfortunately, these shortages have led to many patients being unable to get the life-saving drugs they need. Perhaps some of these pharmacists feel they have done their job by getting better prices for their patients or institutions. But at what cost to patients who can no longer get them? Even free drugs don't help patients if the drugs aren't available.

Source of narcotics

There is no doubt that narcotics are often the only relief from severe pain. At the same time, the abuse potential is well established, and pharmacists who fail to challenge the authenticity and medical need for narcotic prescriptions contribute to the easy "street access" of these abusive drugs. Narcotic abuse and overdoses kill (15,500 deaths in 2009 according to the FDA).

Pharmacists are critical gatekeepers for controlling legitimate access to these powerful drugs. As guardians of the prescription drug supply chain, pharmacists can either facilitate access (ignore the problem) or restrict access to narcotics intended to support addiction. Because of the abuse potential and lethality of overdose, narcotics are perhaps the most important class of prescription drugs in which pharmacists must forcefully control access to safeguard public health.

Most pharmacists take their role and responsibilities seriously and are not the subject of this article. On the other hand, patients continue to die, not just from their diseases but because some pharmacists are not doing their job. Perhaps this article will reinforce these responsibilities and remind those who may have forgotten or have become lax in their duties. Remember, 99 percent is not good enough. Patients' lives depend on perfect job performance by pharmacists.

Mike Wokasch, a pharmacist by training, is a 30-year pharmaceutical industry veteran, having held a number of positions of increasing responsibility at several large pharmaceutical companies including Merck, Abbott, Chiron, Bayer and Covance. Wokasch was also an executive at several technology-based companies including Promega, PanVera and Aurora Biosciences. He is the author of the book, "Pharmaplasia," which explores the changes needed in the pharmaceutical industry as it adapts to healthcare reform.