Janis Randall, RPh, owner of Compounding Solutions
Despite the wealth of pain medications available today, many patients are still in considerable pain. When physicians and patients join forces with a compounding pharmacist, however, it is often possible to develop a medication that can bring relief.
It can be a time-consuming process. "One pharmacist can handle about five compounds a day," says Charles Prickett, RPh, owner of Eastern Valley Drugs. "I do all the compounding here." His employees handle the rest of the prescriptions at his drug store.
Janis Randall, RPh, owner of Compounding Solutions in Trussville, welcomes the time it takes to find just the right medication for patients, because she enjoys knowing she is making a difference in their lives. "That's the nice thing about compounding. You can try several different things," she says.
"I think it's very important for physicians to know that it's a triad relationship," she emphasizes. "Nothing is compounded without all three parties involved: the patient, the physician and the pharmacist. And each medication is customized for that person's needs."
"The patient has to have a need, the physician has to be comfortable with the process, and the pharmacist has to be comfortable with the compounding," agrees Prickett. "That's the triad."
Randall tells of one patient who suffered from pain in her legs and feet for years. She was taking 13 Loritabs every day to manage the pain. "We experimented with several different gels with her doctor's permission, and she finally found the one that worked for her. It did not completely eradicate her pain, but she's down to three pain medications a day."
She decided to open her own compounding pharmacy after selling for a compounding pharmacy for a year. She drove to Montgomery one day and an oncologist left a meeting to talk with her. "He came out and said, 'I'm sorry, I don't have time for you. Tell me one thing. I have a patient who is wounded; her back has not healed in a year. What can you do for her?' I was on the spot. I suggested a wound healing compound that is comprised of all these different drugs. He looked at it and said he wanted to change one ingredient. We shipped the medication and he called me 10 days later." The patient's wound was healing for the first time in a year, and he placed an order for more of the medication.
"I never met the patient, but that was what I was looking for in pharmacy — knowing that I was making a difference for people," Randall says. "That got me so excited, I decided to start my own compounding pharmacy."
Just as each medication is uniquely prepared for each patient, each case is handled differently, depending on which person in the "triad" initiates the process. "Sometimes patients will go to their doctors, and they've sort of run out of options and their doctor is very knowledgeable about compounding and has two or three things they commonly prescribe. Or they'll pick up the phone and ask, what kind of things do we have to offer this patient? And we'll give them choices and the doctor will choose what he thinks might work best for the patient. That happens all the time. I have a lot of primary care doctors in our area that will call and tell me a little bit about the patient's history, their age, how they injured themselves, the nature of their injury, if they have conflicting or other disease states. And then I'll throw out some ideas. Sometimes they'll choose what I throw out first, and sometimes they want to make a few changes."
Topical pain medications work well for many people who can't tolerate oral medications for a variety of reasons. "Some people have very localized pain in one area, maybe a knee or a foot or a shoulder. They can apply a cream or a gel to that place and hopefully they'll get just a localized absorption, but occasionally some people do get a systemic absorption," she explains.
While she fills many prescriptions for topical pain medications, she does more than ointments. "Yesterday we got a call from a woman who had a premature baby. They were looking for a morphine liquid in a tiny enough dose for a baby that would be acceptable in taste and texture to a baby. So we actually do put pain medications in different forms."
Although Prickett has been compounding for 20 years, he doesn't have specific success stories to share; still compounding remains a small but important portion of his business. "Some items are unavailable commercially, and we've been able to help patients with getting them. That is successful right there," he says.