I've had the opportunity to work in both a low income urban area and an affluent suburban area. My first job as a pharmacist was in the urban area. There, most of the population consisted of low income families on medicaid, old people on medicare, and a predominantly Spanish speaking population from Central America, South America, and the Caribbean. There, I thought I dispensed a lot of narcotics, and controlled meds, but when I moved and got transferred to a mainly white suburban area, I was completely dumbfounded.
The amount of narcotics I dispensed in that pharmacy was ridiculous. We had to have 3 safes there just to be able to lock up all that we had in stock. I figured maybe the amphetamines would be the big seller since doctors nowadays love to throw around the diagnosis of ADHD to anyone that comes through the door. But the percocets, oxycontins, and roxicodones were being passed out like candy. People would come in with prescriptions for "chronic intractable pain" and getting quantities of 180 or more. Seems like everyone and their mother had "chronic intractable pain." And what was sad was to see young adults and college students come in with those scripts.
My feeling is that the doctors in the urban area seem to have a grip on their practice and are professional about their work and don't give in to what patients say. They are firm in their belief that they know more than the patient and even though a patient says that they want an antibiotic, these doctors will say no because you are not suffering from any sort of bacterial infection. In the suburbs, it seems like the patient has more control than the ones that went to medical school and devoted their life to medicine. They think that just because they did a quick google search, they know what's best for them. And unfortunately these doctors give in to them because they are quick to post on facebook, twitter, blogs, etc. on how dumb this doctor is because he or she said that they don't need to take XY drug. And just because you are getting bad grades in school because you can't focus on your work because there is a frat party you'd rather go to or a round of Halo you want to play doesn't mean you need Adderall, it means you need to straighten out your priorities. I'm all for being responsible for your own healthcare, but let decisions be made by the professionals.
I also work in both of the areas you mention and I agree with you -- the affluent suburban patients seem to call all the shots and the C-2 prescriptions are high volume and high quantity. God forbid we should 'inconvenience' anyone by asking them to come in every couple of weeks for their potent and potentially dangerous pain medication -- just load 'em up with a couple hundred tablets and call it a day. People have no respect for these medications, and even less for the doctors -- they are just a conduit to get what they want.
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