Opioid crisis puts pharmacists on the front line, pressed to serve as drug cops

GRAND PRAIRIE, Texas — Pharmacist Joe Harmison has been burglarized so many times, he protects his business with a siren-and-strobe-light security system. He keeps his most potent pain pills locked in a gun safe, in a room protected by a steel door.

Still, he was hit with two attempted break-ins in two days last month.

It’s the price he pays for running a pharmacy as an opioid epidemic sweeps the United States.

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The crisis has upended many lives. Pharmacists, however, are in an especially tough position, pulled between patients in dire need of relief and people addicted to opioids who will stop at nothing to get their hands on the drugs. More than 4 million Americans abuse prescription painkillers, federal data show, and such gnawing need has fueled a thriving black market.

From behind their counters, pharmacists are increasingly, and controversially, called upon to play drug cop — to turn away abusers, to reject phony prescriptions, and to protect their inventory of pills from criminals who see pharmacies as an easy target.

“It’s a role that’s been given to us, and many pharmacists choose to embrace it, while others run as far away and as fast as they can,” Harmison said.

“People say, ‘It’s not fun. It’s not what I signed on for.’ But the way I see it, it’s what I’m supposed to do. I’m entrusted with these chemicals,” he said. “Not to be judicious would not be fulfilling my oath.”

A gregarious 69-year-old with a soft Texas drawl, Harmison challenges prescriptions written by doctors from fly-by-night clinics. He flatly turns away some customers, like the guy who drove to this town on the outskirts of Dallas in a vehicle with Louisiana license plates and presented a prescription written by a doctor in Houston, 300 miles away. Not only that, the guy insisted on paying cash.

“I’ve told people, ‘It looks like this prescription has been altered. I suggest you turn around and get out of here because I am going to call the cops,’” Harmison said.

He knows he’s putting himself in danger by turning away addicts who want pills. He points to marks on the frame of his pharmacy’s steel door — gouges where intruders have tried to wedge their way past and get at the drugs. These people are determined. Some could come back, angry and armed. “And that,” he said, “I don’t need.”

But he’s willing to take the risk — in the name of both protecting his integrity and the public health.

Pharmacist Joe Harmison
Kim Leeson for STATPharmacist Joe Harmison said he has turned away customers seeking opioid drug prescriptions that he believes are fraudulent.

An arrest at the pharmacy counter

Others aren’t so sure.

The expectation that they act as watchdogs has sent ripples of controversy among the nation’s 300,000 pharmacists. Some worry that they’ll hurt legitimate patients by denying them medication they desperately need. Challenging criminals could also put a pharmacist’s life at risk or tie him up as a witness in lengthy trials.

“Every time I pick up a pharmacist magazine I read where some pharmacist is caught up in a legal battle because they had to play drug cop,” one pharmacist wrote on the blog Pharm QD.“I mean seriously, we are pharmacists, not the” Drug Enforcement Administration.

Another wrote that there isn’t enough time to play detective: “Our attentions should be with the patients, anyway.”

Richard Logan believes they’re wrong. He has the street credentials to show he’s serious about tackling prescription drug abuse: He’s both a pharmacist and a working detective — an investigator in a multiagency drug task force for Mississippi and Scott counties in southeast Missouri.

“My colleagues do not want to do what I do,” said Logan, 63. “There have been multiple occasions where I have badged people at my pharmacy counter and arrested them right there.”

He relishes slapping those handcuffs on offenders.

“When I see someone trying to abuse the system, in my mind they’re standing in the way of patients who really need those drugs,” he said. “They’re bastardizing the good work that pharmacists are trying to do. So, yeah, putting the cuffs on them feels pretty darn good.”

Not long ago, Logan helped track a doctor who was writing illegal scripts for Schedule II drugs such as OxyContin, Demerol, and Vicodin, which are classified as having high potential for abuse. When the day came for the arrest, his colleagues let him take the doctor down.

“I’ll arrest a doctor, nurse, or pharmacist,” he said. “I have a photo I keep on my cell phone with this physician bent over his vehicle as I put the cuffs on him. It’s one of my proudest moments.”

Other pharmacists also take the issue personally.

“Those people with bad scripts could be selling these drugs to my kids, or to someone who might get so high they run over one of my kids,” said Frank Iannarone III, a pharmacist in Madison, N.J.

Pharmacist Joe Harmison
Kim Leeson for STATDespite the challenges posed by the opioid crisis, Joe Harmison is against proposals to toughen access to such medications for patients who may legitimately need them.

Empathy for the daily battles with pain

The other day, as Harmison sipped a cup of afternoon tea, his cell phone rang with a call from a local detective.

The cop was following up on an attempted burglary of his pharmacy last month. Surveillance cameras caught the criminals wearing gloves, face masks, and hooded sweatshirts as they tried to dismantle Harmison’s security system. The intruders returned one night later, this time entering the pharmacy to search for drugs. The break-in was foiled by the steel door leading to the dispensing room.

Harmison was lucky: Another nearby pharmacy had also recently been hit, and there the bad guys made off with medications carrying a street value of about $1 million.

As the detective talked, Harmison nodded a few times. He hung up with a sigh. “I think it’s gonna go nowhere,” he said of his case. “There’s nothing to go on.”

Though he’s frustrated by all the fraudulent prescriptions that come his way, Harmison sees the legitimate need for these powerful drugs every day. The patients who need them are the customers he serves every day in his pharmacy, a converted physician’s office tucked away in a business complex across the street from Texas General Hospital here in Grand Prairie, a western suburb of Dallas.

Harmison knows most of his customers by name and has studied the details of their diseases — the cancer or other maladies that make each waking hour a battle of pain so acute it often threatens their sanity.

He doesn’t want to make it harder for these patients to get the relief they need.

That’s why he’s has testified before Congress against proposals to toughen access to the medications he dispenses.

“There are people who really need this drug, who do good just to get out of bed with their terminal illnesses,” he said. “Do you really want them to have to get to their doctor every time they need a refill?”

Harmison stood before the computer in his dispensary, filling prescriptions beneath shelved bottles of antibiotics and muscle relaxants. He’s comfortable as drug cop. But he also wants to continue to be the friendly neighborhood pharmacist of Grand Prairie.

Friends have suggested he put bars on his windows and doors. He won’t do it. “If I have to do that, I’m retiring, I’m going home,” he said. “I am not going to work inside a cell.”

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