By Chris Tse and Steven Guan

If you are expecting pill-pushing, insurance-wrestling, and phone-slamming action, then The Pharmacist will show you a whole other face of pharmacy.

The Pharmacist is less about the job of a pharmacist, and more about a private investigator who happened to have a pharmacy license. The main protagonist, Dan Schneider, suffers the loss of his son in a drug-related crime. Fueled by vengeance against his son’s killer and frustration against apathetic law enforcement, Dan accidentally discovers the infancy of the opioid epidemic.

The latest docuseries from Netflix has hauntingly portrayed the systemic corruption which led to the opioid crisis we face today. Unfortunately, the abuse of prescription opioids is already a well-known story to pharmacists. The difference between the story we know, and the story that is told in The Pharmacist is the personal connection with Dan. As the story evolves from the murder of his son to the rampant overprescribing of OxyContin, you can’t help but feel Dan’s sadness, frustration, and hopelessness.

Although I empathize with Dan, I applaud The Pharmacist for their portrayal of victims. After the death of his son, Dan realized that anyone can become hooked on these powerful, addictive drugs and this was not limited to “junkies” or “drug users”.

Jeffrey is not portrayed as a “ruthless drug dealer”; he was born into a life of drug abuse, where dealing drugs was a way to survive.

The people who were addicted to OxyContin were given the drug to treat legitimate pain - at least when initially prescribed. The description of euphoria from opioids makes you realize anyone can become an addict:

The Pharmacist is an introduction to a nation-wide epidemic we still face today. As the credits roll, I feel a mix of pride, satisfaction, but also guilt. I am proud of Dan for advocating on behalf of the 400 000 dead Americans to get justice against Purdue. I am satisfied that Purdue was overrun with litigation. But I feel guilty because there’s still so many people impacted and suffering from opioid misuse.

From the Eyes of a Pharmacist

It is rare to see a pharmacist in the spotlight. We are a profession plagued with inaction, and it stung a bit to see this inaction reflected by Dan’s colleagues in the docuseries. Dan’s actions were incredible, but was The Pharmacist an accurate representation of reality?

The “pill-mill” doctors and lax pharmacists depicted in The Pharmacist did exist. Nowadays, there are systems in place to prevent excessive prescribing and abuse of opioids and other narcotic medications. One such example is Ontario’s Narcotics Monitoring System (NMS), which flags patients trying to fill duplicate prescriptions or patients obtaining narcotics from multiple prescribers.

Naloxone, a temporary antidote to opioid poisoning, is dispensed in pharmacies across Canada. In Ontario, naloxone is free of charge and doesn’t require an ID or health card. Many pharmacies also offer opioid agonist therapy, which uses methadone or buprenorphine to satisfy opioid addictions. Opioid agonist therapy is the gold standard for treatment of opioid use disorder and it has saved many lives.

One persistent problem that pharmacists have not yet solved, is disputing authority. Dan is an inspiration, but he is not the norm. As demonstrated by Dan’s meek pharmacy colleagues, pharmacists and confrontation mix like oil and water. If you are a practicing pharmacist reading this article, you likely know a prescriber who still overprescribes opioids. Between pressure from doctors, patients, upper management, and other pharmacies, it is very difficult to protest like our protagonist from The Pharmacist. Ultimately, the opioid crisis will not be solved by deciding to give out one prescription versus holding another. We need continued systematic improvements, like the introduction of NMS, increased public access to naloxone, and changes to government policy.

As frontline healthcare professionals, we are always facing the opioid crisis. Decisions are not always as clear as the Netflix show depicts. The crisis is more convoluted in reality. Yet we always need to make complex decisions with incomplete info, under management pressure, with a line of customers waiting. That is the role of the pharmacist.