Controlled substance dilemma

Key Points

How many times have we seen patients who appear perfectly fine receive 120 Vicodin and 90 Xanax month after month? Relief pharmacists who travel to many areas often happen upon a particular pharmacy that seems to do nothing else but dispense cocktails from a local doctor and a horde of physician assistants. We all know that the quantities, combinations, and duration of therapies are not in keeping with normal guidelines. However, we have a number of problems:

Pros and cons

This situation is unpleasant and difficult to handle because we don't have any protocols to follow. I have seen pharmacy record-keeping forms that require a diagnosis by the doctor and a proposed length of therapy, but even that approach just yields 50 patients with fibromyalgia, neuralgia, and so on.

No magic bullet

I don't have a magic bullet to suggest. I do think this problem deserves visibility. I rarely hear it discussed in the mainstream media, even though community pharmacists know it intimately.

The physicians responsible for this mess know what they're doing, and they're making millions of dollars. There are pharmacies that are doing the same. What are we doing about it?

Every state has its own board. There is no professional body that can direct these issues. Even the Drug Enforcement Administration has an unbelievably hard time disciplining offenders. The American Medical Association and the patient-doctor relationship make an objective peer review of prescribing habits almost impossible.

With all those hurdles, should we just take the subject off the counter and move on? I hope not.

Darius Randeria founded PharmStat Staffing in 2001 and currently serves as vice president, staffing, AHS PharmStat. He can be reached at dranderia@ahspharmstat.com
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The opinions expressed by guest editorial writers are their own and do not necessarily represent the views of Drug Topics' staff or the staff of Advanstar Communications.