Drug-seekers in the pharmacy

Larry LaBenneIt was 8 p.m. on a Friday night. All was quiet in the pharmacy until a woman at the drop-off window startled me by shouting out a hearty and jovial “Hello!” She proceeded to make cheerful small talk, asked how I have been, and even knew my name, although I was sure that I have never seen her before.

I thought, She’s talking a lot, but I’m not sure that she has really said anything. People who act like this are either drug reps or someone who wants me to dispense narcotics for all the wrong reasons.

She obviously thought I was going to fall for that long-lost-friend routine. Did she really believe I wouldn’t know she got my name and face from the picture on the outside wall?

Reluctantly, I walked over to the counter. Her pretentious smile widened as I approached. I looked down at the paper she held out. Sure enough, oxycodone 30 # 240, issued by a doctor two states away - with a patient address two states away in the opposite direction.

“You must be in a lot of pain,” I said gravely. She looked down for a second and changed her smile to a wince. “It hurts so bad.”

I said, “With that level of pain and at that dose of oxycodone, it may not be safe to drive as much as you have been.”

Her demeanor suddenly changed and she demanded, “Are you going to fill my oxy’s or not?”

“No,” I said. She looked bewildered and surprised.

“That’s all you’re going to give me, is a no? Aren’t you going to tell me that you don’t have it? You can’t just refuse to fill it.”

“I can, and I just did.”

“It’s not up to you to determine whether I’m in pain.”

“I didn’t say you’re not in pain. I just said that I’m not going to fill it.”

She started spouting four-letter words and got even angrier when she saw they had no effect.

“Leave now, or I’ll call the police,” I said.

“I’ll find someone to fill it sooner or later,” she said as she stormed out.

Discern

There are numerous situations in which a diligent pharmacist has genuine difficulty in determining the legitimacy of a narcotic prescription. The-all-too-familiar scenario I just described makes the decision easy. We are told that federal and state laws provide a good set of guidelines, but they don't seem to cover all situations. Either way, for all narcotic prescriptions, professional judgment should be exercised with vigilance.

Unfortunately, pharmacists frequently surrender and dispense under duress, despite their suspicions. In this way, they unintentionally contribute to the pervasive and growing problem of prescription drug abuse. 

Pharmacists

A common reason that pharmacists cave is fear of being sued by the patient or the provider.

Specific provisions in federal and state regulations give pharmacists the prerogative to refuse to fill on any legal or pharmacological basis. In fact, the same regulations also forbid a pharmacist to fill a prescription that a pharmacist knows or has reason to believe will be misused, abused, or diverted. A pharmacist is much more likely to face legal ramifications for filling such a prescription rather than for lawfully refusing to dispense.

However, a pharmacist can be sued for making slanderous or false statements about a patient or prescriber. So pharmacists refusing to fill a prescription should explain their decisions in a friendly but uncompromising manner; cite professional judgment; and avoid making subjective statements about the patient and/or prescriber.

Prescribers

Pharmacists will often call a prescriber to verify issuance of a purported prescription for documentation purposes before filling. However, calling the prescriber merely to verify that a purported prescription was, in fact, issued does not circumvent legal duty to exercise professional judgment in determining whether the prescription was issued within the meaning and intent of the controlled substances act.

For example, a 1979 court case (Talman v. Dept. of Registration & Education) recognized that a prescriber can easily falsify the nature of the patient-provider relationship, and that a pharmacist should be able to recognize the circumstances in which a prescription should not be filled. Therefore, it lacks legal merit to justify the fill merely by verifying with the prescriber that the purported prescription was, in fact, issued.

Management

Yet another factor contributing to the problem is business-centered employment circumstances that distract from pharmacy practice. As a result, pharmacists find themselves uneasily dispensing narcotic prescriptions on the basis of business decisions.

Many employers seem to justify these actions on the grounds that prescribers have the ultimate responsibility to prevent prescription drug misuse and diversion, and that pharmacists merely have a duty to dispense. This reasoning heavily flawed, since the misused/diverted medication is physically provided by the pharmacy.

Report

In future, the problems we all complain about cannot be averted if they are not reported.

Pharmacists concerned about prescribing activities should not hesitate to report their observations to the appropriate law enforcement agency.

Narcotics agents generally find reports from pharmacists credible, and they are receptive to the reporting of relevant information. Pharmacists should be prepared to establish why they believe an activity to be suspicious. The agent is likely to ask for details connected with the suspicious activity, such as general patient(s) demographics, number of prescriptions filled, number of prescriptions presented, and types and quantities of medications being prescribed. The DEA also accepts anonymous tips at http://www.justice.gov/dea/ops/submit.php. Some jurisdictions even give the option of anonymous submission of a tip by text message.

Communicate

Lastly, we all have been told that communication with patients and physicians is an important component in combating drug diversion. It may be even more important for pharmacists to develop a rapport with other local pharmacists. They can keep one another informed of any concerns they have with prescribing activity they observe. This is important, since patients will "pharmacy shop" until they find an unsuspecting pharmacist willing to fill a prescription intended for abuse or diversion.

The next time one of those suspicious individuals presents you with a narcotic prescription that you think is likely to be abused or diverted, remember that a prescription is merely a piece of paper until a pharmacist dispenses. Don't let your pharmacy be the place where the woman in the above scenario finally gets her fill.

Larry LaBenne is staff pharmacist with Martin’s Pharmacy in DuBois, Penn. Contact him at larrylabenne.rx@gmail.com. 

Larry LaBenne

is staff pharmacist with Martin’s Pharmacy in DuBois, Penn. Contact him at

larrylabenne.rx@gmail.com

. - See more at: http://drugtopics.modernmedicine.com/drug-topics/news/teachable-moments-take-your-best-shot#sthash.Q6OvuMHW.dpuf

Larry LaBenne

is staff pharmacist with Martin’s Pharmacy in DuBois, Penn. Contact him at

larrylabenne.rx@gmail.com

. - See more at: http://drugtopics.modernmedicine.com/drug-topics/news/teachable-moments-take-your-best-shot#sthash.Q6OvuMHW.dpuf