Five ways to get the drugs you need

February 25, 2014

pps

Jonathan Sackier
Jonathan Sackier

  • Surgeon, Clinical Professor 
  • 30 years of healthcare experience 
  • Author of the “Fly Well” column in AOPA PILOT 
  • Flying since 15 years old, owns a Columbia 400 

I can just imagine the response this title might elicit:

Dear AOPA Editor,

Has Dr. Sackier lost his mind? Is he seriously encouraging us to seek illicit drugs and engage in risky behaviors? I demand swift and suitable punishment be meted out to him!

Sincerely yours,

Outraged in Ohio

Only that is not what I am proposing, although it must be said that obtaining any of the dangerous and damaging “recreational pharmaceuticals” from a dimly lit street corner lowlife is a lot more straightforward than sourcing medications to maintain your health and, as I like to say, treading on the daisies instead of pushing them up. Let’s explore some of these issues.

  1. Regular checkups by your doctor make eminent sense. As we age, a range of conditions might appear and finding them before symptoms arise is wise. Of course, risks can be mitigated by eating a balanced diet, exercising regularly, and maintaining a healthy weight. So let’s assume your trusty doc has detected a problem, high blood pressure for argument’s sake, and he or she recommends Acme Pharmaceuticals’ brand new drug Stopattackalol. “Well Mr. Smith, you need to start treatment and this is the medication I would go for it I were you.” Except your doctor is not you, may not be a pilot, and as such does not understand the implications of prescribing a drug that could ground you. So it makes sense that you do understand this. Before marching out of there with prescription in hand, jump on to the AOPA “good-to-go” medication list, and if the new drug is not FAA-allowed, discuss alternatives with your doctor.
  2. So, next step. What are your obligations to the FAA and your aviation medical examiner regarding your condition and therapy? Make sure you understand that very clearly, so you do not cause yourself another medical condition—a major headache, which might require another med!
  3. All right, bureaucracy taken care of, now you just need to pick up your tablets. Unfortunately it is not that simple; fully 25 percent of patients walk away from pharmacy counters empty handed, gripping their chests to control the pain caused by sticker shock. Drugs are expensive! Before we get into ways to reduce the pain, a brief word about why pills are pricey. To bring a new chemical entity (fancy medispeak for “drug”) to market can cost a company around $1 billion and take 11 years, and many never make back their investment. Although the tablets themselves only cost pennies to manufacture, the developers have to recover sunken costs, rather like buying a computer program on CD-ROM—the plastic does not seem to be worth the $20, but one is paying for years of research and development. I know healthcare costs are out of control and a major source of pain for all of us—myself included—but just blaming pharma is naïve. Our research-based pharmaceutical companies employ hundreds of thousands of people, bring lots of money into the U.S. economy, and reward many through their pension plans, all while saving lives. During the Soviet era, the Soviet industry did precious little innovation and just focused on duplication while our capitalist economy has spawned advances that have transformed countless lives.
  4. Enough of my soapbox. If the drug you are offered is out of your price range, discuss whether a generic version might work for you. These copies of patented meds are the same chemical molecules but because the manufacturer has not invested in the R&D, it can make, and sell, the drug for considerably less. Also check online whether the drug company offers discount coupons; given the high walk-away numbers, pharmaceutical companies may “buy down” the cost of copays for your therapy. Also look into Pharmaceutical Benefit Management (PBM) discount cards. Some of these are free, and others require a subscription which may also provide for discounts on other health-related expenses. Do your research to ascertain if such programs work for your situation. Finally, if your insurance company rejects claims for any medications, do not roll over, but consider an appeal directly to them or engage your state ombudsman or patient advocacy organizations who speak on behalf of either disease-oriented groups or specific constituencies.
  5. This next one astounds me: Hypertension, hyperthyroidism, hypertrophic pulmonary osteoarthropathy (yes, it is a real disease) or hyperglotaritis (this one is fake though), once diagnosed, are not going away on their own. So why is it that so many patients unilaterally decide to stop taking their medication? Please, I implore you, if you have high cholesterol or anything else for which drugs have been prescribed, do not stop taking them without a full and frank conversation with your physician. The implications could be profound, and not just for your freedom to fly.
  6. Just recently, FDA Commissioner Dr. Margaret Hamburg visited India amid a series of scandals threatening that proud country’s international business reach and the safety of people around the world. A number of overseas pharmaceutical manufacturers have been found to have released, and sold online, medications that either contained no active ingredients or even dangerous ingredients. This alone should be enough to suggest caution when buying online, but there is more to the story. If you have a medical condition that merits treatment, further monitoring may be necessary, for instance blood tests to measure clotting or liver function. Online purchase will not provide the medical oversight that may be necessary. It astounds me how easy it is to get drugs online after answering relatively benign questions purportedly posed by a doctor at the other end of the computer. There may be cases where this is fine and I am sure there are some perfectly honorable and diligent pharmacies but please, use caution when considering using such services.

So, getting the drugs you need may take a few more steps than you thought necessary, just don’t take any steps toward dodgy-looking youth under street lamps selling little plastic bags!     

Jonathan Sackier