In 2012, right before prescription drug-monitoring programs (PDMP) shut everything down, I was seeing 11 doctors every month—the same 11 doctors, all on a refill basis. Each of them thought they were my pain management specialist or my psychiatrist, and prescribed the opioids and accompanying pharmaceuticals that I needed.
Oxycodone, oxymorphone, hydromorphone, methadone. It was the golden age of doctor-shopping. Anything was possible. One general practitioner wanted to wean me off the 10 mg Percocets he’d been prescribing and switch me to fentanyl patches. He said that because fentanyl was a designer drug, there was less risk of me getting addicted.
At first I was just sticking to prescribers inside the Medicaid network, but that would only cover one prescription of each class of drug per month. So I branched out to those who generously allowed me to pay in cash. Sometimes you’d have to give the doctor $100 on your way out, then give another $100 to the receptionist—his wife—but for the most part the out-of-pocket costs were really negligible. A lot of us made a living this way, reselling the drugs to people without prescriptions of their own.
Not all generics are created equal, or at least what people believe.
It wasn’t just opioids. But, as pharmaceuticals go, opioids are cheap. The rectangular white “coffins”—methadone tablets, the kind there was a market for—I was getting prescribed at 60 mg per day for pain. Each tablet cost me about $0.71, and would resale for between $6 and $8.
A prescription for 8 mg generic hydromorphone tablets, three times a day—the circle-shaped kind, not the shield-shaped kind—cost me $1.09 per tablet. Those sold all day long for $8 per tablet, and that was for bulk buys of 100 at a time. If someone was buying singles, they paid $12 per tablet.
Not all generics are created equal, or so people believe. People wanted not just any generic Xanax, but the 2 mg “G3722” manufactured by Greenstone LLC. They wanted the Teva Pharmaceuticals generic Klonopin, not another kind. The 30 mg orange ovals of generic Adderall were the most popular, though the round pink 20 mg tablets were up there too.
Some preferences it’s fair to chalk up to mythology, or individual things people had convinced themselves about the properties of one generic versus another. But, not to attach a moral value to drugs, some pills are obviously better or worse than others.
One company’s 2 mg buprenorphine tablet might be just a little microdot, the way it ought to be, but Roxane Laboratories made a 2 mg that was huge. All filler. Even if you weren’t going to crush and inject it, it was just this big ball of chalk no one wanted to deal with.
In the first couple of appointments one doctor kept sticking me with generic Adderall tablets that were not 5 mg, not 10 mg, but 7.5 mg. As if anyone had ever heard of such a thing. They had tons of filler, and nobody wanted to buy them in the first place because they were weird.
A monthly prescription of roxies could pay your rent, and that was just one scrip from just one doctor.
But 30 mg Roxicodone (roxies) tablets, if they were the M-30s everyone wanted, were going for $30 each. A monthly prescription could pay your rent, and that was just one scrip from just one doctor. I knew so many people who, in 2014 when the PDMP really came into full swing, man that was it for them. Their rent wasn’t paid, they had nothing. Had to figure everything out from scratch if they could.
These days, PDMP are how the Drug Enforcement Administration tracks controlled substance prescriptions—mainly opioids, especially if they come with a benzodiazepine and a muscle relaxant—by doctors who catered to such doctor-shoppers as myself. Whereas in 2012 my 11 doctors didn’t know about each other, or at least could pretend they didn’t, now prescribers are generally required to check a state database before they write you a prescription for anything interesting, and pharmacists must do the same before they fill it.
It’s been probably 10 years now since I’ve seen methadone pills on the street. PDMP and the opioid prescription crackdowns cut off tons of chronic pain patients from the pharmaceuticals they were using for an approved medical purpose, and many ended up navigating the much riskier street supply.
Doctor-shoppers like me were blamed for the crackdowns. But when you moralize drug use, there’s never a black-and-white line between the people whose need for pharmaceuticals is legitimate and the people whose need is not. All of us were cut off or suddenly faced with barriers to everything except street supply. When the supply we’d been using was safer.
Image via Wyoming Department of Health
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