The Nanny State

TW: opioid use, bad medical people, chronic illness and pain talk, drug use, brief mention of disordered eating.

 

In the news, yet again, are opioids. Prince is reported to have died from an opioid overdose, and so the media is again awash in scare stories about how opioids are dangerous, and they’re so easy to overdose on. I’m sure everyone reading this has seen one of those articles, and thought ‘but that’s not like me!’.

 

The truth is that we are right. It is not like us. I started with Nurofen Plus, an ibuprofen/codeine blend, after a concussion. I was given no treatment at the hospital, and had to make my own way. Six weeks later, I was diagnosed with post-concussion syndrome, and my hormonal migraines suddenly disconnected from hormones and became all the time.

I still take Nurofen Plus, even though at best all it does is make the pain less. I have a very good reason for this. My reason is that I am allergic to paracetamol, and I’m on a very long waiting list for the pain clinic. My psychiatrist is watching me go from acute pain to chronic pain (although arguably I was already there and he just is seeing it progress further, as it becomes more obvious and I grow more comfortable talking to him), and there is nothing he can do except say ‘keep working on getting it down’. He asked around, and confirmed for himself the thing I learned through very painful and demeaning trial and error – there is nothing else that I can take. I am also deathly allergic to milk, and I know from experience that the lactose, used as a binding agent or sugar base in many cheap pills, can set off an anaphylactic reaction. Until I get off the waiting list, this is the only thing I can take that will make it so I can get to medical appointments, do basic shopping and eating, and get more meds.

 

It’s not great. Everyone will tell you it’s bad – the ibuprofen destroys the stomach lining (however, my stomach lining was destroyed from vomiting several times a day when I was comfort-eating cheese in order to have an allergic reaction to get me out of that rather unhealthy workplace, and has healed greatly since leaving there and converting to a vegan diet. My relationship with food is still not great, but that’s nothing to do with the medication.) The codeine has side effects. It can be addictive. The latter is the reason it’s only available over the counter in pharmacies. The government were trying to make it prescription only, but they put that off due to significant resistance. In my case, in the case of people like me, and people who are in similar situations for their own reasons, that was a relief.

 

Instead, however, from April 15th of this year, the Pharmacists’ Guild of Australia came up with a different ‘solution’. It wasn’t publicised, and nobody was notified before it was implemented, so people going to get cold medication (for example, Demazin and Codral), will also be lumped in with it, caught surprised and perhaps denied medication they need.

This ‘solution’ is that, rather than just talking to a pharmacist (and the ensuing ‘you have to see a doctor, this isn’t the best medication, have you tried ground unicorn hooves?’ conversation with someone who doesn’t know the first thing about your medical history) for their approval, you now also have to show ID to get a codeine medication in Australia. This isn’t the case for any medication not containing codeine on that level, so you can still get things like thrush cream and heart medication and Epipens without going through this particular humiliation.

The first time this happened to me, the pharmacist shoved a poorly photocopied flier in my face and put it back away where I couldn’t read it, and I was desperate, so I showed my drivers’ license (not supposed to be ID) and got out. Since then, I have been making a mental note of which pharmacies ask me, and not returning. I now fit the popular pattern of an addict – someone going to a different pharmacy each time to hide their usage. I can’t talk, so the idea of having to go through this conversation each time is very hard for me, as it would be for people with various kinds of anxiety, or people who have privacy concerns, or people who are sick and their thinking is impaired, or any other reason a person considers valid for not wanting to have an invasive personal conversation.

The most recent time this happened, the assistant said “Aideee?” and when I gave her a blank look, made an annoyed face, shrugged her shoulders, and made a rectangle with her fingers. “Drivers license,” she said. She spoke with an accent. Without context clues froma complete sentence, the telltale flyer hidden far enough away that the fine print is illegible, and having not had to show ID there before, I had no idea what she was saying. She snatched my drivers license away and kept it behind the desk. The pharmacist wasn’t there. I couldn’t go back later, because they had taken my license out of my sight (this is a no-no, for any kind of card. They’re not supposed to take it, in the same way they’re not supposed to swipe your credit card for you.) and I had to wait for a small eternity, standing by the counter, my back complaining, and the tears threatening, because I had just come out of that horrible gynaecologist appointment, and I wanted my meds, comfort food, and home.

 

That flyer, if you dig around a bit, you can find on the Pharmacists’ Guild site. I don’t want to give them hits, so you will have to find it yourself. It’s not hard, if you have the right search string and a PDF reader. It contains many things.

Notably, and one thing that has never been mentioned, in any pharmacy where they have taken my ID, is that they record all the details, and by purchasing the medication (which you need for your medical treatment, so you can’t just decide not to get it), you consent to them not only recording your name, address, and license number, but allow them to share it on a database which is open to every pharmacy who is involved in this scheme, so that is, every pharmacy, and by extension, every staff member that works there. You do not have to do this for any other medication on that grade (S3), and not even to collect your prescription for things graded much higher.

We live in an age where you can verify your identity online with your drivers license number – I just registered for a postal vote with it, for example. By keeping these details and making them accessible, they Pharmacists’ Guild is creating a database that pharmacy staff, any mildly enterprising hacker, or anyone who can see the piece of paper they write it all on (I kid you not; I have seen this at two pharmacies, in plain sight, and I could have snapped a picture on my phone of everyone’s details as they wrote in mine), can impersonate you to government agencies, or anyone else linked to them for this verification process. Can anyone say identity theft?

The policy also allows pharmacists to deny providing medication based on how often you’ve used it in the past. This hasn’t happened to me yet, because I scramble for my phone and tell them that I’m under supervision and waiting on a referral for pain management, but as Nurofen Plus is more expensive on prescription, nobody will prescribe it to me, because they think it’s stupid to have me pay more for something I should be able to access freely. I still get variations on ‘well you should ask for something else’ and ‘this isn’t the best medication for you’, which everyone knows already. My former GP wouldn’t follow my gastroenterologist’s recommendation that I be put on pure codeine tablets, because he said I “couldn’t cope with rehab”. My psychiatrist was shocked by this, and thinks it contributed to my condition escalating to the point it is now (not being properly managed will do that), but he won’t prescribe pain medication because it’s, you know, not his job. I have, in the meantime, been put on migraine medication that made the migraines worse, have tried medication which gave me vertigo and left me unable to see for 15 hours, and been to the GP and the ER with allergy symptoms. I don’t feel like explaining all of that to a pharmacist to justify why I might need two or three packets in a week, and why I need that specific brand, and I prefer that size because the blister packs are smaller, and so on. My note, which I carry in case of emergencies, would be a lot longer, and the fact is that they don’t need to know all that. (We live in a society where pharmacists can provide medical certificates for leave purposes, so their job is already inflated as it is.) Their job isn’t to diagnose patients, or provide detailed management – their job is to provide medication and make sure it’s the correct dose and won’t interact with anything else and accidentally kill someone. So “are you on any other medication?” is fine, “do you have stomach problems?” is okay(ish), the time they wouldn’t let me have it without a lecture because I grabbed a pregnancy test for someone who was too embarrassed to get it themselves because of the lecture, not okay, and “you can’t have this because I saw you six months ago” is not okay. (That happened last week. She was a relief pharmacist. I know I’m distinctive, but it was also hilarious because I had to buy pads at the same time and the assistant saw that and apologised and wished me luck. In other words, there is a valid reason to repeatedly buy medication that has a positive effect.)

 

Eventually, I suppose, all pharmacies will do this, either by peer pressure, or someone will decide that it’s working when it’s really not, and make it compulsory. Technically, it’s legal, because pharmacies are private property, and they can put any conditions they want on entries and purchases (like bag checks – they are allowed to ask, but you don’t have to comply), but it’s not great, and it’s certainly not a good look. You can not show your license, and risk not getting your meds, and having to go home and make do, or go somewhere else and try again, if you have the energy for that, but the reality is that for many, many people, that’s not a choice. If you’re snuffed up with the flu and your brain is mush and you just need to get it and get home so you can sleep, you don’t want to have to remember your ID, and you probably don’t want germs on it. If you’re in so much pain that you can’t walk properly, and the lights hurt, and your outside clothes hurt, you don’t want to have to fiddle around with pulling a thin plastic card out of your wallet, especially if because of your condition, your hands don’t work. It’s not just that they screen people who really need it by who is willing to show ID and who isn’t, they are recording it and keeping a database. Technically, they are bound by the 10 Privacy Principles, but they also rely on disclosure, and none of the pharmacies I have been to who have opted into this are actually disclosing anything about how they are using the information they are taking and allowing people to make an informed choice. Sometimes I go to a pharmacy and they offer to open it for me and get a glass of water so I can have some right there, because that’s how bad I look, even in outside clothes and makeup. I doubt they would agree that someone who they can see is visibly impaired can and/or should be making choices about their privacy and medical information, either, but that probably didn’t occur to anyone.

 

I’m not sure what to do about all this. I can make a list of the places I’ve been asked for ID, but it would be so local that it would only help people near me, and would probably out me. I can maintain a database for everyone, but that would require server space and energy, and I’m not sure I have that. (If people start sending me their lists, though, I’ll make a separate entry for all of them.) I thought about making an online petition, but I’ve never actually seen one of those be successful.

Hopefully, I can at least get the word out, so that other people can make informed choices, and perhaps the market can push back on this. However, eventually the government will make it harder to get the medication we need, no matter what we say, because they already took these off the shelves, and made it harder, and they’re very obvious about doing it again. Perhaps, one day, I’ll be in a position to risk not getting my meds, and see what happens if I refuse to participate in their scheme.

 

But I don’t think having a medical condition should override my right to privacy, and put me in a position where people think they can decide what is best for me without even knowing me. If they want to have a say, they can recommend I sign up for one of their medication reviews ($5 for 20 minutes of how to take medication and whether you should take Cartia and Aspirin at the same time) and I can decline. Otherwise, it’s not their job, and they’re being an obstacle to any chance I, and people like me, have at functioning. Which sucks.

 

TL;DR: Pharmacies across Australia are now asking for and recording details from your drivers licence in order to supply medications containing codeine. This is not a government requirement. They do not tell you they are keeping the details. They take your ID away from you in order to record it. This is not fair, as other medications of the same grade do not require this.  They are justifying it because codeine can be addictive. People who are using these medications often can’t use anything else and are under medical supervision, and are not addicted. Please spread the word, and push back if you feel safe doing so.

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