When you take a prescription to the pharmacy, you expect the pharmacist to understand what he or she is handing over to you -- since, by definition, a pharmacist is "a person who is professionally qualified to prepare and dispense medicinal drugs." They are trained professionals who understand the "actions of drugs, drug uses, therapeutic roles, side effects, potential drug interactions and monitoring parameters."
Pharmacists are essentially the last line of defense between patients and potentially dangerous drugs -- and pharmacies even tout the expertise and personalized care they offer to their customers.
But according to a new report, you may not want to rely so much on a pharmacy's promise to take care of you and your health.
A recent report by the Chicago Tribune found that pharmacists don't always warn customers about potentially harmful drug combinations. In fact, the investigation into Chicago-area pharmacies found that it only happens about half of the time -- which means the other 50% of patients head home with medications that could cause extremely serious harm to their health.
Report: Only 51% of pharmacies warned patients about dangers of drug combinations
The Tribune sent reporters out to local pharmacies with prescriptions for two different medications: one for a common antibiotic (clarithromycin) and the other for drug commonly used to treat high cholesterol (simvastatin). When taken alone, these drugs are known to be pretty safe. But if you take them together, "they can cause a severe breakdown in muscle tissue and lead to kidney failure and death," according to the Tribune.
The group conducted a total of 223 "tests," which involved a reporter taking the two prescriptions to be filled simultaneously at one of various pharmacies, including local and independent stores, as well as regional and national chains.
Each pharmacy got a simple pass or fail. If the pharmacist recognized and noted the potentially harmful interaction of the two drugs and/or tried to contact the doctor who prescribed them, it was a pass. If the pharmacist didn't do either of these things, it was a fail.
Out of the 223 tests, only 114 pharmacies passed -- meaning if the situations were real, 109 patients would have walked away having no idea that their medications could end up killing them.
Here's a closer look at some of the fail rates:
- Independent pharmacies had the highest fail rate at 72% (23 fails out of 32 tests).
- CVS had the second-highest fail rate at 63%.
- Target, Kmart and Costco all had fail rates around 60%, with Walmart at 43%.
Walgreens failed only 30% of the tests conducted at its stores -- but missing 1 out of every 3 is still pretty bad.
Dangerous drug combinations have become a 'major public health problem'
According to the Tribune, dangerous drug combinations have become an increasingly bigger problem in the U.S., "hospitalizing tens of thousands of people each year."
The report added that "pharmacists are the last line of defense, and their role is growing as Americans use more prescription drugs than ever."
One in 10 Americans take five or more drugs, which is twice the percentage seen in 1994.
For the stores that passed the test, the pharmacists were very clear about the warnings. "You'll be on the floor. You can't have the two together," one Walgreens pharmacist told the Tribune. One Kmart pharmacist said, "I've seen people go to the hospital on this combination."
But on the other hand, the report points out that "in test after test, other pharmacists dispensed dangerous drug pairs at a fast-food pace, with little attention paid to customers. They failed to catch combinations that could trigger a stroke, result in kidney failure, deprive the body of oxygen or lead to unexpected pregnancy with a risk of birth defects."
What's causing the problem?
Part of the problem is pharmacists are so busy that it's difficult for many of them to offer that personalized care that the stores promise, because they're just filling as many prescriptions as possible each day.
In one situation, a pharmacist told the Tribune that "she typically fills 200 prescriptions in a nine-hour shift, or one every 2.7 minutes." She previously worked at a Walmart, where she said it was even worse. "We were doing 600 a day with two pharmacists with 10-hour shifts" -- which is one prescription every two minutes.
The pressure to fill so many requests comes from a variety of things -- intense competition, internal scoring methods, performance metrics and more -- it all just depends on the specific pharmacy.
In states where the law requires pharmacies to offer patient counseling, many of them have streamlined that part of the process by simply making customers check a box at check-out, stating whether they have questions about their prescriptions.
But that doesn't solve the problem if you don't know what to ask -- and most people don't because they aren't experts.
Overall, most of the professionals interviewed by the Tribune agreed that the biggest issue is time -- they're understaffed and overworked, and the results of the new report make that very clear.
In response to the report, several pharmacies have promised to improve their policies and systems to reduce the number of missed warnings.
How to protect yourself
If you're prescribed a new medicine, make sure to talk your doctor about any other drugs you're already taking or any other new ones you're being prescribed.
If you aren't sure, always ask the pharmacist to ensure the safety of the medication(s_). If your request for help is ignored, take your business elsewhere!