Pharmacists and Advocacy for Patients in Pain | TWIRx

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1:45Bev C. Schechtman: Hey, this is, wait, why do I always say that? this is this is this is this week in pharmacy it's like two this is is this is this is twerks uh welcome to the show very special show today with my friend pharmacy 50 most influential for i think it was the alumni 2025 class uh shane jaraminsky how are you what's going on todd how are you nice to see everybody hey we have two returning guests to the pharmacy podcast network and it wasn't called Twerks back then. I didn't have my own podcast until I had Twerks because the network was supposed to be off by itself and I was supposed to have hosts come in and talk about specific things.

2:30Bev C. Schechtman: So I get my own, my very first podcast of doing this 17 years back in 2023 and Claudia and Bev, you haven't been on Twerks but you were on other shows that we've had. So welcome back to the Pharmacy Podcast Network.

2:45Dr. Shane Jerominski: Thank you. Thanks for having us.

2:49Bev C. Schechtman: Claudia.

2:51Dr. Shane Jerominski: Hi, thanks for having us back.

2:53Bev C. Schechtman: Absolutely. All right. I want to start with the two of you, Bev. You were the first guest that I had back, you said, in 2020. It's making me feel old because of how fast time's going. But set the stage for us. Tell us who you are, a little bit about yourself, and your relationship and partnership with Claudia.

3:14Dr. Shane Jerominski: So my name is Bev Schechtman. I am the vice president of the Doctor Patient Forum. I first reached out to Claudia in 2017. We both have Crohn's disease, and she was on a Crohn's group on Facebook after a horrific hospital stay where I was denied opioids for kidney stones because of a question I answered on the opioid risk tool about pre-adolescent sexual abuse. They use that to deny me opioids in the hospital for kidney stones. I reached out to Claudia. the Don't Punish Pain Rally started from that and then where we had rallies in all 50 states and then the Doctor Patient Forum I think it started 2019 something like that the non-profit and I do a lot of the research and the back end stuff a lot of the putting together the videos taking clips listening to all the CMEs and Claudia does a lot of the front face stuff on social media where she gets to get attacked and I get to sit back and not get attacked.

4:16Listen, Claudia is like a social media slash media.

4:23Bev C. Schechtman: And it wasn't even called social media when Claudia first started doing this. You are a powerhouse when it comes to media. Even if you weren't talking about pain management, if you were out talking about you were one of TMZ's reporters or something like that, you're just a good reporter of what's going on and you do it with passion for patients. So give an introduction of yourself and what you do.

4:50Dr. Shane Jerominski: I think I'm so passionate because I'm a theater kid. And I think theater kids are always going to be a little more passionate than, you know, people who, I spent a lot of time in the theater and I'm an Italian Scorpio. So I am 100 % passionate about what we do. You know, there's a growing suicide list. I went on social media 2000. Gosh, I think it's 2017. And I announced I would organize a national protest for people who couldn't get their pain treated. Fast forward to today. We have about, I don't know, all together people who follow us on TikTok, Facebook, probably 700 ,000 who follow our efforts.

5:31Dr. Shane Jerominski: We've got chapters in all 50 states and I am primarily the spokesperson so I'm the person that people see on a regular basis and I think you know why we're all here today is because of a video that I made several weeks ago. My job is to make videos get the message out there. You know I don't have an easy job I have the job of telling people to make OxyContin great again which is triggering for a lot of people, but we've got to stop the bleeding. So my videos can be extremely controversial to people. And I understand there's some big feelings with my videos, but I made a video in response to what I'm seeing on social media with a lot of the younger PharmDs.

6:22Dr. Shane Jerominski: And it was just very scary to me, a bit appalling, because so many of the younger PharmDs were boasting about not dispensing pain medication. And I had texted Bev and I said, there's a theme here. They're never talking about withholding abortion medication or Suboxone. It was always confined to, this is why I'm not going to fill pain medication. But there was like a sense of arrogance in some of the younger PharmDs, but let me say one thing. I have immense respect for the pharmacist role in medicine. You know, I've got a friend whose daughters worked very hard to become pharmacist, so I have a healthy respect for the pharmacist.

7:04Dr. Shane Jerominski: What I don't like is I don't like to see these arrogant PharmDs on social media boasting about not dispensing pain medication and accusing people of being drug seekers, which is why I made the video. And the message, you know, I had to make the video. It's my job to raise awareness to every aspect of the pain patient being attacked. And I think, you know, let's face it, that's why we're here today. Many PharmDs were outraged by the video sparked a lot of controversy, but not one pharmacist was willing to acknowledge that we have a problem. They all, you know, ran, they all stitched the video. I was slaughtered on social media.

7:52Dr. Shane Jerominski: I'm unfazed by that, that my job is the voice and the face. So, but then it got, then it took a nasty turn as it so often does on social media. Once again, I'm not fazed by that, But I didn't know Shane was the accidental pharmacist. I think a pharmacist said that his wife, somebody was wishing ill will on his wife. And I don't know if that was you, Shane, because I'm really not tech savvy, which a lot of people find this hard to believe. I'm the spokesperson. And basically, Bev does all of the heavy lifting. So I'm awful sorry if that is you, Shane. And if somebody was saying ugliness to your wife, I've been on, listen, I'm on that, I'm on the same end that your wife is on.

8:43Dr. Shane Jerominski: So, but I'm awful sorry that that happened. But we, how can we, you know, that's for a different show. But I do want to say if anybody was wishing ill on your wife, that shouldn't have happened.

8:58Claudia A. Merandi: Well, thank you for saying that. I appreciate that. And it comes with the territory. You're absolutely right. You and I probably agree on a lot more than you would imagine, Claudia. I am the same thing. I am the mouthpiece for a lot of areas in pharmacy. And I say some of the things that need to be said that a lot of other pharmacists won't say because they're tied to a corporation that would fire them immediately. So I have become the default face in some situations. And I do, first off, let me say I respect the idea of saying those things that need to be said to creating a space for discussion.

9:33Claudia A. Merandi: bringing two what seemingly opposing groups coming together to have that discussion is important. And what you did, you said you're a theater kid and I can see it, but what it is is like a little bit of sensationalizing and sometimes sensationalizing is necessary, but it is a little bit of that.

9:50Dr. Shane Jerominski: I don't know. I don't feel like we sensationalized. I think that people don't understand that our passion comes from the fact that every day, all day, literally every day, all day, our inbox is flooded with messages from people with a gun in their hand, ready to end their lives. We are not being sensationalistic. The fact is it has been left up to pain patients to fight for patient abandonment, forced opioid tapers, harms from the PDMP and analytics and lack of continuity of care when there's an entire industry fighting for people to have access for medication for opioid use disorder. This has been left up to us.

10:32Dr. Shane Jerominski: People reach out to us for their last resort. We've had people reach out to us that we knew were going to kill themselves that ended up killing themselves with their wife and a double suicide. So I don't feel like I know that part of the, maybe it's a bit of the younger generation of like trying to sensationalize for social media. We actually don't do that. That's just not, we really don't. These are actual, this is real life for us like for us it's not i'm not saying it's a game for you but for us it's not about making memes it's not about creating waves it's not about you know having a meme with a cigarette like this is real life for us and we're the only ones fighting for this and we have no

11:09Claudia A. Merandi: voice other than us the real the real story the real story there's real stories behind all of this but when you say something like make oxycontin great again that is triggering and it's also sensationalizing in my opinion because to to to go online and say the answer to people with guns in their heads is to make oxycontin great again does not sit well with the health care community uh you know the oxycontin has a very good place in that i'll i'll let talk bring this in because

11:39Bev C. Schechtman: i think we're getting off let me let me do something because both of you um bev and claudia i want to thank you you set the stage for what i'm what i'm trying to pan out for both sides so that there's audiences that Bev and Claudia are bringing to us that we don't normally get. And I just want to say thank you both. And I also want to shout out to those people listening, those pain patients. This is ultimately about bringing relief to you and management of your pain and being empathetic to what your pain is. Remember, guys, I've said this to Claudia and Bev before. I'm the patient on this show, just like you are.

12:14Bev C. Schechtman: I mean, I'm not a pharmacist. I'm not a, you know, I'm a technologist and marketer and somebody that's been in pharmacy for a really long time and sees what pharmacists are actually doing. But before we get into the, into the, I want this to turn out to be a movable debate. I want to just set some, some basics. And that is the two of you are exposed to people that are, um, for lack of better word, they're, they're, they're bleeding inside. They're, they're in literal pain they don't know what to do and you experience this on a on a constant basis boom boom boom boom and and it's very intense and by the way dentists are are known to want to leave the profession because when they inflict pain on there's a whole psychological write-up on this when they inflict pain on their um their patients and they could see grin grinsing of the face it literally took a an effect on these people because i think it's like a human thing you can't help but to you see somebody in pain and you're less like fuck like let's get them some help look they're in pain so we know we know that you both are sincere in that and people can look you up on social media and see that passion now i want you to turn off your pain advocacy hat for a second i want you to come to pharmacy land so there are listeners that are raised in different generations um i'm closer to your generation like i said gen xers um and we just think a little differently than what i see millennials and definitely gen z thinking about um but there is a pharmacist out there it's a story that she watched her dad as a pharmacist and she wanted to be nothing more than than be a pharmacist and she watched her dad bring in people with um problems they had you know ailments, leukemia and like compounding medications and specializing.

14:11Bev C. Schechtman: And she grows up seeing that the impact that he has on people's lives, he knows them by name, he knows their family history. He knows if little Jimmy's lying, like the whole thing. So the whole fundamental of starting this all off is pharmacists and what their purpose is, what their goals are as healthcare professionals, because they've dreamt about becoming pharmacists since they were like little kids or, you know, something that they're working on. And in that batch of people out of the 330 million Americans that they're taking care of, at least in the United States, obviously much more worldwide, their whole existence and their nerdiness of doing it, they want to take care of seniors.

14:56Bev C. Schechtman: They're the pediatric specialist. They're the, you know, the community pharmacist that's doing more of like the whole tackle box of stuff. There's the researchers and the medical science liaisons. What they have in common is that pharmacological study of how medications literally work on the DNA of individuals in transition and titration and compounding and your enzymes and your pharmacogenomics and how your genes respond to opioids. And oh my goodness, this could become a new podcast show for the four of us of how long it would take to get all of this out that's what they do you're

15:40Claudia A. Merandi: you're right there's there's a huge there's a lot to this argument yeah but i think the one thing that's misunderstood and this is where i'd like to start with this what's misunderstood about opioid therapy is we've turned it into a binary argument we've turned it into either opioids are dangerous drugs that should be avoided at all costs or opiates are essential medications that should be dispensed without question by pharmacists in every situation. Who is saying that, Shane?

16:06Dr. Shane Jerominski: Who is saying that? That's what we've been, you've attributed that to us. You've made memes about it saying we want everyone to, who has ever said that because we've never. Well, you guys keep pushing up that report from the American Medical Association, which

16:19Claudia A. Merandi: essentially the AMA is, the article talking about how the AMA thinks that pharmacists are withholding drugs and using their clinical judgment to supersede anything that comes out there. And they're using an example of an ophthalmologist or an optometrist who wrote, sorry, ophthalmologist who wrote for a cream for rosacea and the pharmacist denied the prescription. But then they go on to like trying to put, they're trying to change the law to say that pharmacists can be held legally responsible if they don't dispense the medication.

16:49Dr. Shane Jerominski: So let me just, let me clear this up now because it's probably better at the beginning. We have never advocated for opioids to be first line, second line, third line, or on their own. Not one time have we ever said that. We have a very healthy respect for the possible harms and benefits of opioids.

17:07Claudia A. Merandi: Can I just say one thing right there? Someone who has a healthy respect for opioids wouldn't have a mantra like make OxyContin great again.

17:16Dr. Shane Jerominski: That's not true because here's the thing, Shane, there's two separate issues here, okay? When you have an opioid naive person, there's a different set of rules as far as someone who has been what they call a legacy patient who has been on opioids. 17 studies show, regardless of dose, duration, or combination of medication, it is always more harmful to cut a patient off of opioids that has been on them than to let them remain on them. The patient population we are fighting for, for the most part, is that population where maybe they should never have been put on opioids to begin with, but that's actually moot point at this.

17:52Dr. Shane Jerominski: It's actually a moot point because they have been on them and they're becoming abandoned. they're on higher doses that maybe they should have never been put on but the fact is they have been and so for pharmacists to joke and make fun on social media saying oh my patient on this amount of medication i'm not going to give it to them like it's a joke when these people are going home and we have so much evidence behind do not force taper these patients and that's the difference like yeah make oxycontin great again because right now everything has been about vilifying the philagonist, everything. And, you know, we've said that pharmacists, we've gotten from you guys like, oh, well, how come, don't fight the DEA.

18:34Dr. Shane Jerominski: It's not our fault. But when it comes to Suboxone, the NABP and the NCPA, their MOUD guidelines, they know how to fight for Suboxone. They know how to fight against the DEA. The pharmacists know how to fight against the red flags for cash only pay and distance from patient to provider when it has to do with a certain population of people. And when it has to do with pain patients, all of a sudden the suspicious order reporting, the NARCS care, the PDMP analytics, the cash pay, the red flags, the DEA, all of a sudden that becomes our job to fight. How come you guys, pharmacies in general, pharmacists in general, will fight for one group of patients who have a voice?

19:15Dr. Shane Jerominski: These people have key opinion leaders and money and a platform and will not.

19:20Claudia A. Merandi: You really got to the root of the problem. And I think this is one place we are both in absolute agreement that pharmacists are trapped inside a system that is making it easier for us to dispense a drug like Suboxone than it is for us to dispense a full agonist opioid. And the reason why you were saying you're not you're not saying individual pharmacists, but you were talking about organizations that are advocating for this. And the reason why those organizations are advocating for this is because the money they're taking from companies like CVS and Walgreens, there's liability that exists with full agonist opioids that don't necessarily exist the same way with things like Suboxone.

19:58Claudia A. Merandi: So I am in agreement that that you follow the money, you will find out the reason why it looks like this. What you did say that I can disagree with is that pharmacists are going online and laughing or making light of withholding medication. And I'm advocating for those patients, what you called legacy patients or non-opioid patients that have been on opiates for a long time. The risk of tapering, the risk of cutting them off is terrible. But we're in a situation here where it's easier for us to pass the buck, where it's saying we don't have it in stock. And a lot of times we don't, thanks to the DEA cutting supply of that.

20:41Claudia A. Merandi: Now that the wholesalers have been fined. Wholesalers will just cut you off.

20:44Bev C. Schechtman: Yeah, wholesalers will cut you off.

20:45Claudia A. Merandi: You guys know that?

20:46Bev C. Schechtman: Do you know that if you own a private pharmacy, Claudia's Pharmacy, right? Yeah. And all of a sudden you get an email out of the blue. Yeah. Or they're like, oh, yeah, no more. Oh, yeah, we hear from, listen, yes, we know that.

21:01Dr. Shane Jerominski: We hear from independent pharmacies on a regular, and we did meet with Senator Sheldon Whitehouse two weeks ago to discuss this, this problem. And there's handcuffs on them. Yeah, I get it. But, but, but the organizations, pharmacy organizations will fight against the handcuffs for suboxone and not against opioids. That's my point.

21:22Claudia A. Merandi: You're right. And that's a, that's a great point taken. I work for independent pharmacies. And the one that I work at primarily is we serve as hospice patients. So we have end of life care, really high dose medications. And every single month, we're fighting with McKesson, because we're reaching our limit for liquid morphine, we're reaching, reaching our limit for benzodiazepines. And I've had to justify our ordering to a non pharmacist that works there just in regulatory compliance. And they're saying, well why are you dispensing this much i wanted to say it's because we have fucking contracts all over the desert for for patients that are in palliative end-of-life care why do you why else do you think that we're doing this so we are we have multiple masters that we're reporting to now and you know pharmacists have so many things that they're fighting for and i don't want them to think that pain patients aren't important to us i just want you to understand that we have so many different things that are going on.

22:22Claudia A. Merandi: My realm, I've been drawn into this argument because of my platform on social media, but I would never call my, I never called myself a pain advocate. I called myself a workforce reform advocate because I was trying to advocate for giving the pharmacists and the people behind the counter enough space to do their job appropriately. If we weren't so overwhelmed, if we were better staffed, if we had the resources to take time with every single one of those patients that are legacy opioid patients, to make them become, instead of customers, patients. You understand, we understand patients. When they're just a customer, like the way it is in a CVS model, where every time you go in, you see a different pharmacist.

23:06Claudia A. Merandi: Every time you go in, you feel like a cattle being, that they know nothing about you. Then you're a customer. You're not a patient. But when you're a patient, you're never going to be denied because we're going to do the extra work to make sure we understand why you're on what you're on. Make the annotations, put in the notes, call the doctor's office, make sure that even when they're not there, the primary pharmacist isn't there, you can look at that patient's profile and understand why the drugs are written the way that they are.

23:34Bev C. Schechtman: And think of the attitudes, like Claudia, You brought up kind of the snottiness and the disheveled looking, you know, pharmacist. And once again, I kind of started this out. Let's pull this whole conversation out on its head from a generational perspective. I think differently than other generations do. So if they're being smart asses or they're kind of being, you know, pushy about saying about cutting something off, even if they said that, which I would shame them if that were the case. it it's like it could be it could be like one or two jerkos that you know maybe have an attitude about something they don't understand pain management because they've never really experienced themselves so when you take an entire industry instead of those individuals and you you know you promote to your the power that you have as we were saying in media and now we know you were in theater.

24:32Bev C. Schechtman: My daughter's in theater and I was in theater. So yeah, I get that. When you're pulling all of that attention and you start labeling them pharmacists, and then of course they have to experience and try to start putting the jigsaw puzzle pieces together, but they only have 10 % of the information, which is the most important part because it's their pain, but they have no idea that the other 90 % of the whole system to get them their prescription, their opioid prescription is under attack of like 22 systems that all come back to the freaking pharmacist. Like, and that kind of pressure on top of the independent, and this is a call out to independent pharmacies, by the way, because if you want really good pain management, go to an independent community pharmacy and sit down with them and slow down the process and stop fast fooding medicine.

25:23Bev C. Schechtman: I mean, this is freaking pain. Let us dial into it, maybe add stuff to it or subtract stuff from it or whatever it is. But personalizing it, that isn't a pharmacist. That is a pharmacist.

25:35Dr. Shane Jerominski: But who said pharmacists were all, Todd? Like her video literally said the part that was stitched is the problem. Because what her video said is I'm seeing a number of younger pharmacists who I'm going to call pharmacists making fun of patients. That's what her video said. But the stitching part, it's like to sensationalize, they wanted to make it look like she said an entire industry. Look, we've had pharmacists on our podcast. We fight for pharmacists all the time. We never said an entire industry. What she said and what we've said is some, I am seeing a number of who are doing this. And it's not just pharmacists.

26:15Dr. Shane Jerominski: It's nurses in the emergency room. It's doctors. It's nurse practitioners. They make fun of pain patients. They make fun of denying them opioids in the emergency room. They make fun of denying them in the pharmacy. They make fun of cutting them off. They just, they mock them for fun because it's sensationalistic. But we never, ever once said an entire industry, that's what was portrayed by those who wanted clicks and likes by stitching a portion of her video.

26:40Claudia A. Merandi: I think that they latched onto it because there was a little bit, there was a touch of irony to it that, you know, she was saying, she ultimately said pharmacists and she talked about younger pharmacists looking like unmade beds and unkempt. And they're passing judgment by their outward appearance. And I think that you would in the same breath say so many pharmacists out there are passing judgment by the outward appearance of a pain patient. If they don't look like a classic pain patient, if it's pain that you can't see, if it's invisible, and then they come in and they have this high dose drug, you're going to start asking questions.

27:17Claudia A. Merandi: And the thing is, is I think that asking questions is not evidence of arrogance or cruelty. That's something that's really important. Let me say one more time. Asking questions, a pharmacist asking questions is not evidence of arrogance or cruelty. It's part of our job.

27:33Dr. Shane Jerominski: We never said it was, Shane. And this is why when you made the meme or whatever saying, Claudia wants us to just feel every, whatever that was, roll up in the car, whatever one of the memes you made that we just want unending doses. That's really not fair. And it's actually very harmful to us because we have never, ever, ever one time advocated for anything like that, nor would we, because it can harm patients. And so the fact that you say there's like, it's binary, it's not binary. I'm not seeing, I actually haven't seen any patient advocates or doctors advocating for pain patients say on ending doses all the time, no matter what the dose to everyone or none.

28:16Dr. Shane Jerominski: Like, I really don't see that very much. I haven't come across it in our advocacy. We certainly have never advocated for that. But it's being portrayed as though we do to kind of almost as a straw man to attack us as though we want everyone to get opioids all the time for everything. and that's just not the case.

28:33Claudia A. Merandi: So when you're saying that, in one thing you're saying that you don't want just patients to get opiates for everything, you're vilifying all these other drugs. You're saying that gabapentin has a holistic side effect. You're saying that - I'm sorry, it's Shane, right?

28:49Dr. Shane Jerominski: Shane, yeah.

28:49Claudia A. Merandi: I get Sean all the time and Jane on the phone. So don't worry. I respond to any one of them.

28:55Dr. Shane Jerominski: So I have a 25-year-old daughter and a 21-year-old daughter. And when my 25-year-old daughter walks out of the house and looks a certain way, I say, you're not leaving like that, are you? Are you angry at yourself? Get back in, fix yourself up. So I'm showing my age. I'm, you know, I'm 58 years old. So I probably think a little bit differently than you do. Maybe even a little bit differently than Bev does. You know, I'm 10 years older. So with each generation, I think we learn a little bit more. I think what was sensational was hundreds of pharmacists stitching my video accusing me of being funded by Purdue Pharmaceuticals.

29:34Dr. Shane Jerominski: Let's be honest here. If we could just be honest for a minute, how dear pain patients have a voice. And when we do have a voice, the default is always to say that we are funded by Purdue. I mean, I've got a doctor who made an account on X calling me Karen Sackler. So I think it's just so easy to assume we're funded by pharma because of our advocacy. What wasn't funny is when I was accused of drug seeking, and because of that interaction, I left the hospital with a colostomy bag. And I think if the PharmDs who have stitched my video and mocked me, I think if you folks walked a day in my shoes or bed shoes, you'd probably look at it a little bit differently.

30:23Dr. Shane Jerominski: I think so many of the younger PharmDs are viewing pain through the lens of addiction. And I'm confident that your education has a lot to do with this. We know what's going on. You know, I'm in Rhode Island, University of Rhode Island. I've met with these students, and they're telling me what they are being taught. You know, we've skewed if somebody needs pain medication, we're always going to the place of these are drug addicts because so many people are getting their science from that fictional series dope sick my my 90 second my i mean i think my video is 90 seconds because i'm the most visible i'm always going to be the person that gets uh attacked the most which is fine but i think pharma d's also you know put their touch on my words my words are always being weaponized but we have a very serious crisis on our hands and many many independent pharmacies have reached out to us over the years.

31:24Dr. Shane Jerominski: There are pharmacists incarcerated with some of our doctors. So we understand every aspect of what the pharmacist is going through, which is why we routinely meet with senators who conduct oversight of the DOJ, because that's what we need. We need a DEA oversight hearing. And those are the people in the United States who have the power to make this happen. And so many PharmDs, well, why don't you do, what are you doing? Why don't you challenge the policies? We do challenge the policies. I got a law passed. So other, so 49 states would take a version of my bill and, you know, tailor it to their state.

32:06Dr. Shane Jerominski: We're only two people. I can't be in all 50 states. I can't be the voice for pharmacists, but we are making headway, which is why we're meeting with these senators. And if you're a PharmD who's listening to this, please support our efforts because I would like nothing better than to have 50 Claudias, 50 BEVs in all 50 states where they can meet with their senator. I think we've got 20 something senators who conduct oversight of the DOJ. That's what we should all be working towards is removing these red flags. The red flags have caused red flags. Suboxone has become the savior. OxyContin has become the devil and we need to get back to a place of normalcy.

32:52Dr. Shane Jerominski: We certainly don't advocate for unfettered access to opioids, but because we advocate for opioids and because people are getting their science from the fictional series Dope Sick, that's how this comes off to people. How dare you advocate for pain medication? How dare you want to, you know, how dare you mention gabapentin's linked to dementia. How dare you mention suboxone's linked to catastrophic dental decay? I don't get money to promote any of those lawsuits. But once again, I have a job to do. My job was to let our followers know 65 million scripts, I believe, were written for gabapentin. You know, people have a right to know if you're experiencing cognitive decline and you're on GABA, it's something to, you know, to look into.

33:44Dr. Shane Jerominski: And that's to address, yes. And to address what you said, Shane, the reason we so-called vilify those things is because an entire industry that we call opioid elimination has been made out of eliminating opioids. Right. And I think when anyone is getting any medication, whether that is Remicade or methotrexate like I get or Simzia or opioids or Suboxone or Gabapentin or even a medical device, everyone should have informed consent. They should be told possible harms and possible benefits, period. That includes addiction risk, but the accurate addiction risk, not upstated or overstated. That includes dementia risk.

34:26Dr. Shane Jerominski: That includes all of it. And what's happening that I don't think maybe you don't know, maybe you do know, but maybe you don't know, is that patients are being extorted. So what happens is pain patients are being told at these interventional pain clinics, they'll be told, listen, you can get your 15 Vicodin a month, but you must get these procedures, epidural serin injection, this, you must take gabapentin, you must take Cymbalta, you must see a therapist, you must, must, must. and they tell them nothing about possible harms of any of those things. And that's the problem we have. The reason we're talking about harms from those things is because they're not being told to the patient.

35:07Dr. Shane Jerominski: We don't have to talk about the harms of opioids because it's everywhere. Literally every day, everyone's talking about Purdue still.

35:13Claudia A. Merandi: Those things should be explained to the patient. And if pharmacists are doing their jobs, if doctors are doing their jobs and working together, those risks are explained for everything. And I would, let me start, there's a lot to unpack in those two things you said. first of all pharmacists are not getting their science from stories like dope no no i didn't know i wasn't no no you know i understand the general public might see might see something like dope sick and say oh everyone who's on opiates is drug seeking um but it does it does show the risks of what can happen for the wrong patient starting on that or staying on it for more than

35:48Dr. Shane Jerominski: for an extended period of time but why aren't we talking about the risks of somebody being on suboxone for a long time. We should be.

35:56Claudia A. Merandi: We should be talking about all those risks.

35:59Dr. Shane Jerominski: What were you taught is the addiction risk of a patient on long-term opioids? What would you say in the most recent studies is the risk of addiction?

36:10Claudia A. Merandi: What would I say the most recent?

36:12Dr. Shane Jerominski: In the most recent studies, like the most recent statistics out there, what would you consider a percentage of risk of addiction for a patient on long-term opioids, chronic opioids, however you want to say it for pain what what do you think the risk of addiction is like how many people like what percent yeah what percentage percentage I mean I don't want to throw throw one out there

36:33Claudia A. Merandi: because I'm sure it's you know I think that let's go back to what where you were talking about how in in our you said at University of Rhode Island that uh these students are being taught to vilify oxycontin and since they really push buprenorphine I think that it's not just that I think that what what students are being taught in school is that their license is at risk for making a mistake that there that there is a lot of liability that ultimately ends with them even though there are so many people in this food chain of getting getting the medication to a patient ultimately it's on and i know this because i have been in situations my wife has been deposed because of of patients getting things and then families claiming that this is, this was something that should have been stopped.

37:26Claudia A. Merandi: And so, so, and, and, and a place like the university of Rhode Island where CVS is headquarters is Woonsocket. I'm sure they fund that university a lot. So CVS probably has a lot to say about what the education should look like there.

37:42Dr. Shane Jerominski: A lot of the pain education is coming from ASAM though, from addiction medicine. But the reason I ask you the percentage,

37:48Claudia A. Merandi: You don't think a company like CVS, though, has a lot to say about that?

37:52Dr. Shane Jerominski: Oh, yeah, yeah. No, I'm not contradicting you. I'm saying in addition to a lot of the, absolutely. Oh, absolutely. There was a lawsuit filed against CVS, Edie Fuag versus CVS and Walgreens, for the pharmacist not dispensing the medication. They had a website, Justice for Chronic Pain Patients, an attorney I used to work for. He's now the judge or the judge that was overseeing that case. So we know this is happening. Yeah, of course. We know it's a problem.

38:20Claudia A. Merandi: Yeah, well, CVS and Walgreens and all of them have also been sued significantly more for dispensing medications. Yes, absolutely.

38:29Dr. Shane Jerominski: And those lawsuits are a big part of the problem. Like a lot of the issue is because of those lawsuits, the suspicious order reporting and the thresholds from the distributor agreement. That's a huge, as you know, like a huge part of the problem in pharmacies. We totally understand. You don't get notified that you're at your limit until you're at your limit.

38:45Claudia A. Merandi: And every area has been overcorrected. And the only people that are really suffering here is chronic pain patients and the pharmacists who have to do all of these extra things and really end up siding. It's defensive pharmacy practice. I get it.

39:04Dr. Shane Jerominski: That's why the time has come for us to come together. I don't know if that's going to happen, but my work will continue. Beth's work will continue. we have to apply pressure to the DEA. That's the only way around this. And I thought, I have stayed awake at night. Okay, we tried this, we tried this, we tried. What do we, there's only one solution. And Bev and I did meet with the DEA a few weeks ago and we had this conversation, but here's, we don't have an association behind us. It's just us. It's not only chronic pain patients. It's, we've collected thousands of stories over the years from acute patients, went to the pharmacy, pharmacist said, nope, I don't feel I'm not going to fill it.

39:46Dr. Shane Jerominski: You're better off just taking Tylenol and ibuprofen or no, I can't fill this for you unless you also get this filled. Well, I don't need that. It doesn't matter. You need to get that.

39:57Claudia A. Merandi: Well, sometimes the insurance company is the one that's doing that. You were saying how, you know, sometimes you went to these, these pain clinics or whatever, and they're saying, you have to have this injection. You have to be on gabapentin. You have to be on these other medications a lot of times if you're if you're trying to get certain drugs certain opiates there might be a prior authorization for it there might be there might be step therapy and certain things so that's the reason why i understand that but the reason i made the video

40:23Dr. Shane Jerominski: to begin with is this really you see this right here this has robbed the younger generation of really connecting with people and and the doctors i've been saying this for years you know um i have some friends, they're, you know, in their seventies who were doctors and they are just, they shake their head. You know, a lot of doc, older doctors contact me. I was just at a television station recording a segment and a doctor recognized me. He's like, Oh my God, please. I got to tell you what's happening to my wife. They're not willing to give her, her pain medication, just Suboxone. My wife isn't an addict.

40:57Dr. Shane Jerominski: So, you know, everybody is going to be affected. It may not be pain medication. It may be your kid's ADHD medication. It may be my muscular dystrophy patients. They can't get their clients. They can't get their benzodiazepines. I advocated for a judge whose kid had ALS. He's deceased now, had to choose between the benzo or their pain medication. It all goes back to one problem, two problems, lawyers and the DEA. And at the Doctor Patient Forum, we remain committed to raising awareness. We lobby for change on both a state and federal level. And if you're a PharmD listening to this, I'm awful sorry if you interpreted my video as something other than it was.

41:45Dr. Shane Jerominski: But I got to tell you, every day I was seeing those horrible videos of these younger. I would text them. I was like, look at this video. Another one.

41:54Claudia A. Merandi: so bad i would like you guys to show me one of them that really upset you so i can see as an example we would love to definitely definitely send that to me and you know what i agree with the two people that you called out there but i would also say looking at these corporations and corporations have gone above to protect themselves they've given arbitrary mme required limits on that walmart you know there are certain drugs that walmart won't fill legitimate pain medications for established patients. And they've said, you know what? We don't need that business. So we're going to channel that to CVS and Walgreens and independent pharmacies.

42:31Claudia A. Merandi: And those things are really, so we have not just the DEA, not just state boards of pharmacy coming after us. You have the corporations trying to protect themselves. But that's in response to the DEA and the lawyers though. It is, but also I think even then, they like the idea of not having limiting risk is the larger the corporation, the less they want to limit that risk. And if they could say these prescriptions, they're not really that, they're not, they're not a medication that's going to increase our margins enough for us to incur that risk. So let's push that off to someone else. And I think the same thing happens with young pharmacists.

43:15Claudia A. Merandi: They're, they're assessing their own personal risk. And when you're staring down six figures of student debt and you're given a situation where it's on the fence maybe one red flag red flag doesn't mean that the prescription is invalid and it shouldn't be filled but in a young pharmacist head they haven't seen enough of these things they have they realize okay wait i'm 100 prescriptions behind i have this red flag i'm trying to call the doctor's office i can't get through this it might need a diagnosis code i don't have a lot of history on this patient because they're filling here because they're out of town or whatever yeah they they're erring on the side of caution and they're they're doing the wrong thing for that patient and they've they because they realize okay i'm protecting myself they don't realize they're going to send this patient away for a weekend of agony because they can't fill it anywhere else and i i always try to side with the patients when i can't i've been a pharmacist for almost 20 years now i've seen i've seen suffering.

44:14Claudia A. Merandi: I've seen real suffering every day and I feel it. You know, I'm not the smartest pharmacist to ever be behind the bench, but I feel like I am one of the most empathetic. And when I see someone suffering, I try to do everything I can within in the confines of the law to help those patients.

44:32Dr. Shane Jerominski: Pharmacists shouldn't have to work under this pressure and doctors shouldn't have to work under this pressure. You know, one of the one of the people from the DEA we met with, they just, that's their job just to go into the pharmacies and start counting, you know, do an audit. So I know, and you know, if I had a child that was a pharmacist or a doctor, I would probably, you know, be sick, you know, because I would be sick to my stomach worrying, oh my God, my kid could go to prison, but I also, but I got to go back to, because I got to stay true to who I am like this. This has been the demise.

45:07Dr. Shane Jerominski: This is the demise of the world, the device. And, you know, all we ask is if you're a young nurse, if you're a young PharmD, if you're a young, you know, emergency room doctor, like leave your bias behind before you go on social media and make a hateful video because you are stigmatizing. When you stigmatize OxyContin, you are stigmatizing the user. And I always think back to that gentleman with ALS who, I mean, he had to choose between his liquid benzo for spasms or his pain medication. And, you know, we just have to continue to be, you know, we remain steadfast in our advocacy. We have to take this to the DEA.

45:52Dr. Shane Jerominski: The next step is to get on Capitol Hill with pharmacists by our side, with physicians by our side. You know, I'm not the person that does what I'm told to do. I'm doing something because I know it's right. And that's what I just wish more providers were on our team. So we got to get those people out of prison. We've got doctors. They're in their 80s. They are behind bars. did they use a lot of discernment? Probably not. Were they good business men or women? No, they were far too trusting, but they don't deserve to die behind bars. Neither do those pharmacists. So, you know, you guys, I'm sure there are people, I'm sure there are people that

46:37Claudia A. Merandi: are in situations, pharmacists and doctors alike that are behind bars because they dispensed medications, but there's a lot of people there. The system does work. There are pill mills that have existed. There are places where they've dispensed ridiculous amounts. They've taken cash prescriptions hand over fist. Those days are so long gone, Shane.

46:58Dr. Shane Jerominski: Those days are so long gone where there's so many pill mills everywhere.

47:02Claudia A. Merandi: You're saying that those days are so long gone. I will send you what just happened in Inland Empire, how a whole clinic was just shut down down here. All of that's just happened recently. We can talk about it being like a time past. Maybe it was more proliferative back during the height of the opioid epidemic, but it still exists. And we do have to have some regulation in place. I'm not... We do. We have a lot of regulation in place though.

47:31Dr. Shane Jerominski: And what you were explaining about being empathetic, I want to thank you for that because I can see in your face that you mean it, that you want to be there for the patient and that you want to help the patient and that just sometimes the system stops you from being able to do that. And I respect that. I absolutely, I don't know if I can explain this properly, but there's a difference between what you just said, Shane, and the pharmacists, both on social media and in real life, who just make fun of the patient and say, you think I'm going to fill this? Get out of here. There's a difference. There's a difference.

48:03Claudia A. Merandi: I guess because I'm not on TikTok as much, I don't see some of the younger

48:06Dr. Shane Jerominski: generation but we have people record their their their interactions with their pharmacies where the pharmacist is literally making fun of them to their face calling their name out in front of everyone saying you think i'm gonna fill your your oxycontin that's not happening and it's just not

48:22Claudia A. Merandi: it's not okay like it's not i i'd like to see those too because we you know we put up we put up everything the good and the bad we call out pharmacists that are doing the wrong things any pharmacist that's ever in a situation where they're in front of a patient and they're they're doing that I the whole pharmacist community the whole health care community should reject it I've seen where health care communities where the health care community has rallied behind patients when something happened I don't remember what state it was in but that whole clinic where they were taking pictures this happened on TikTok where they were taking pictures of the fluid the remaining on that so anything that's egregious like that gets called out the the the farm the medical student that was making fun of women's health issues.

49:07Claudia A. Merandi: Right. Because that's acceptable

49:09Dr. Shane Jerominski: to call out though, Shane, the vast majority on social media, or at least those who are willing to speak, are not going to speak up for somebody on a phallaginous opioid who's treated poorly. It's actually applauded, at least where we are on social media, what we see. Unless they're affected or they're loved ones. Yeah.

49:29Claudia A. Merandi: We've never seen... Well, you advocate harder when you advocate harder when it's your own loved one. And we've never seen anyone though, Shane.

49:36Dr. Shane Jerominski: We've never seen, this is the point. We haven't seen healthcare professionals rally behind pain patients or anyone who needs acute opioids for acute pain, chronic pain, end of life cancer, whatever. We've not seen that happen. We're the ones having to rally. We see them make fun of us, but we haven't seen the rally. And I guess that's where my anger comes from and resentment towards healthcare professionals on social media because they're so willing to rally for issues that are acceptable, like you said, like reproductive rights or even opioid use disorder. But when it comes to someone in physical pain, it's just not socially acceptable to rally.

50:13Dr. Shane Jerominski: Let me offer my platform and every platform that

50:19Claudia A. Merandi: I touch from that. I would point you to places like I know you had your issues with Dr. Katie Forbes who made a crazy statement and said that you I think it was in a joking way but she also did some of the same things she got she got she got everybody talking she she had made in passing oh was she being funded by Purdue Pharma but she also brought two communities together that sometimes are at odds and are getting people to talk to each other I would point you to pizza's not working and Dr Bled Tanaway I'd point you to Rx comedy all of these all these platforms we can advocate for patients. And you're right.

50:53Claudia A. Merandi: The only way we can affect change is to have both of these communities come together and rally against the forces that are holding. Exactly. Even Buddy

51:02Dr. Shane Jerominski: Carver, when he came to our event, he listened to our whole presentation. He spoke and literally, he basically was, you have to understand, you have to be careful. And Claudia said, because it's career suicide. And he was like, yeah. So that's the issue. Like for politicians, for doctors, for healthcare professionals. Even those who stand up for us, they have to toe that line. Because if you are seen as someone advocating for a full agonist opioid access to, it could kill your career. It really can. But it's changing now because there's too many suicides. Too many people have died for this to go unnoticed.

51:40Dr. Shane Jerominski: And just that last meeting with the senator's office. Big, big change in the conversation than nine years ago when I first met because now people are applying pressure. People are canceling surgeries. People are saying no to those pain clinics. People are saying, you're not going to abuse me anymore. That's it. I'm done being abused. So that's the good part of social media.

52:04Claudia A. Merandi: I think that pharmacists are finding their voice as well. And the pharmacist community is. And sometimes they do it the wrong way and sometimes they say some of those things and you're and you're seeing the worst i think you see the best and worst of humanity online and through social media you really do i say

52:20Dr. Shane Jerominski: i have the most amazing i'm still friends with two pharmacists who retired uh many years ago my pharmacist have they've always been they're like they're like friends i'm in a state that's teeny teeny tiny so you know and people ask me well you know has this happened to you i was like was being accused of being a drug seeker, which left me with a colostomy bag. But other than that, it's been, you know, smooth sailing. Thank God. But, you know, I think the time has come now for the communities to come together and to take this off social media and take it to Capitol Hill. And I think the pharmacists probably have a little bit more power than we do as patients.

53:08Dr. Shane Jerominski: You know, we have no funding. Like I know, I think you made a grifter saying something about, was it you or a different pharmacist that Claudia was a grifter? We just so you know, so everyone knows who is listening. We have no grants, no funding. Our only source of income is through donations and through Patreon. Claudia and I make about a thousand dollars a month doing what we do. So there is no grifting happening. And that's only recent for the first eight years, Bev and I, you know, just, you know, we, I, people laugh, but I say we dedicated our life to serving others. And we're going to continue to do that because most of our constituents are bed bound.

53:49Dr. Shane Jerominski: They're, they're too sick. Yeah. And I would, but I would love what you said, Claudia, like if we could somehow Shane speak off of social media at my dog's going to bark, I'm sorry. If we could speak off of social media and figure out a way to to try to affect change together I mean you're welcome to join us on calls when we meet with senators we'd love to have the the pharmacist voice because that's what we

54:18Claudia A. Merandi: need no I I am all for this I have like I said my my focus has always been trying to help with work workplace reform because yeah a lot I don't know if you use CVS or you use Walgreens I do and some of them are really the pharmacist is in a situation there sometimes where they're just overworked and they're understaffed and there's constant turnover because technicians are not paid appropriately for the amount of work that they need to do it's awful because of it there's medication errors that occur constantly because of this situation. So what we're advocating for is for technicians to be paid better so well-trained staff stay in role and they understand all the little intricacies so they can get as many medications out to the patients as necessary.

55:05Claudia A. Merandi: And you talked about all those patients out there that you've dealt with, that you've heard of suicides and patients that have ended their life because they couldn't deal with it anymore. I can't tell you how many pharmacists stories that have happened over the last few years and they're increasing

55:24Dr. Shane Jerominski: yeah do you have statistics on that that's something i'd actually like to to post and speak about if you have any information the most recent the most recent statistic is that the

55:33Claudia A. Merandi: pharmacists have an increased risk over the general population for suicide if you could send me i

55:40Dr. Shane Jerominski: would i'd be happy to speak about that because we hear about that with physicians but i have not heard about that specifically from pharmacists.

55:45Claudia A. Merandi: One of our own that was advocating online for a long time, Todd and I both know him, Dr. Eric Geyer. He ran the political pharmacist page. It was amazing. Yeah, was an amazing guy.

55:56Bev C. Schechtman: All about the patient, all about advocacy, helped to start Pizzas Not Working, which then it manifested from just this little hashtag into this enormous campaign. So it's it's helping to to change health care and what the pharmacists are going through and how they're connected. I wanted to take us upstream real quick before we have to wrap up. When I say upstream, there's forces that have pay grades that are much greater than all of our all the money that all of our families will ever make over the generations of families that we have in comparison to the pharmaceutical manufacturers who also are paying attention to the um where the money is and how money works and how drugs are being developed and i mean there's there there's human beings there's shitty people in every sector of human beings and there's pharmacists who can be jagoffs and there's pain patients who can be jerkos.

57:05Bev C. Schechtman: And I mean, there's all of us and what we go through. The same thing in pharmaceuticals and in the entire ecosystem that we live in. I've met with CEOs of pharmaceutical manufacturing companies who are so in tune to the mission because they've had a loved one or they've had someone that they know has been impacted by the disease that they're helping to literally eradicate or fight. And then I've seen, you know, the memes of that, what's his name, Scalicati or something Pharma Bro, where he's taking advantage and marking up a price. Martin Shkreli. Yeah. So, I mean, and he, you know, so we have people in every sector of healthcare that can be jerks that make the rest of us look like shitheads.

57:49Bev C. Schechtman: And that's just the way it is. We're going to have to deal with that. But I know the pharmacists that I've gravitated towards in supporting. They don't pay me. I promote them over and over and over again. All of my hosts, none of my hosts pay me anything. And I'm putting out their content. It's because I know that they're part of the change. And I know that what they're going through to get there. And I don't think either sides of our courts really understand the other sides as people and as humans. And the way that Shane has just reached out to everybody on the planet from different sectors and the way that the two of you have advocated and been connected with, I do think that there's more that we're going to be able to do together, Rx, you know, together and being together and getting something done.

58:37Bev C. Schechtman: and we should have next steps. We should meet back on This Week in Pharmacy, but I want to bring a senator or a state representative or someone who wants a platform and then sprinkle in other pharmacists who are pain advocates because they're out there. A shout out to, like I said, we started this show and I mentioned Dr. Jeffrey Feuden, who's very much missed in campaign management. So yeah, there's other, there's other champions too. So, um, yeah, I, I want to thank, um, Shane, um, I'm going to kind of give you, um, the last word on, on your mission. Cause I do want to give you a, give a shout out to the, uh, the union work that you're doing.

59:23Bev C. Schechtman: If you'd give us just a short update on that. Yeah.

59:26Claudia A. Merandi: So, uh, the, the update on that is the Pharmacy Guild has active campaigns in almost all 50 states. We've won elections in Rhode Island. We have two of the 24-hour stores that are some of the busiest CVSs in the country that are bargaining their first contract. We have CVS Specialty in Redlands, California, that's close to their very first contract. We have multiple stores of Safeways in Washington State. We have Providence Hospital where all 72 pharmacists have voted to win their election. So there's stores in Arizona. We can change a workplace. The Pharmacy Guild can go in and unionize a store with two pharmacists and three technicians, or we can unionize a facility like CVS Specialty in Redlands where all 125 technicians are getting close to having their first contract.

1:00:21Claudia A. Merandi: I think that this is where the intersection of doing the best for chronic pain patients and my work comes together. If we can fix the labor piece inside these pharmacies, a chronic pain patient who's having any difficulty filling a prescription will be able to go in and have a pharmacist that can give them 10 minutes, 15 minutes of their undefined attention and explain what they can do to get their medication today, whether it be in that location, let them know what the issue is, what they have to do, whether it be the insurance is stopping it, whether it's the arbitrary rules of the company they're trying to fill it with, anything, what their concerns are.

1:01:03Claudia A. Merandi: When that discourse happens and you turn a customer into a patient, you avoid all of those problems. And if I can, if our team and the Pharmacy Guild and all the people that I work with can change that culture inside of a pharmacy, we can better serve every patient out there. So it's a win. And I think the way that we can work together is if we're on the same team and we advocate for you and you advocate for us, there's real power in where you go to fill your prescriptions. I want to let every chronic pain patient know you said, Claudia, you're the face, you're advocating for people that are bed bound.

1:01:40Claudia A. Merandi: There's still power in numbers for all of those patients to take their business somewhere else if they're not if they're not bargaining in good faith if they're if they're an understaffed pharmacy show them with your prescriptions show them with your business and your insurance and all the things that they're billing show them that you have power you can affect change and i am all in i will help you guys wherever i can even if it's just sharing it even if we have to put up something a little bit sensational to get people talking. And let me end this by saying I apologize wholeheartedly for anything that seemed a little bit offensive or off color that I posted after that original harm assist video.

1:02:22Claudia A. Merandi: But I was doing it with the intent of getting us together and getting people together to make real change. Thank you guys for having me. I really appreciate it. Yeah.

1:02:33Bev C. Schechtman: Yeah. Thank you, Claudia and Bev. you're going to be coming back for sure. I want to do more maybe focused groups and anything that you need for me to help you guys strengthen our relationships with providers. Because like I said, I can't help the patients. You guys are on the front line. So are our pharmacists and our technicians and they want what's best. I have up on the screen, if you're watching on YouTube or one of our live streams, It says the doctor, the doctor patient forum.com. That's the doctor patient forum.com. But in wrapping up, I want to give last word to Claudia and Bev.

1:03:14Dr. Shane Jerominski: Well, I think, I think people are going to be angry that it wasn't more hostile. And we ended on, so I'm sorry, listeners that we don't come from a place of hostility. We come from a place of help. So I hope people aren't too disappointed because I'd love to have Sean, Shane, I'm sorry, that's so bad. That's my menopause. I probably need an increase in my estrogen. But we'd love to have Shane come on our podcast. Our, you know, our constituents really need to understand what pharmacists are going through because they're in a pressure cooker. I know, I know, I get it. I get it. Like I said, they're in prison.

1:03:57Dr. Shane Jerominski: There's some people in prison. They don't belong there. So thank you, Todd, for this opportunity.

1:04:04Bev C. Schechtman: Yeah, thank you.

1:04:06Dr. Shane Jerominski: I just want to say like one thing I didn't touch on, I'll do it really, really fast that I really want to just address is one thing we fight for with the doctor patient forum that has to do with pharmacy is actual harms from the PDMP and for data analytics programs like NARCS care and the red flags. because these red flagging systems tend to flag the sickest patients and then they cause the very thing they're trying to prevent, like you said, go to a different pharmacy, but see, then that's a red flag for the patients and then their NARCS care score can go up. Or if they don't have it in one pharmacy, going to another again.

1:04:40Dr. Shane Jerominski: And so a lot of times there aren't pharmacies within 100 miles of a patient. A lot of times the pharmacy doesn't have the medication, a certain MME or whatever. We have an open NARCS care petition that we submitted to the FDA, a citizen's petition asking them to declare it as software as a medical device so that it can be regulated and transparent so people actually know what goes into it. I'm not saying the PDMP is just harmful, but there is not a lot of focus on the harms that come from the PDMP, what it actually does, what we know it does, and what it might do. And so I think there needs to be more research there.

1:05:13Dr. Shane Jerominski: So this is just something that we focus on also. I just wanted to let you know, Shane, that that is part of what we focus on. Because I know you're given those tools to try to determine things. And sometimes they're not the best tools that you're given. But I do appreciate your kindness and your empathy. And yeah, like Claudia, I think people will be mad that we're not screaming at each other. But Todd, thank you. You're always the best. I love, Todd, I like stick up for you. Anytime anyone attacks you on social media, I feel like I need to be like, no, Todd's our friend.

1:05:43Bev C. Schechtman: don't do it i'll move around i always dodge it i got that gen x skin too because it's you had to you had to i got so i got made fun of in catholic school for having a big head and you know it's how old are you i'm 53 52 so we all get yeah so you i was 76 you were born in

1:06:04Claudia A. Merandi: what 74 72 72 oh 72 do you mean i'm the youngest on here you are shane for sure i'm 48 i am

1:06:12Dr. Shane Jerominski: 48 so if you were born at 72 you're not 52 i just wanted to let you know that i can't i'm not see i'm not getting it's just getting old but shane we would like to have you on the podcast we'd like to

1:06:25Claudia A. Merandi: continue this conversation i would and i believe me i i know that people are going to be a little bit upset because they're going to say look but i wanted to try and have that human connection we could have turned this into a debate but i didn't want to do that because i don't think that's beneficial for any one of us because we are on the same team ultimately and we need to fight the forces that are preventing us from really doing our job and really servicing the

1:06:47Dr. Shane Jerominski: patients all patients yes shane can you give us your contact information after so that we can send i'll send you some of that stuff and if you want um that one uh podcast with tim atkinson at pain week i can send it to you if you want so you can see what i'm talking about i don't i would love I called him to see if I contacted him to see if he'd come on our podcast, but he said something like those who he were. I don't know. He has restrictions on where he can go, but maybe he can go on your podcast. It's been a few years, but he's he still he seems great. He's he's fighting. He did research, I guess, on patient abandonment and forced papers.

1:07:22Dr. Shane Jerominski: So Shane, are you trying to organize pharmacists? Is that what you're trying to do?

1:07:27Claudia A. Merandi: Yeah. So myself, Dr. Bled Tanaway, Dr. Maurice Shaw and Lonnie, Dr. Lonnie Duong. By the way, I don't call myself doctor ever. The only thing it's on is my checks. So I wanted to let you know I'm not part of that generation who insists on that. I'm a pharmacist and that's what I want to be. I don't want to be a doctor.

1:07:45Claudia A. Merandi: We started advocating years ago, but during the walkouts that occurred in Kansas City, there was a bunch of pharmacists who got so upset with the CBS targets out there, they decided to walk off the job. and a lot of them wanted to be able to put stuff out, but they were worried about losing their job. And I ended up being the voice on television to get their word out. So we organized after that, like CVS tried to play it off. Like this is very specific to this area of the country. It doesn't happen everywhere. But because of a platform like the accidental pharmacist, everyone was saying how, you know, this is happening everywhere.

1:08:20Claudia A. Merandi: Pharmacies are understaffed everywhere. There's so many, we're worried about making mistakes because of the way that they're staffing these locations. So during that time, I ended up being on Fox Business and CNBC and NBC, and there was print articles everywhere. And at that point, IAM Healthcare, which is the International Association of Machinists and Aerospace Workers, they have a smaller healthcare wing. They gave us the resources to launch the Pharmacy Guild. So we're part of IAM, but we're our own entity that only represents pharmacists and technicians. And we have close to a thousand members right now.

1:08:57Claudia A. Merandi: We're still bargaining their first contracts. And we've grown a lot, but we still need more. We have full-time organizers in Florida, in Michigan, in California, in Arizona. And we actually need more because there's lots of people that want to organize these places to have safer working conditions.

1:09:16Dr. Shane Jerominski: Yeah, that's great. Oh, God. Yeah, I'm I'm pro union all the way. I come from union blood. So I know the importance of organize. I mean, I tried to organize doctors years ago. Yeah. But apparently it's illegal for doctors to organize. But I was like, who gives a shit?

1:09:33Claudia A. Merandi: Well, it's changing now. I mean, it is because there's lots of residents that are actually trying to organize. But the thing is, is that it would, it's very difficult. If it wasn't for IAM taking, I mean, they put a lot of resources in. We've been at the American Pharmacists Association conventions every year. We've had our own convention here in Palm Springs. They've really put a lot of resources into trying to change this industry and really rein in the control that CVS Caremark has on what pharmacists do and what our careers look like.

1:10:06Dr. Shane Jerominski: Yeah, that's great. Shayna, I would love to have you on our podcast just to talk about that. Can I say something off the record, like really off the record? Sure, sure. We're still recording. Oh, really? Oh, no, I can't say it then. All right, just let me shut twerks down.

1:10:21Bev C. Schechtman: We appreciate you all listeners out there. Please share this with someone that you know should be hearing it. Another pharmacist, somebody in pain management, also reach out to Claudia and Bev and Shane. Thank you so much for being on twerks. It's always great to see you and can't wait to have you back.

1:10:39Claudia A. Merandi: Thanks a lot. Pharmacy on. Thanks.