Pharmacists on track to be tracked October 29, 2018 billbrownblog.com

Just when you thought the pharmacy world couldn’t get any wackier, bingo, it does.  This week the Canadian Healthcare Network ran the following headline:

“Shoppers Drug Mart (SDM) To Begin Tracking Pharmacy Performance”.

First of all it should be noted that this really is LOBLAW not “Shoppers Drug Mart”.  SDM has really become just a brand, a very powerful brand albeit, but it is LOBLAW, the owner of SDM, that controls and manages SDM.

Second, it is likely ‘pharmacists’ that they want to track not ‘pharmacies’.  Same old challenge separating a ‘pharmacist’ from a ‘pharmacy’.  We know what a pharmacist is, and a pharmacy is just a space (a retail store) with lots of stuff (most of it not health related) on shelves.  Pharmacies in Canada are overwhelmingly owned and controlled by non-pharmacists; in this case Loblaw Companies Limited which is a subsidiary of George Weston Limited, Executive Chairman & CEO, Galen Weston Jr., the most important and powerful pharmacy leader in Canada today.

How the heck do you track a pharmacy?  It is individual pharmacists that LOBLAW wants to track.  To separate the wheat from the chafe, and to set standards which become minimum requirements for continued employment.

As an aside, LOBLAW has 135,000 employees, the vast majority of which are represented by the United Food and Commercial Workers union.  I wonder what would happen if LOBLAW attempted to track performance measurements on even one of these 135,000?

So a more accurate headline might have read: ‘Loblaw To Begin Tracking Pharmacists’ Performance’

A great deal of negative reaction from pharmacists flooded this news, but one particular comment really captured the tragic comedy that the pharmacy profession has become, as the once proud profession has become totally controlled by non-pharmacist corporations, collectively referred to as Big Pharmacy Retail (BPR).

The comment, with minor editing:

“I was left alone on a Saturday night with no assistant from 5 PM onward. I was bombarded with blister pack change requests, drop in requests for the flu shot, phones ringing off the hook, and customer inquiries. At one point I had 7 people waiting at the pick-up counter and 3 people in line at the drop off with 2 phone lines ringing. I wonder what kind of rating I would have had from that night alone. No breaks, no help, no raise in 5 years. It’s a sad state for the retail pharmacist, and then SDM pulls this stunt with a service survey?”

Does anyone believe that this is the exception?  As retail margins and market share continue to come under fierce competitive pressures, and from frontal assaults by online shopping, the pressure to maintain profitability becomes intolerable. Hence, the pursuit to produce more revenues with less cost of production becomes the core driving force.  Those ‘district managers’ (aka the swat teams of the retail offensive) run on high adrenaline 24 hours a day

The immediate question surely must be, what exactly does LOBLAW want to track?  In the case of the example of the pharmacist quoted above, how much more productivity could be squeezed out of this one individual?  If it is quality of patient care that is being measured, how is this squared by the need to cut labour costs through cutting hours and not replacing personnel who quit?

While such efforts to track and measure pharmacists by LOBLAW (and Green Shield) become the new reality for working pharmacists, the Ontario College of Pharmacists (OCP) is also working on an initiative to establish quality indicators for pharmacy care.

http://www.ocpinfo.com/library/other/download/quality-roundtable-synopsis.pdf

Will these OCP inspired measurements or indicators conflict with the ones that LOBLAW demands?  How do the values and obligations of a healthcare profession dovetail with the imperatives of a massive retail conglomerate like Weston/LOBLAW?

In the interest of the mental health of pharmacists (in Ontario anyways), would it be reasonable to ask the Ontario Pharmacists Association (OPA), who allegedly represent the interests of 10,000 members, to lead an initiative with the objective of creating a forum to bring together LOBLAW and the OCP to create a common set of measurements and indicators of success?   Please excuse my sarcasm.

Let’s keep this simple.  A ‘pharmacy’ does not legally exist unless there is a licensed registered graduate pharmacist on the premises, no matter whether it is an 800 square foot pharmacy, or a 200,000 square foot super mega drug food combo.  BPR believes it owns thousands of pharmacies, but really these are all just real estate/buildings which cannot even open their doors without a pharmacist present in the building.  Pharmacists remain the means of production.

Here is a suggested response to this initiative to track individual pharmacists’ performance based on arbitrary measurements, which make no sense in face of the already brutal working conditions most retail employee pharmacists working for BPR endure every day.

Ignore the whole thing.  Pull Martin Luther King Jr…peaceful protest.  The issue is one of control.  Control of the profession is long gone, (just don’t tell the OCP) but control of you as a person must remain with you.  Just do your job according to the obligations you undertook when you became a pharmacist to ensure maximum patient care.  Focus on your professional duties.  In the end they can’t fire everybody.

 

Cannabis, Cannabis, Cannabis: enough already. October 15, 2018

 

This stuff has been around for 5000 years at least.  It’s called grass, or weed, or pot, or hash or dope for a reason; it makes people dopey.  Some people like feeling dopey and that’s OK as long as they don’t harm anyone but themselves.  The latest move to decriminalize cannabis is an overdue idea as it is widely used for so called ‘recreational’ reasons.  To some people, feeling stoned or dopey is their form of recreation.  Apparently as many as 4 million Canadians use pot regularly, in spite of its illegal status.

While anecdote is not evidence, there are some documented experiences of patients using so called ‘medical cannabis’, especially in treating chronic pain, nausea during cancer treatment, and some forms of epilepsy gaining some benefit, largely from the cannabinoid component in weed.  This is a teeny fraction of cannabis users (about 120,000) and for them the term medical marijuana may not be an oxymoron.

For everyone else, the term medical marijuana is an inside joke.  It is ‘medical’ if the person says it is, kind of like ‘medical bourbon’.  It’s all in the eyes of the beholder.  The CMA remains doubtful about the usefulness and/or efficacy of medical cannabis.  Only 10% of physicians will even touch the stuff.  So why does pharmacy keep talking about it?  The main reason is as always money, big money.

In reality, what most ‘users’ are after is the THC; the “good stuff” that makes you stoned.  The use/harm of cannabis is probably no worse or no better than the use of alcohol, another toxin widely used by people for ‘recreational purposes’.  Way too much money, police resources, courts and prisons and way too many ruined lives have been wasted since the prohibition of cannabis in the 1930s.  Criminalizing cannabis for political and misinformed reasons, has been one of the largest examples of wasted taxpayers’ money in history.

Cannabis legalization is coming to Canada on Oct. 17, finally legalizing the stuff.    Plenty of enterprises across the country, from growers to retailers to the tech and tourism sectors, to stock brokers and of course drug stores are all chomping at the bit to reap a windfall from legal marijuana. But there remain difficult questions about cannabis use in the workplace, in homes, & while driving or operating dangerous machinery.  How many lives may be lost on the roads before someone realizes that maybe this whole thing was rushed for political reasons?  It’s fine if people like being stoned while listening to Pink Floyd in their own home or at a party.  It’s another thing if a stoned truck driver hauling 100 tons of steel plows into a stream of stopped vehicles on a highway because of his reduced reaction time.

Globe & Mail October 15, 2018                                                                                              Cannabis makes it harder to identify and react to driving distractions that can result in crashes, a clinical trial at McGill University found. About 80 per cent of the participants, aged 18 to 24, also reported feeling less safe to drive after using the drug, including five hours later.

One thing for sure, lots of people are going to make many tens of millions of dollars on cannabis.  The stock market thrives on hype like this.  It reminds one of the heady days of high tech.  As always, the usual suckers are going to get burned badly.

So what is Pharmacy’s official position on cannabis?  To say it is total confusion would be an understatement.  Note that at this point in time, pharmacies are not even part of the distribution channel for either ‘medical marijuana’ or the recreational stuff.  Pharmacies are presently not in the loop.

But as pharmacy struggles to find a place in this Wild West cannabis landscape, it is torn between its professional obligations , and the dominating reality that pharmacy is largely now controlled by corporate interests (BPR) in search of profits from the sale of any products, even the many useless or even harmful products found in many drug stores today.

To illustrate this embarrassment to pharmacy, this week an email was sent out by the OPA (Ontario Pharmacists Association) re a deputation made on October 11th before the Standing Committee on Social Policy at Queens Park.  The delegation consisted of the Chief Pharmacy Officer and the Vice Chair of the OPA.  In this document the OPA clearly states that the 10,000 pharmacist members represented by OPA OPPOSE the sale of recreational cannabis products in pharmacies.  The deputation largely advocates that pharmacists be allowed to dispense medical marijuana; the document also alleges that cannabis is just another drug that pharmacists can and should be available to consult on.

OPA deputation October 11, 2018                                                                                                   “In the absence of an amendment we would ask the Ontario government to seek formal approval of the Federal government for provincial authority to task pharmacists with the dispensing of medicinal cannabis pursuant to a medical order

At the same time, we want to make it absolutely clear that the members of the OPA   DO NOT want to distribute recreational cannabis”

Of course everyone knows that this is NOT where the real money is.

In contrast to this position, the NPAC (Neighbourhood Pharmacy Association of Canada (hitherto known as the Canadian Association of Chain Drug Stores) made a submission recently to the government of British Columbia (as well as to other provincial governments) re cannabis regulation.  In this document, argument is presented that pharmacists should be part of the distribution channel for medical marijuana for the same reasons as the OPA submission did.  The big difference in this NPAC document is that the NPAC clearly states that its members (Big Pharmacy Retail/BPR and all the assorted pharmacy brands/banners) DO want to sell recreational marijuana, and a spurious argument is outlined to support the position that pharmacists know how to handle tricky goods.  So does the LCBO.

Recent submission by NPAC to BC government                                                                         “Our members strongly believe that the Access to Cannabis for Medical Purposes Regulations should be amended so that pharmacists can be authorized to distribute and dispense medical cannabis.  Pharmacies play a significant role in managing the distribution of controlled products and they would be committed to work with all levels of government to ensure that recreational cannabis products are also sold legally in pharmacies”

And of course everyone knows that this IS where the real money is.

The large majority of the 10,000 pharmacist members of the OPA work for NPAC companies.  What is their individual position?  Who really represents them?  What about individual choice?  Do pharmacists support their provincial advocacy body’s position or their NPAC employer?  Some may not want to get involved with cannabis at all?  Will they be granted this choice by their NPAC backed employers?

Recognizing this contradiction, does anyone know what most pharmacists really think about being involved in the sale of cannabis products?  The non-pharmacist pharmacy owners (BPR) know what they want; they see a great opportunity to create traffic and boost profits at the retail level and there is no way BPR wants to be left behind.

Additionally, what is the position of the Pharmacy Regulatory Bodies?  The OCP (Ontario College of Pharmacists) has declared its position.  As part of its ‘Opioid Strategy’, it will now require all Ontario pharmacists to complete formal cannabis education as a condition for licensure by the year 2020.  Why isn’t there compulsory education for other drugs?  What makes cannabis so special?  Is this just more politics and an attempt at appearing proactive?   Isn’t this a case of overreaching of authority?  Would this OCP licensing requirement withstand a legal challenge?

In BC only 8% of registered pharmacists voted in recent council elections.  The BC College of Pharmacists is puzzled as to why.  Wonder what the percentage is in Ontario.

All this for a substance which may never actually come under the control of pharmacists, ‘medicinal’ or recreational.  There is a good possibility that pharmacy may be shut out altogether…not even the medical stuff, let alone the recreational stuff.

All this hype acts to give a 5,000 year old herbal substance, known as cannabis a heightened position within society that it simply does not deserve.  In the final analysis cannabis is just dope by another name.  Enjoy it if it’s your thing, but remember it still stinks, turns your hair yellow, probably does nothing for your libido, and makes you slur your words…so please don’t glorify it

Those pharmacists who consider themselves to be ‘conscientious objectors’ when it comes to cannabis in any form, must retain the right to just say no.