What do label stickers on prescription drugs mean?

Q) I see a new sticker has been affixed to my refill of Tylenol #3’s. Why did you put that on now? I’ve been using these for years.

A) Pharmacies often put “stickers” or extra labels on the vials of pills they give out. This serves as a reminder to patients to help them get the most out of their medications and to make them safer to take. Typically, these stickers may encourage a patient to take a specific medication with food, or to stay out of the sun or warn them that the pill may make them drowsy so caution should be exercised when undertaking tasks that require some degree of focus (like driving or writing a column!!).

Most of the time, the decision to put a sticker on a vial is left to the pharmacist’s discretion and the use of these tends to vary widely even amongst pharmacists working in the same store. Some tend to use more, wishing to instruct the patient on as many do’s and don’ts as possible. Others feel that if you apply too many extra labels, patients are more inclined to ignore them due to information overload.

This new label referred to above is being affixed only to narcotic/ opioid prescription bottles and the application of this sticker is not being left to the pharmacist’s discretion. The federal government has dictated that this label will be mandatory by October, 2018 and many pharmacies have decided to go ahead with this initiative well before then.

The content of the label must warn the patient that opioids can cause addiction, dependence and an overdose. The prescription is also to be accompanied by a pamphlet that goes into more detail about these potential serious outcomes. It is Health Canada’s latest effort to raise public awareness about the risks of opioid use. While this is undoubtedly a well-intentioned effort with no real negative consequences, it is still another non-solution to the ongoing opioid epidemic (along with making patients return fentanyl patches to the pharmacy before getting new ones and refusing to cover the costs of higher strengths of certain narcotics).

None of these steps are poor ideas, they just aren’t going to be remotely effective in stemming the tide. Nor is increasing the access to Naloxone kits or supervised injection sites which are still only reactionary rather than preventative steps. Some solutions do seem to be working however, particularly in the re-education of our physicians.

Doctor’s are, by and large, doing their part as there is a much greater awareness of the risks of these drugs and the vast majority of M.D.s are doing their best to limit their prescribing them. The stats back this up although unfortunately the mortality rates do not, which serves as pretty effective evidence this can’t all be laid at the feet of the medical community.

The reality is that all doctors have patients that are in severe pain and need, and deserve, to have their pain lessened. There is no magic blood test or body scan that can tell a physician just how much pain a particular patient is in so they must depend on their clinical instincts and what the patient’s tell them to guide their prescribing. No easy task for sure.

It is a fallacy to lay this solely at the feet of our doctors as well. A large part of drug addiction (opioids and the bevy of street drugs that are out there) involves mental health issues and our resources and, plans to fix our substandard model of care, have been widely acknowledged to be sadly lacking for far too many years. Addressing our shortcomings here should be a major step in preventing this crisis from self-replicating into perpetuity. As well, we need to do a much better job of stopping additives such as fentanyl and carfentanyl from being incorporated into assorted “party” drugs which is turning them into lethal cocktails. While I have no answers as to how this can be accomplished, it needs to happen soon.

In the meantime, some countries such as the Netherlands, have set up labs that will test street drugs, for a small fee, to ensure they only contain what they are supposed to (be it Ecstasy, cocaine…). Canada is working on this, but it needs to happen soon.

Lastly, perhaps we have to rethink our “no-blame, no-shame” policy when it comes to addiction as the skyrocketing numbers don’t seem to support it as some sort of harm reduction mantra. Perhaps there is a happy medium that can be found where we don’t criminalize addicts as we have in the past but also don’t hold their hands the entire time and say they are not responsible, when in fact, they did make a choice in the large majority of cases.

Controversial thoughts no doubt, but it is clear that our conventional strategies are not working and I seriously doubt the addition of another colourful label to a vial is suddenly going to reverse the course we are currently on.