Benzo Combo No No
Pharmacy, USA, Virginia | Healthy | January 11, 2018
(I work in a popular chain pharmacy/convenience store as a pharmacy technician. It is a week before Christmas and patients are swarming in to get medications refilled before they depart for the holidays. I’m currently working at a prescription filling station that is directly across from where the pharmacist verifies them, allowing us to talk as we work. Another technician takes in a couple of prescriptions and preps them for data entry; however, when the pharmacist spots them, he immediately sees a problem.)
Pharmacist: “Whoa, I am not filling this.”
Other Technician: “Why, what’s up?”
Pharmacist: “This drug combo, carisoprodol, benzo, and an opiate…”
Me: “Bad combo?”
Pharmacist: “It’s outright lethal. I need to speak with the patient.”
(We try to page the patient back to the pharmacy via the store intercom, but it appears that they’ve already left. The pharmacist decides to contact the doctor who prescribed the drug trio to alert them to the potentially fatal consequences. He immediately identifies this doctor as being a sketchy one that he has dealt with in the past. Nonetheless, he steels himself for the call and gets him on the line.)
Pharmacist: “Hi, I’m calling because of a couple of prescriptions that you’ve prescribed for [Patient]. When taken together these drugs are a potentially lethal combo. I wanted to see if perhaps we could if we could get the carisoprodol switched to, say Flexeril.”
Doctor: “There’s been no issues in the past.”
Pharmacist: “Right… but you are aware that is THE Unholy Trinity of drugs, correct? If nothing has happened previously then great, but all it takes is a single time or misstep and the patient is going to die. I highly suggest a switch here.”
Doctor: “I don’t want to do that.”
Pharmacist: *blinks* “So, just so we’re on the same page, you want to knowingly prescribe this potentially deadly combo to the patient, rather than switching?”
Doctor: “I’ve already discussed it with the patient. It’s fine.”
Pharmacist: “Okay, well, I’m going to notify the patient of your decision and make them aware of what’s going on here. I need to cover my bases.”
Doctor: “All right, sure.”
(The pharmacist was shocked by the nonchalant nature of the doctor, but decided to follow his gut instinct and not fill all three scripts. While there are noted instances of patients taking these drugs together, they are few and far between, and the benefits do not outweigh the risks; finally, the sketchy nature of the doctor meant that the pharmacist was less than comfortable doing so. He notified the patient of the situation (who seemed more disappointed with the fact that we wouldn’t fill all three drugs than with the fact that the combo was lethal) and wrote a note on the prescription stating that it was denied as well as our contact number should the patient try to have it filled elsewhere.)
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