Our guest: Heidi Bragg, MBA, RPh, Drug Diversion Specialist Texas Children’s Hospital
Drug diversion monitoring in healthcare often focuses heavily on nursing units, but what about diversion within the pharmacy itself? In this episode, Heidi Bragg, Drug Diversion Specialist at Texas Children’s Hospital, shares compelling cases and insights about pharmacy-based diversion. Drawing from her extensive pharmacy experience, Heidi discusses why we must ‘mind our own store’ and remain vigilant about diversion risks within pharmacy departments. Through real-world examples and professional expertise, this conversation between two pharmacists highlights critical blind spots in traditional diversion monitoring approaches and emphasizes the importance of comprehensive pharmacy surveillance.
Transcript
Terri
My guest today is Heidi Bragg, the drug diversion specialist at Texas Children’s. Today we are going to talk about pharmacy and the fact that we sometimes forget that the pharmacy needs to mind their own house. Right. So this discussion between two pharmacists that see all too often the focus on nursing when it comes to diversion, and this podcast is going to serve as that reminder that we really cannot forget that there is most definitely diversion within the pharmacy as well. Welcome, Heidi. Yeah, Tell us a little bit about yourself.
Heidi Bragg
Hi. So I’m Heidi and I’ve been a pharmacist since 1994, so quite a while. And I’ve had a very varied past as far as my work history. So I’ve worked in all kinds of pharmacies, but also worked for the Board of Pharmacy in Texas for a number of years and saw some very sad drug diversion cases that were kind of breathtaking and really that pharmacists were taken advantage of because they just didn’t even know to look. So as we look at drug diversion programs, I always want to remind pharmacists, particularly in health system pharmacies, that most of the drugs are stored in the pharmacy. And so we’re not exempt from having drug diversion issues. And so we have to watch out for that.
Terri
Yeah, absolutely. And you had mentioned in all of your varied experiences, you have quite a breadth of experiences that either maybe at places that you worked or as you know, your involvement at the board of pharmacy, some historical. A lot of historical cases where diversion occurred in the pharmacy. So let’s start there. What kinds of things have you seen or been made aware of by others of diversion in the pharmacy? I mean, I think, you know, a lot of what I think is front and center and people think of are those big cases where it has to do with, you know, that the meds are coming in and then they’re going out by the bottles of a thousand. Right. That’s typically what you think of. And be hospital. That could be retail. That’s just those big, large volumes.
Terri
And then that’s where it kind of shifts too, between not necessarily the person with the substance use disorder, but maybe you start thinking about selling and making money. Right. But there’s a lot more things.
Heidi Bragg
Yeah, that’s definitely something that was eye opening for me when I started working in a regulatory practice was that I’m not looking for drug abusers. I’m looking for people who want to make a lot of money. And so you bring up a very good point. You know, we have all the drugs in the Pharmacy, we have the ability to order, which, you know, our nursing colleagues don’t really have that capability. And so how do you mind your own house to make sure that the drugs that are coming into the pharmacy are getting into our system of accountability, and even after that no one is doing something wrong with them. And so when you look at the ASHP guidelines for a drug diversion program, there’s lots of good tips in there about the types of processes that should be in place.
Heidi Bragg
And it may be a little bit different everywhere how you will actually do this. But one of the most important things to do is get an independent list of everything that’s ordered during a timeframe and make sure that it entered your system of accountability. So by starting that practice, it really, you know, keeps people mindful that we’re watching what comes in. And one story that I have from a past employer, a new technician, was actually new to the state where she was working, had only been working at the facility for about two weeks, but had a long history of being a technician on a Friday night, as she was filling the Pyxis machines throughout the hospital, she went to the day surgery center, where no one was there because it’s Friday night.
Heidi Bragg
And so before the cutoff time at the wholesaler, placed a phone call and placed an order. And so that order came in on Saturday morning. And she was the technician working Saturday morning. She was working with one pharmacist. And so that pharmacist, although they were there and present when the order arrived, they were very busy working, and they weren’t necessarily staying right beside her as she was checking everything in. And then, because she’s fairly new, she told the pharmacist, listen, I need these boxes because I’m moving. I’m going to go take them to my car. And so she had placed an order for pints of promethazine with codeine, which in our area is a very desired product on the streets. Of course, we don’t buy pints in the hospital.
Heidi Bragg
So when the invoice hit the desk of the purchaser on Monday morning, alerts went up and we did confront this person.
And she actually relinquished her technician registration to the board of pharmacy. She’d only been working two weeks, and then, voila, she was done. But that’s a good example where our purchaser knew immediately that something was wrong and couldn’t find those promethazine with codeine pints anywhere in the pharmacy. Because initially she thought, the purchaser thought, oh, well, this was ordered by mistake, right?
Terri
Like, oh, A mistake. I gotta fix this now and send this back.
Heidi Bragg
Exactly. But then when she couldn’t find those bottles, she knew this was not a mistake, this was on purpose. And so that’s a very good example. We’re having astute personnel and having them escalate it and not just wait for the problem to resolve was very vital in resolving that issue.
Terri
Right, right.
Heidi Bragg
And because they had processes in place, they knew what to do. So that was also important in that situation.
Terri
Yeah, you had said, you know, take an independent list and check it. Is that a recommendation on a daily basis? Weekly, monthly spot check? What have you seen is required and works best?
Heidi Bragg
What I see mostly is monthly, but you have to do what’s sustainable for your pharmacy. So if your pharmacy orders a lot of controlled substances and doing it at the end of the month is too tedious because there’s too much, then maybe you have to do it weekly. But you don’t want to have the same person doing it. And obviously you don’t want the person who’s doing the ordering to be the person who’s checking. You want that kind of independent review to make sure that you’re actually seeing all of the products that are being entered into the automation.
Terri
Right.
Heidi Bragg
So, you know, it should be a sustainable process, but it actually as simple as it is, it’s very high yield and you definitely catch those people who don’t understand that there are processes in place. So like our technician in that situation, that was a good example. I guess the other biggest tip I have for pharmacists is you have to be very aware of what’s going on. And you know, you work beside technicians all day, every day, and they’re people that you may have known for decades, you may have worked with them forever, and you have a deep sense of trust. But that’s exactly what will happen, is that someone who has that, you know, trust, if something changes in their life, they can use that to their advantage. So I always encourage people to keep people honest.
Heidi Bragg
And so my next story has to do with repackaging of medications. And certainly we get a lot of drug shortages in our business and they wreak havoc with our processes. And so at a time when unit dose hydrocodone was not available, the purchaser in a pharmacy was purchasing 100 count bottles and then they were having to unit dose those products. And you know, it’s tedious, it’s, it just feels like such a waste of time. But it has to be done because we need everything to be Unit dose. But nobody in the pharmacy really seemed to realize that even after the unit dose was available again, the purchaser was still buying 100 count bottles and unit dosing. And it was actually a very observant patient who called attention to what happened. And the nurse brought them a hydrocodone tablet.
Heidi Bragg
And they said, that doesn’t look like what I took before. Sure enough, the markings were checked and the tablet was actually a carbamazepine tablet. This trusted individual who had worked at the hospital for 20 plus years, had found medication that resembled the medication that she was unit dosing and was substituting and was very smart about it because the products that had a different inscription, she would have the blank side of the tablet showing. So honestly, when you just looked at the tablets, you didn’t really notice that it was the wrong thing because the inscription was showing for the correct tablets.
Terri
Well, and the empty bottle is sitting right there.
Heidi Bragg
Right there. And honestly, when I looked at it the first time, I didn’t notice, but it was an exact pattern. Like every other tablet was turned over. And so that was a very interesting diversion from the perspective that we could go back and look at when the carbamazepine purchases increased. And so we had an idea of how long it happened. And it’s interesting because this person was kind of in charge of the technicians in the pharmacy, and then also the one who printed all of the labels. And so when the pharmacists were like, oh, no, we don’t have any more unit dose of blah, blah, she was like, don’t worry, I’ll do it. Yeah, always coming to the rescue.
Heidi Bragg
And so it’s very hard for me to explain to people that, yes, you always have those people that you can rely on that are so great and so trustworthy, but when you give someone that much power, you know, the story in this situation was this person had a car accident, got hooked on hydrocodone as a result of that car accident, and she was using the supply herself.
Terri
Okay, that’s what I was gonna ask, because it’s a good reminder of you’ve worked with somebody for so long and they have been trustworthy for so long, but things change. And so I was gonna ask you what changed?
Heidi Bragg
Yep. And. And so that’s where being in tune with the people around you helps. I mean, you don’t want to be suspicious of everybody’s every movement, but being kind of conscientious of people going through hard times in their life, people talking about having severe cash shortage or needing Money. And then all of a sudden they don’t talk about that anymore. There is kind of an infamous case that I was not involved with, but it was with my previous employer, where a technician who was stealing medications from the pharmacy started to drive a Hummer. And that’s not something that most technicians can just afford. So why didn’t it occur to anyone that this person had a much larger influx of cash than what you would expect a technician to be able to have access to?
Terri
So, yeah, I think a tendency there would be to say, oh, well, it’s their spouse. Or it’s, you know, it’s like, well, I don’t know, maybe they inherited money. It’s like, you’re not going to go up to somebody and say, how did you afford that?
Heidi Bragg
I know we don’t want to be nosy, but on some level, when it’s someone who’s in a trustworthy position, you have to be a little bit like, verify.
Terri
Verify. Yeah. You know, going back to the technician that was unit dose packaging, looking back at it, were there other signs? I mean, did she not used to. She wouldn’t normally do unit dosing, didn’t used to do that, didn’t help with those kinds of things, or were there other things that people should have maybe questioned and didn’t?
Heidi Bragg
So I would say one of the things that could have been questioned were the purchases of drugs that weren’t often used. So why didn’t anyone notice that we’re buying an awful lot of carbamazepine. I’ll tell you why they didn’t notice. It’s inexpensive. And so that’s where even looking at drugs that aren’t controlled substances. But if you notice some unusual purchases of things to not let it just go, you have to figure out, like, why did this happen? Also, I talk about that with adjunct drugs. So we’ve definitely seen cases where, going back kind of the NER to the nursing side, nurses will take a handful of injectable Benadryl out of the automation and be administering Benadryl instead of the pain medication because the patient gets drowsy. So they think they’ve had pain relief.
Heidi Bragg
So if you notice over and over again, hey, we don’t have this on blind count, but maybe we need to put it on blind count because the drawer keeps showing up empty. And so we know the nurses are in there just kind of shopping for what they want.
Terri
Right.
Heidi Bragg
So, you know, a lot of these things are things that we learn in retrospect. It’s. It’s hard to Say that I could have figured that out the first time. But definitely in retrospect, Benadryl is something we watch in our house currently, just from the perspective that we’ve had a number of cases where it played a factor in a diversion of a controlled substance.
Terri
I’ve been hearing that more and more Benadryl is coming up more and more in people’s stories and things that they’re going through. And I think substitutions in general, but specifically, I’ve heard that Med mentioned a lot, but I think substitutions are, I mean, you know, the method has to keep changing.
Heidi Bragg
It does.
Terri
So there are different ways to do it. And I think it also, you know, it’s not also just pharmacy minding your own house, but pharmacy being educated.
Heidi Bragg
I agree.
Terri
I mean, I think a lot of times they there, I know I have encountered it where the pharmacy is just not knowledgeable on diversion, period. And a lot of the staff, I mean, maybe your director might be or your diversion specialist might be, but a lot of the staff, they don’t even give it any thought whatsoever. And something odd happens, or like you said, you know, the techs keep like, why is this Benadryl pocket always empty when it says there should be 20? You know, they need to know and then they need to say something. And so it’s any med. I mean, we could be just talking about an expensive med, which, you know, hopefully somebody’s going to notice because like you said, they’re watching those. But anytime it’s like, why are we ordering so much?
Terri
Or why do I keep refilling this when I didn’t ever have to be refilling this, they need to say something because there could be something else going on.
Heidi Bragg
Yes. And that’s also where sometimes having the. If your drug diversion program is located in the pharmacy to also have some external source that’s going to come in and at least audit that. It’s hard to, you know, the fox watching the hen house. But pharmacy is where we have a lot of drugs. And I think one of the scariest parts to me is that pharmacy is where we also have the most intelligence about our automation. And so kind of this last story I have to tell you is it’s going to make everyone go, oh, no. But when you’re setting up your automation, you have to tell the automation which medications you’re going to be doing blind count on, which medications you want to receive notification if the count is off.
Heidi Bragg
And so if you have a technician who has that knowledge base, so maybe they were your automation Technician originally, but now they’ve. Something in their life has changed and they’re working at night. They still know how to go in and change those things. Before, SOMA was a controlled substance. So it was quite a few years ago. About 10 years ago was kind of the first time I’d encountered a technician who was truly doing it for profit. That was the case. She’d been the automation technician at this hospital for a long time. So she knew how to go in. And although carisoprodol had been on blind count and also would show up on the override report and any.
Terri
Discrepancy reports.
Heidi Bragg
Thank you. I was missing that word. She turned all that off. And so then her MO was she would go and refill a handful of sleeves. So sometimes 70, sometimes 80 into one of the units in one of those pie shaped drawers in the pyxis. And then
later in her shift, she would go back, do an inventory of that drawer and zero it out and take the meds out. And now she had 80 soma that she could sell. And I remember interviewing her and she looked me straight in the eyes and said, I made $18,000 tax free last year. And that was a real eye opening experience for me because I always thought people stole so that they could use the medications or give it to someone that they knew.
Heidi Bragg
And I, it was naive of me to not realize that they would sell, but I learned real quick just about how valuable these drugs are. So that’s like you said, pharmacists need to understand this, that you have to keep an eye out for this. Not because your technician might say steal it to use it, but that it is very valuable on the street. When you realize that an Oxycontin goes $1 per milligram. Wow, that’s a lot of money. And so it can really be enticing to someone who has financial difficulties.
Terri
Yeah. So was she modifying the settings like at the beginning of the shift and then taking them back to the.
Heidi Bragg
I mean, how often do you go in and check your settings? She just had to do it one time and it was, you know. No, it didn’t occur to anyone that wasn’t showing up on overrides and it wasn’t showing up in discrepancies.
Terri
Yeah, nobody was using it. It’s not until somebody says, and probably a nurse. This used to require a witness, but it doesn’t require how come. And then that requires the person she told to say something and to look into it instead of just, well, I don’t know, don’t worry about it.
Heidi Bragg
The way we actually found her was in a process that’s kind of similar to what California requires. Now we started really analyzing everything that was purchased versus everything that was billed for in a timeframe. And we did that as a rolling like 90 days. And you know, sometimes there were discrepancies because, you know, maybe something you don’t use a lot would expire and you’d purchase it. So like when chloral hydrate was still on the market, it would go out of date. You know, it would get sent to the reverse distributor and then they’d buy a new pint bottle and but that was easy to explain and we could see that it was still on the shelf. So that is exactly how we found this person is, wait a minute, we’re buying all of this soma, but we’re not billing for very many.
Heidi Bragg
So where are the, you know, 10,000 soma that we purchased? Because they’re not in the safe. And then literally knowing that were missing those drugs, it was very easy to go to the automation and see that she’s the only one touching the medication.
Terri
Yeah.
Heidi Bragg
And she’s constantly touching it, you know, taking it to the unit, taking it out, taking it to the unit, taking it out. So it was a no brainer.
Terri
Right, Right. Interesting. What are your thoughts on, you know, sometimes it’s the top administrator, Right. In your pharmacy that has all access. And you know, I would always try to limit. You got to have somebody watching the, you know, the person that has the access, the full access and double checking each other. But what are your thoughts on how to. And you know, and it also plays into the culture of the department. Right. If I am your director of pharmacy and I had the attitude that, you know, I’m the boss, don’t question me, well then it’s going to be hard for people to question and me for easy to get away with something. Right. Because people don’t question. So it goes to the culture as well. But what are your thoughts on watching. Watching the boss.
Heidi Bragg
Yeah, no, I agree that watching the boss is important. There’s a very good example of a gentleman who was the director of pharmacy in New York Hospital and he was stealing oxygen cotton, he was signing it out like he was taking it to a non ADM location, but that non ADM location was his pocket. And so it never showed up as a discrepancy in their safe. But it, he wasn’t really taking it to a legitimate place. And so you do have to have someone who watches the boss or you have to have the boss not have access, which most directors of pharmacy aren’t comfortable with that, you know, because what if in an emergency they need to have access?
Heidi Bragg
And I, and I understand that, but like you have to have someone who doesn’t have the ability touch the drugs, but they have authority to get help if there’s problems with the records.
Terri
Right.
Heidi Bragg
And that’s the part that’s hard. I think it was important to me when I decided to change my role that I worked outside of the pharmacy. I have applied for some positions where it was in the pharmacy. And it just makes me uncomfortable to know, wait, I don’t have a dotted line or anything to compliance or regulatory or a lawyer somewhere, because what if my chief pharmacy officer doesn’t want to report these, you know, missing morphine out of the vaults? Yeah. That always puts the diversion person in a very uncomfortable position.
Terri
That’s true. Yeah. Then you start thinking, do I step outside and just drop a hint to somebody?
Heidi Bragg
And yeah, it does make it really challenging. And I do like the fact that I work at Texas Children’s Hospital in Houston and I report to a lawyer who’s in risk management. And a lot of people don’t understand the importance of reporting to a lawyer until you’ve gone through a deep investigation with the government. But being able to do things as part of attorney work product is very valuable. And so I appreciate the fact that I’m able to do a full investigation and not be worried that it’s going to fall into the wrong hands. Instead, we can use that as attorney work product and know that we have a way to safeguard that information. In other states you might be able to do that as part of peer review, but in Texas in particular, peer review is a little bit different.
Heidi Bragg
So this is probably the best way in my state to do this.
Terri
Yeah. And I’ve only heard of peer review being used for physicians. I don’t know if some states incorporate other disciplines that way.
Heidi Bragg
Yeah, A lot of pharmacies will call it continuous quality improvement and there are some states that require it. But it’s not necessarily drug diversion related. It’s more about errors.
Terri
Right.
Heidi Bragg
Yeah. And so, you know, there’s definitely a lot of stuff that we find out in the course of an investigation that we might not want to be public information. So there are things that we want to make better and do better the next time. And so it’s already so challenging because you mentioned that, you know, substitution has become such an issue. Where I live in Texas, substitution has become such a big issue that I warn all of our nurses that it’s something that could, and they could end up in jail. Our attorney, district attorney here in Harris county, they’re willing to take those to trial. And we have a 25 year old nurse that just recently lost her license for life and had to go to jail.
Heidi Bragg
And that’s another reason why I really hope that people learn a little bit more about diversion and report incidents before the person escalates to that point.
Terri
Yeah, yeah. They think they’re protecting them by not saying anything, but they’re not. Yeah, not them or the patients for that matter. And you know, the legal aspect that you bring up I think is a really good point. I think, you know, you learn as you go. I think maybe a lot of places don’t have it under legal for sure and don’t have legal involved. And so that you’re doing an investigation, it looks just like what you’re doing, but maybe it’s not legally protected. So what are the boundaries on that? That’s an interesting.
Heidi Bragg
Yeah. And like if you actually talk to risk, I mean they’re already used to doing root cause analysis and so they’re used to exactly what we do. It hasn’t always been an easy fit, but as we’re in this division longer, it becomes better and fit, especially as our attorneys learn more about diversion. It’s been a good growing process for us.
Terri
Yeah, I’m sure it is. That’s the key, is that you all understand it, you’re all on the same page in terms of what you’re protecting and you know, then you move forward. So it’s just what I have found too many times is that the diversion specialist has to get everybody else up to speed and on board to take it seriously. Right. And then to what are we going to do about this? And once everybody’s there, then it’s great.
Heidi Bragg
Yes, I agree. And you know, I feel very fortunate currently where I work that being outside of the pharmacy, we still look at the pharmacy and they know that, but that we’re a very good independent review and really help to potentially solve issues that come up.
Terri
Right, right. I believe you have diversion software. Have you found that useful in watching pharmacy or. It’s got some limitations.
Heidi Bragg
It has some limitations. And the diversion software, it tends to be more oriented towards the administration side because there’s a lot of data there that they can parse and look at. In my particular situation, we happen to have some automation in our pharmacy. So we do get to see our pharmacy a little bit. But my biggest word of caution about the software is you have to know the weaknesses. And I’ll be honest, the weakness isn’t always the software. The weakness could be that there’s a process going on in your pharmacy that operationally you have to do it that way for some reason, but that means you have to turn off some alerts in the software.
Heidi Bragg
And so if you’re not communicating with the team that is implementing the software so that you know where those vulnerabilities are, you’re not going to know to look for them.
Terri
Right. Yeah.
Heidi Bragg
And so we found this when we’re working on our implementation. It isn’t that the software has deficiencies, it’s that our pharmacy, because of some of the ways that we get the process done, it can’t be monitored by the software. And you know, we have some weird little nuances every hospital does, but to be aware of what is now vulnerable so that no one can take advantage of that.
Terri
Yeah.
Heidi Bragg
And so the software, just like when everyone got automation. Automation doesn’t automatically make it safe just because it’s in a locked cabinet. You still have to monitor all of the reports and look for tracks and trends. It’s the same thing with this, particularly the artificial intelligence type software. We’re using it as a tool, but it’s not our only tool to determine if there’s been diversion. We still have a lot of hands on monitoring going on and you have to decide the balance between what is worthwhile, what is covered by the software and then don’t duplicate that effort. But then make sure that you’re covering the areas where the processes in your pharmacy aren’t monitored by the software. So, yeah, I think that all of the softwares have very positive things about them.
Heidi Bragg
And I’m excited about the concept that we might be able to determine that there’s been a diversion earlier. But we still just have to be very careful because it’s not the only answer.
Terri
Agreed. Yeah. Well said on that.
Heidi Bragg
Yeah.
Terri
I want touch on something that when you and I have had other conversations, you’ve talked about seeing a trend in bariatric patients. And so I’m wondering if you can expand on that. I don’t think that’s necessarily in the pharmacy house.
Heidi Bragg
So we wanted to say that it was anecdotal, but I actually would say that our employee assistance program has noticed a similar type of trend. And we don’t obviously interact with all of the people that our employee assistance program does. They’re helping individuals who, you know, didn’t divert drugs necessarily, but may need help in other ways. So one thing that people who, you know, people are having an easier time getting bariatric surgery. So I think that’s one of the things I would mention is that a lot more people are accessing the bariatric surgeries and don’t have a really good appreciation for how much that changes their metabolism of items. So they think about it from the food perspective, but not necessarily from the perspective of illicit substances, alcohol or prescription substances.
Heidi Bragg
And so there has been a number of times that it’s been interesting that the individual that we are speaking with as part of our program is a fairly recent person who’s received bariatric surgery. So not that they’ve just come back, but you know, that they’re been back a few months and then their pattern of behavior in the automation drastically changes and they definitely start doing processes that are questionable. And it just seemed to escalate very quickly. And when we talk with our colleagues about that, other diversion programs have mentioned that they’ve noticed the same trend. And then as I mentioned, our employee assistance program has mentioned that they have some opportunities to help people who are coming back from bariatric surgery but are struggling with substances.
Terri
So do you find that it’s. That it’s during their post op care they’re given the substances and then the way it affects them is just lifechanging at that point?
Heidi Bragg
Yes. I think that they end up experiencing such a high because they have such. The short gut syndrome that they get that intense euphoria and you know, it’s all of the biology takes over at that point and it becomes a matter of a true physical addiction.
Terri
Sounds like there’s some room for post op order sets for this.
Heidi Bragg
Yeah.
Terri
Population.
Heidi Bragg
Yeah. And I, if nothing else, education about like, hey, you need to get off of these drugs faster than you think. But I’m not saying they don’t have pain. I, I get it, had a major surgery. But it’s also the altered metabolism to.
Terri
Big risk factor for them.
Heidi Bragg
It kind of goes hand in hand with alcohol too. So that when they drink that they, it takes much less alcohol to have a more powerful effect so that some of the bariatric patients are struggling with alcohol. So.
Terri
Yeah, that’s too bad. It’s not what you need.
Heidi Bragg
No. I mean, you’re going through so much and, but again, I think that’s where we’re starting to have a greater appreciation for warning signs to patients who are taking opiates and, you know, we. This wouldn’t be the first time to say, like, as healthcare workers, we think, oh, we know how that works, it’s going to be fine. But no, we need to really be honest and come up with a plan for, like, this is how you’re going to get off your opiates.
Terri
Right, Right. And, I mean, if the message could just get out, I don’t know. And. And I guess we all think that we’re different and. And we can handle it, or the stigma or, you know, we’re embarrassed or what have you, but if the message could get out, that it could hit any of us at any time for any reason, you know, with exposure, and if we experience that feeling of, whoa, this is life changing right then, right there, realize, okay, this may feel good and I may wish this could go on, but this is the beginning of a terrible road. And so let me stop it right there and get help. But people don’t. I guess. I guess the feeling is great and different and I can’t speak to. You never felt it.
Heidi Bragg
Yeah. But to your point, wouldn’t it be powerful to sit with someone who’s just had bariatric surgery to say, you do need these pain medications now, but you also need to come down, you know, like, step off of them in a very purposeful way, and that if you find you’re craving them. We need to have a different discussion.
Terri
Right now, not two years from now when it’s out of control. Yeah, that would be very powerful. Well, this was a great discussion. I have not had anyone on the podcast where we focused on pharmacy, and we need to, because there definitely are risks within the pharmacy and they are not immune. I have worked. I can think of one person that was just the oddest person I’ve ever worked with. And a couple years later, I found out in the IV room he was taking some things for himself in addition to other things out of the vault. But. And then there’s been somebody else that before I was even in this space working as a pharmacist, that I told my supervisor something is not right here, and I was ignorant.
