Why couldn't I buy this OTC medication?

[Silvercatowner]

I'm struggling to understand. I have co-codomol prescribed by my GP - I have arthritis. I ran out and realised my usual pharmacy had lost the repeat prescription that the surgery sent over. I went into another pharmacy - the person behind the counter asked why I needed it and explained - but they wouldn't sell me any. Apparently I needed to contact my surgery (an hour on the phone usually) or 111. I went to another pharmacy and bought the pills - I wasn't asked why I needed them (but was ready to say I had toothache or somesuch limited condition).

Is is just co-codamol you are prescribed for your arthritis?

Are you you medicated for the actual condition?

I recently had a horrible flare (I have arthritis) and I was advised by my rheumatology nurse to add in some co-codamol to see me through the worst. My pharmacist wouldn't sell them to me!!! I get my prescription pain meds from said pharmacy but my actual arthritis medication is prescribed by the hospital. I made the mistake of being honest about what I already take to the pharmacist who served me and that was it. They said I needed a prescription from GP or hospital to get OTC medication.

It's obviously a slightly different situation and I do understand the pharmacist's position. I did actually go to a different chemist for the medication and said it was for backache

As an aside I think you need to review your pain medication and / or what you use to treat your actual arthritis.

Pharmacist here.

There are three categories of drugs.

GSL - general sales licence. Can be sold in any shop/supermarket/vending machine etc.

P - pharmacy only. Sold only in pharmacies at the discretion of the pharmacist.

POM - prescription only medication. Self explanatory, exceptions made in genuine emergencies if the pharmacist deems this appropriate.

The P medicines are a funny one. The pharmacist in charge takes personal responsibility for the sale of these medicines and is entitled to refuse sale. However, pharmacists, like any other health professionals, don’t always get it right. I have definitely seen over cautious pharmacists, and I have also seen lax ones. I’d prefer the over cautious personally. Additionally, it’s often not the pharmacist selling these medicines, it’s NVQ2 level trained staff, despite the fact the pharmacist takes responsibility for the sale.

I would usually not sell co-codamol to someone who had it on prescription. But you are right, you can just go elsewhere. The rules are strange and I’m not going to defend them. But that’s how it is.

I was grilled by a pharmacy assistant in Boots when I asked for co-codomol, asked my condition and then further details - it was really unnecessary - felt like a bit of a power trip. I told her to keep them and went to the independent next door - I won't go into Boots anymore. It's frustrating when you have a long-term condition and need co-codamol - the GP tells you to buy it over the counter and then the chemist makes you feel like you are doing something underhand. It's so frustrating and upsetting - especially when you are in pain.

@FudgeSundae

Every so often you get a ridiculous pharmacist. I had one that wouldn’t let me buy baby aspirin (which is an OTC medication) because I was pregnant. Even though the midwife had told me to take it because I was pregnant! Luckily my GP is amazing so I was able to get a prescription sent to the pharmacy the same day. But they absolutely can and do refuse OTC medication.

It is illegal for that 'ridiculous pharmacist' to sell aspirin to a pregnant woman. They would have put their licence at risk had they given you it without a prescription.

@TasteRevolution It is frustrating if a GP has told you to, but GPs are often wrong as it is not their job to know about over the counter sales regulations. It feels very unfair in my job to take the flack from someone who has been misinformed by someone else! Big chains like Boots use a standard formula of questions to make sure an important detail isn’t missed, e.g. an interacting medication, or an opportunity to advice on a more suitable treatment. Can’t really comment on the power trip thing but I would say lots of people take valid questions as a personal attack. But the fact is medicines and health involve personal factors, and the aim is risk reduction. I greatly sympathise about being in pain, it’s so horrible.

*advise

[quote XxHollyValancexX]@TasteRevolution It is frustrating if a GP has told you to, but GPs are often wrong as it is not their job to know about over the counter sales regulations. It feels very unfair in my job to take the flack from someone who has been misinformed by someone else! Big chains like Boots use a standard formula of questions to make sure an important detail isn’t missed, e.g. an interacting medication, or an opportunity to advice on a more suitable treatment. Can’t really comment on the power trip thing but I would say lots of people take valid questions as a personal attack. But the fact is medicines and health involve personal factors, and the aim is risk reduction. I greatly sympathise about being in pain, it’s so horrible.[/quote]
I can only say that my experience in Boots stood out - no one else has ever questioned me to that extent - it was completely unnecessary.

[quote XxHollyValancexX]@TasteRevolution It is frustrating if a GP has told you to, but GPs are often wrong as it is not their job to know about over the counter sales regulations. It feels very unfair in my job to take the flack from someone who has been misinformed by someone else! Big chains like Boots use a standard formula of questions to make sure an important detail isn’t missed, e.g. an interacting medication, or an opportunity to advice on a more suitable treatment. Can’t really comment on the power trip thing but I would say lots of people take valid questions as a personal attack. But the fact is medicines and health involve personal factors, and the aim is risk reduction. I greatly sympathise about being in pain, it’s so horrible.[/quote]
Have also been prescribed medication by a consultant and the pharmacist scared the shit out of me and told me not to take it, it was too dangerous The consultant was furious when I told them what happened. Patients end up getting caught in the middle. It’s very frustrating.

@TasteRevolution It all works in a very strange, outdated way in my opinion. Your example shows this. Pharmacists cannot see full health records and therefore we don’t even know why someone is taking a medication (if there is more than one use for it). We are very much in the dark, trying to mitigate risks when we don’t have all the facts at our disposal. Any unusual uses or doses will and should be questioned by a pharmacist because prescribing mistakes happen all the time, except you don’t really hear about those. I have certainly had to put consultants in their place before now for being wrong about the use of a drug in order to protect the patient. But we don’t always get it right. Part of the problem is that we pharmacists take 50% of the responsibility if we dispense something that the DOCTOR has got wrong. We can not only lose our registration but be prosecuted for manslaughter (unlike the doctor!). This leads to being cautious in the extreme, and sometimes this causes patients to be affected negatively by our caution. This is not done with anything but the intention to reduce harm, but of course it really is far from ideal as it can backfire.

@TasteRevolution And yes, there are definitely coarse mannered, interrogative, know it all’s (but they really don’t) working on medicines counters 😬 A little knowledge is dangerous! I find it deeply embarrassing when working with them and it really sets my teeth on edge that I am taking legal responsibility for their words and actions.

@LizDoingTheCanCan

Electronic prescriptions don't get lost. If it wasn't ready they could have dispensed it while you waited.

It does come across that you were trying to get more, and the first chemist did the right thing. Please speak to your GP for more support. (No judgment, I'm also on medication I'll never be able to come off.)

I took this to be a very well-meaning and constructive post.

@Silvercatowner

Yes, prescription was sent electronically but chemist loses stuff very regularly. I didn't realise that it wasn't ready - my fault but didn't think I wouldn't be able to buy it OTC. But I could buy it OTC... just not from that chemist!!! And yes - I probably am addicted to codeine - it's prescribed separately as well and I've been taking it for 15 years now. My GP is happy with the management of my arthritis and so am I (and I don't drink or smoke, or take other drugs, just to add). Weird. If it happens again I'll just say I've got toothache or something. Thanks for the thoughts. I suspect *@FudgeSundae* is closest to an explanation!

Why didn’t you just buy some from the chemist that lost your prescription? Surely they’d have known they’d lost it, that it was due and so sell you some?

@TasteRevolution

I was grilled by a pharmacy assistant in Boots when I asked for co-codomol, asked my condition and then further details - it was really unnecessary - felt like a bit of a power trip. I told her to keep them and went to the independent next door - I won't go into Boots anymore. It's frustrating when you have a long-term condition and need co-codamol - the GP tells you to buy it over the counter and then the chemist makes you feel like you are doing something underhand. It's so frustrating and upsetting - especially when you are in pain.

Pharmacy assistant doing their job gets castigated!

2 day course?! 😂 I wish my dispensers and counter assistants only had to train for 2 days, that would free up a lot of my time and cost a lot less!

The lack of understanding from fellow HCPs is concerning as well. I don’t care if your sister is a nurse, I am not about to lose my registration because you want to dip your 2 month old baby’s dummy into a bottle of Sudafed liquid (a genuine complaint I’ve had before!)

Apologies, I’m very defensive about this because my counter assistants and dispensers are so valuable to me, I’d be lost and running a very dangerous pharmacy without them.

Anyway, OP, sorry to hear of your experience. I’m not entirely sure how they would’ve lost it. Even if it had already been dispensed and put into retrieval, they could’ve re-dispensed it for you.
Would definitely recommend that if this happens again; obtain the prescription barcode or using your NHS number, get the item(s) elsewhere.

I think people forget that medicines can be dangerous (the golden rule; the dose makes the poison) and unfortunately, in my area anyway, there’s a huge amount of OTC abuse.
If you were to mention that you take prescribed co-codamol AND codeine but had run out so were seeking OTC co-codamol, I would not sell it to you.

You also say that you probably are addicted to codeine - have you spoken to your GP about this?

A lot of pharmacy teams are so ‘difficult’ about otc co-cocodamol is because we see codeine addiction every day. It’s awful to see and is even more awful for the people addicted as well.

We don’t enjoy having to ask questions, we understand that it can feel intrusive and we don’t want people to go without a treatment.

The company I did my pre-reg with and continued to work for for 5 years, have always had guidelines on OTC consultations but would receive complaints about them being intrusive, so a lot of staff would just settle on asking things like “is it for yourself and do you take any other medication?” and continuing with the sale. However, they would receive complaints and phone calls from patients who had gone home, read the information leaflet, and found out that the medication was unsuitable for them. So there is a reason why these consultations are important.

I’m reluctant to recommend an online pharmacy. They’re brilliant for certain situations like housebound patients but a pain in the arse when it comes to interim prescriptions (antibiotics, newly prescribed items etc). Also, by losing regular items, the pharmacy obviously loses funds, which leads to cuts. The drive for pharmacies being the first port of call for advice & services is a brilliant idea, just as long as there’s the staff to provide these services…

I’m not saying every pharmacist, every dispenser, and every counter assistant is perfect. They’re not. I’ve worked with enough and be served by enough to know this! But, unfortunately, all HCPs are capable of being less than perfect and making mistakes. Yes, even doctors, nurses, consultants, specialists, surgeons etc…

Sorry to hijack the thread with this massive rambling but I feel very protective over my profession, especially after our workload increased massively over the pandemic while GP and dental surgeries were closed.

I don't really trust pharmacists. One gave me sodium valproate instead of valproate semi-sodium and insisted it was the same, and while I know they're extremely similar, that wasn't what I was prescribed. One gave me citalopram instead of escitalopram and tried to "reassure" me it was just the same drug by a different name, then looked blank when I tried to talk about optical isomers and the fact I'd need twice as much to get the same effect. And one told me that for my hayfever symptoms I could take any antihistamine I wanted with my MAOI. Each time, I'd asked to speak to the pharmacist, so either they lied to me and I was speaking to a sales assistant, or the pharmacist doesn't know basic stuff about their job.

@ClumpingBambooIsALie That is all beyond shocking. I can’t say I blame you with those experiences! I sincerely hope you didn’t come to any harm. Then again, I don’t trust doctors due to many experiences. The takeaway is don’t trust anyone blindly I guess.

@tevadiva great username! Yes, doctors and nurses and all the rest do make plenty of mistakes. But are under far less scrutiny. I have witnessed so many things since working in a GP surgery that make my hair curl.

Holly — no harm, as luckily I'm able to check my drugs and have a reasonable idea of what I'm prescribed and why. I'm more concerned about patients who for whatever reason (dementia? trouble with reading? all kinds of stuff, I suppose) rely entirely on the pharmacist getting stuff right. It's awkward because it's a high-pressure job and in hundreds and hundreds of instances, getting a prescription has been entirely uneventful for me, whereas the times they've got it wrong are burned in my memory forever

@Soontobe60
Pharmacy assistant doing their job gets castigated! She was not doing her job, she was being excessive but I'm sure she appreciates your support!😂

[quote XxHollyValancexX]@TasteRevolution It all works in a very strange, outdated way in my opinion. Your example shows this. Pharmacists cannot see full health records and therefore we don’t even know why someone is taking a medication (if there is more than one use for it). We are very much in the dark, trying to mitigate risks when we don’t have all the facts at our disposal. Any unusual uses or doses will and should be questioned by a pharmacist because prescribing mistakes happen all the time, except you don’t really hear about those. I have certainly had to put consultants in their place before now for being wrong about the use of a drug in order to protect the patient. But we don’t always get it right. Part of the problem is that we pharmacists take 50% of the responsibility if we dispense something that the DOCTOR has got wrong. We can not only lose our registration but be prosecuted for manslaughter (unlike the doctor!). This leads to being cautious in the extreme, and sometimes this causes patients to be affected negatively by our caution. This is not done with anything but the intention to reduce harm, but of course it really is far from ideal as it can backfire.[/quote]
@XxhollyValencexX

Interesting to see your views on things. And a huge thank you as a GP for all you do. You are an amazing help to us!

tevadiva — I have a grudge against Teva because their generic lamotrigine were the most horrible tablets I've ever taken (massive! weird colour! unnecessarily pointy! porous and covered in foul-tasting powder to ensure they'll stick to the back of your tongue before moving on to use their pointy corners to stick in your throat!). Used to actively avoid the pharmacy that sometimes stocked it :-|

[quote XxHollyValancexX]@TasteRevolution And yes, there are definitely coarse mannered, interrogative, know it all’s (but they really don’t) working on medicines counters 😬 A little knowledge is dangerous! I find it deeply embarrassing when working with them and it really sets my teeth on edge that I am taking legal responsibility for their words and actions.[/quote]
And I think the other problem is that counter assistants are asking you about your personal medical history in a shop, it's not the environment I wish to discuss my personal business.

@Musicaltheatremum I am a pharmacist. I work in a GP surgery.

@TasteRevolution The shop environment aspect is another reason I would reform everything. But we have to work with what we’ve got for now. I would suggest asking to speak in the consultation room.

But ultimately they are doing their job I’m afraid. They need to establish what drug is being asked for, why, what other medicines are being taken, what other conditions the person has, if there are any factors like pregnancy or breastfeeding. They also need to point out the dose, relevant cautions, tell the person to read the leaflet, safety-net (if this hasn’t helped within 1 week see your GP etc.) all while trying to maintain confidentiality at a shop counter. It can feel like an impossible sometimes. But that IS doing the job properly. It’s not fun, we take a lot of grief, but we could seriously harm someone (not to mention lose our job or be prosecuted) for not doing things correctly.

[quote XxHollyValancexX]@TasteRevolution The shop environment aspect is another reason I would reform everything. But we have to work with what we’ve got for now. I would suggest asking to speak in the consultation room.

But ultimately they are doing their job I’m afraid. They need to establish what drug is being asked for, why, what other medicines are being taken, what other conditions the person has, if there are any factors like pregnancy or breastfeeding. They also need to point out the dose, relevant cautions, tell the person to read the leaflet, safety-net (if this hasn’t helped within 1 week see your GP etc.) all while trying to maintain confidentiality at a shop counter. It can feel like an impossible sometimes. But that IS doing the job properly. It’s not fun, we take a lot of grief, but we could seriously harm someone (not to mention lose our job or be prosecuted) for not doing things correctly.[/quote]
They went further than the situation you described - that was why I objected - they delved further into my medical condition than was necessary...they overstepped.

@Silvercatowner

Thanks everyone for the perspectives. I understand more now. (Loving the touching faith in GP/pharmacy practices though - that has made me laugh).

Our local pharmacy where our GP surgery send the prescriptions (can only be electronic) lose them all the time, it is so frustrating doing the 'but the pharmacy say they dont have it' 'but the GP has sent it over' discussion over and over again with the pair of them