Pharmacists: Ever dispensed a placebo?

From today’s National Post:

The practice is discouraged by major medical groups, considered unethical by many doctors and with uncertain benefit, but one in five Canadian physicians prescribes or hands out some kind of placebo to their often-unknowing patients, a new study suggests.

The article references a paper in the Canadian Journal of Psychiatry which does not appear to be online.

It continues:

McGill’s Prof. Raz and his team conducted a survey of specialists throughout Canada, receiving responses from 606 doctors, 257 of them psychiatrists. About 20% of both psychiatrists and non-psychiatrists said they had used placebos in treating patients. The specific treatments they confirmed using included actual placebo tablets, sugar pills and saline injections. Some — including 35% of psychiatrists — said they also used “sub-therapeutic” doses of real drugs, amounts too small to have any chemical effect on the patient.

Interesting. I’ve been a pharmacist for almost 20 years (gulp) and have never seen a prescription for a “placebo” – nor have I ever seen a bottle of  “placebo” tablets waiting for such a prescription. An informal poll with a few colleagues revealed the same thing: No-one has ever seen a “placebo” dispensed. Perhaps my sample isn’t representative. Or it could be these prescriptions are being dispensed by the physician directly from the office.

So my question is to the pharmacists out there: Have you ever seen a prescription for a placebo? Did you fill it? And what did you fill it with? What are your thoughts about filling prescriptions for placebos? Would you do it? And what would you tell your patient?

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9 thoughts on “Pharmacists: Ever dispensed a placebo?

  1. I was a pharmacist from 1987 until 2002, with a couple years of hiatus from 92 to 94. I learned about placebos in school, but never dispensed a single one.

  2. About 1982 my pharmacist told me to prescribe Lilly 37 if I wanted to give a placebo. I did a rudimentary search for Lilly 37 and got no results.

  3. In my early career I was asked to dispense a placebo statin by a consultant physician (let’s call him Dr Sagan). The patient had suffered a number of supposed adverse effects on various statins. Saganstatin was dispensed and the ADR duly developed.

    I would not do this now, but was wet behind te ears then.

  4. I’ve practiced as a community pharmacist since 1981. During my first year of practice, a physician contacted me to ask that I replace the contents of a Fiorinal C 1/2 capsule with lactose. I did. Counselling wasn’t mandated at that time and it was a refill.

    Interesting comments to the article identifying homeopathic agents as expensive placebos. I often joke that I dispense placebos (I am referring to instances where watchful waiting or non-drug alternatives would have worked better or that the drugs prescribed are of marginal benefit) on a regular basis when people ask if I get scripts for placebos….

  5. Back in my student and intern days (late 1970s- early 1980s) there were commercially available placebos produced – I seem to recall one for Seconal that we dispensed fairly regularly. I also had the experience of a physician requesting the emptying of active Fiorinal with codeine capsules and replacing with lactose during that era.

  6. We have a placebo bottle on our shelves. Ironically, it has a DIN number with recommended dosage: ”Take as prescribed by a physician.” I’ve never received a script for placebo, but I know that we prepare blister packs for a nursing home resident with 1 tablet at betime. *shrug*

    • It has a DIN? Could it be that it has an NPN (Natural Product Number)? I don’t know of any placebos with a DIN, though “Placebo Tablet” by Odan Laboratories Ltd. has an NPN (00501190). If it has a DIN, please let me know.

  7. I’ve also read that physicians prescribe placebos, but have never seen a prescription for it in over 30 years in pharmacy. But as mentioned above, I have seen physicians use subtherapeutic doses of antidepressants and antipsychotics.

  8. Yup, got a prescription about three years ago for “Obecalp 100mg daily” — I had no idea what it was until I got ahold of the doc – placebo backwards! Slick – but I refused to play. She wanted to use placebo instead of giving an unnecessary antibiotic to one of those patients who don’t take no for an answer.

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