I see a pain management Doctor once a month for the past two years due to chronic pain from an traumatic injury. This Doctor is compassionate, but careful with who he prescribes what to, but he is still very liberal with pain medication.
Naturally, where there is a Doctor that is liberal with prescribing pain meds, there will be a million patients trying to see him.
So, I’m sitting there in this crowded waiting room thinking, “man, it must be a pain in the ass for this Doctor because if they do check every script, I bet pharmacies don’t leave him or his staff alone.”
So it got me thinking, do pharmacies verify all narcotic scripts? Do they just verify ones that are questionable? Do they just verify Schedule II narcotics?
If so, that would seem very time consuming, is it? Why not just do everything over some sort of medical intra net?
I work as a Pharmacy Tech in a major chain retail pharmacy. We only call the Doctor’s office if we think its a forgery. However, if there is a patient that we think is a drug adict, we might refuse to fill all of his/her controlled medications.
Normally with forgeries, they are almost all ways written in the same way, Loratab 10/500, take 1-2 tablets every 6 hours as needed for pain. Quantity 90.
I believe that my doctor electronically transmits most prescriptions to my pharmacy - I can request renewals from the doctor on-line. It’s a real drugstore, not a giant chain, and I think they know their clients reasonably well. They also have a record of what you get, so I’d suspect they’d confirm suspicious paper prescriptions. I’ve never had an issue the few times we’ve gotten Tylenol with codeine or vicodin.
Also, I’ve always wondered why Pharmacists felt it was up to them who decides who is or who isn’t a drug addict? Isn’t that none of their business?
Because one time I had a script for 120 Lortab and they wouldn’t fill it because the Pharmacist said “your insurance states that you just had some filled two weeks ago” and he handed me a copy of my original script and said “here, this is just as good as a real script, just hold onto this and we’ll fill your original in two weeks, it’s way too soon for you.”
naturally I was pissed and demanded my original script back. What had happened was I had my tooth pulled and got 15 Hydrocodone filled two weeks prior and my insurance paid for it, so it was coming up that I already had some filled.
Why do people do that? Some people may be addicted, but at the same time, they may also have cancer and need this medication.
I understand that, but I had a friend of mine who was taking 20mg Oxycontin and one time the Pharmacist pulled him aside and asked him if he “had a problem with these” and my friend said “yeah, I do” and pulled up his shirt revealing his deformed vertebrae in his back from the radiation.
It is illegal for pharmacists and doctors to dispense opiate narcotics to maintain an addiction. Therefore both are obliged by law to be relatively sure that the prescriptions are not only legitimate, but that they are not feeding an addiction.
Diversion of physician prescriptions is the number one source of illicit narcotics. At least that’s what the DEA agent I talked to last year told us, at the prescriber’s seminar. Most of these folks get the scrips that later get diverted (for money) by complaining of back pain. Many have interestingly shaped spines or other deformities, but most look pretty normal.
Which is why I prescribe narcotics generally only for either acute moderate to severe pain, or malignant pain.
I think it is part of their job and therefore it is their business. Pharmacists are the ones that can catch multiple prescriptions for the same drug from different doctors and all the other standard tricks. They go to school for a long time so that they can catch potential adverse drug interactions as well as mistakes by doctors. They aren’t there just to silently fill whatever comes across their counter.
I clerked in a pharmacy when I was in high school in the late 70s, so this is dated info. Small one pharmacist + clerk shop in a medical building.
At that time a narcotic perscription required a Doctors’s signiture. Most other drugs did not. If it was on preprinted Rx stationary, or phoned in that was OK, but narcaotics had to have a hard copy signature, and phoned-in was not OK.
The only time it was phone verified was if it was for some reason suspect. That could mean a doctor we’d never heard of or perhaps a patient who claimed to live at a distant address.
I recall once pissing off a regular customer because thier doctor failed to sign a narcotic perscription, and they had to drive across town, in pain, to correct the error. I recall another case where the pharmacist caught a patient double-doctoring to get extra Darvocet…they were addicted & abusing, not dealing.
Don’t think Oxycontin and such were around back then…Pretty sure that the Darvon and Darvocet were the strongest stuff we ever dispensed.
aside:
All prescriptions were required to have the patients address, yet doctors NEVER wrote that, so we always had to fill that in before filling the Rx. The pharmacy job was not my first job. My first job was a paperboy, a few years earlier. Since it was a neighborhood pharmacy, a lot of the patients were my former paper route customers, yet failed to make the connection. It used to really wierd them out when they’d watch me fill in thier correct address without ever asking!
Ahh, I didn’t know this. I can see more clearly as to why they ask certain questions now. Because I’ve been asked some odd questions by Pharmacists before and felt a little…well…violated and offended. I’ve always thought that if the Doctor doesn’t think you’re addicted, then he wouldn’t write the script.
One thing though, if the Pharmacist makes the decision that the person with the script IS a drug addict, what happens? Does the person not get the meds? What would happen if the patient said “Hey Doc, the Pharmacist said I am addicted to these meds, so they took away the script you gave me for my chronic pain” ?
It just seemed to me that a Doctor would know a little better than a Pharmacist (not saying Pharmacists don’t know what they’re doing) when it came to who got which meds and who may have a problem with them.
But again, isn’t that second guessing the prescribing Doctor? I’ve even discussed this in the past with my Doctor and he got angry at the Pharmacy. But since Qadgop said it’s illegal to feed an addiction, I know why now.
If the pharmacist feels they might be violating the law by filling the scrip, they can return the scrip to the patient. Or, if their index of suspicion is high that the scrip is a forgery, or not legit, they’ll usually try to contact the doc and then hold on to the scrip if they can’t confirm its legitimacy.
Pharmacists are health professionals too, and not mere servants of the doctor’s orders. I know pharmacists that hesitate to fill certain doctors’ scrips, because they feel the doctor does not practice good medicine. This often results in a referral to the Medical Examining Board, or even the local DA, if they suspect the doctor is trading narcotics for money.
Lots of “pills for bills” docs have been busted because they’ve been turned in by pharmacists. More power to those pharmacists.
BTW, if the need for opiate pain relief is legitimate (such as major injury or malignant pain), opiates legally can (and should) be prescribed even in the presence of physical or psychological opiate addiction.
Nowadays in the US, we do have two opiates, methadone and buprenorphine, which can be used to maintain or detox from an opiate addiction. The former requires tons of paperwork to be allowed to prescribe it for such, the latter not quite so much. But very few physicians have these certifications. I am certified to use buprenorphine, but generally only use it to detox folks from their opiates, when appropriate.
Not that I’m aware of. We need to document in the patient’s chart why we prescribe what we do, how much, etc. But that’s all I’ve ever done. And it is expected that if one continues to dispense potent narcotics month after month, one need to see the patient periodically and document their status in the chart.
If the doctor dispenses schedule II narcotics from his office, meticulous records, which must be inspected regularly by the DEA, need to be kept.
In some states, I do believe that Schedule II drugs (oxycodone, morphine, demerol, methadone, et al) need to be written on duplicate (or even triplicate) scrips, and a copy kept at the doctor’s office, and perhaps turned into someone somewhere. But my state doesn’t do that, so I’m unaware of the mechanics of it.
Perhaps some doc who practices where that is done can elaborate on the process.
Prescribing DEA scheduled drugs is a privilege and a duty and a tremendous responsibility, and the physician who takes it lightly, without thoughtfully assessing his/her patient and their situation, is a fool. Dispensing DEA scheduled drugs (as pharmacists do) is also fraught with these features.
In this instance, we will give the script back to the patient or contact the doctor and return the script to the patient or destroy/void it at the MD’s request.
As Qadgop has previously stated, the Pharmacist is not just a slave to the Dr’s prescribing whim. They have a license to protect too. For instance, if you were allergic to morphine, and the Dr. prescribes you MS Contin, and the pharmacist is aware of your allergy and fills it anyway…when you die, he is just as liable as the MD is for the fact that you received a medication that you had an allergy to.
As to your idea that the doctor knows more than the Pharmacist does whether or not you’re addicted, I think you have a very idealized view of a lot of MD’s. Many don’t look twice on your chart to see when the last time you received a script for Percocet, they just get into the habit of writing you a new script each time you come into the office. I have caught literally dozens of scripts that were too soon that doctors have told me to void because they weren’t aware they had just written the same prescription two weeks earlier for a 30-day supply. Double this if certain patients happen to be doctor-shopping.
It’s not a horrible thing to second guess doctors, you know. They aren’t infallible, and they should understand the when the pharmacist calls them to verify a script, we’re working towards the general goal which is the health and safety of the patient, not the battling of professional egos.
If the doctor dispenses schedule II narcotics from his office, meticulous records, which must be inspected regularly by the DEA, need to be kept.
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That must be it, I probably misinterpreted what I heard. Thanks.
I believe that the state of New York has to have CII’s in triplicate, where the MD keeps a copy, the second copy goes to the DEA/State Pharmacy Board and the third copy goes to the Pharmacy.
California has to have them on specific pad that denotes a span of numbers to be circled for the quantity.
Makes me glad Florida doesn’t require all that mess.