“codeine allergy” usually refers to someone who either thinks having an allergy makes them special somehow, or someone whose tummy got upset because they took it without food on their stomach. Granted, some people do develop a true allergic reaction to it, but they are much rarer.
And at least in AR, you can buy cough syrup containing codeine at pharmacies without a prescription - you are limited to (I think) four ounces a day and you have to sign for it, but it’s a service only the hometowny little pharmacies do. Wal-Mart and Walgreens, the two big names in town don’t sell it without a prescription.
My doctor says that Texas is going to all-electronic prescriptions pretty soon. While he will write out a physical prescription, it’ll be a print out, and he signs it. Usually, though, he’ll just send a prescription to my preferred pharmacy online, while he’s there in the room with me. I like this new method, as there’s less chance for error, and it shortens my waiting time at the pharmacy.
My Dr. writes his very well, I have no trouble reading them. He writes the drug name, dose, and instructions all in separate boxes. My Dentist prints hers out and then signs them. I had one Dr. send his directly to the drugstore.
If so, this must be protocol for drugs with potential for abuse.
I just happen to have a copy of my last prescriptions here (I use a mail order pharmacy for maintenance meds, so I always keep photocopies for reference–it actually helped when one prescription got mixed up). Of the 6 maintenance meds I take, 4 are written by the physician for brand name vice generic (Actos, Hyzaar, Pravachol and Protonix). But I don’t think any of those have any real potential for abuse (they are, respectively: a diabetes med, hypertension med, statin (cholesterol lowering) and proton pump inhibitor (for GERD)).
My Dr. only writes brand name when he knows there is no generic. He told me that he is going to be able to submit prescriptions from his Palm Pilot but I have not seen him do that yet. I mostly do mail order so he probably won’t do that for me.
That might be a factor in my case. I’m pretty sure that Actos and Hyzaar have no generic yet. Pravachol and Protonix have (IIRC) very recently gone generic, and that may not have caught up with my doc yet.
I’m also on metformin (brand name: Glucophage). For about a year my doc kept writing that prescription for Glucophage, and the pharmacy kept filling it with generic metformin (which was fine by me; kept the co-pay down). I’m pretty sure he was aware for at least 8 months that it was generic, since I told him that the pharmacy was substituting the generic for the branded drug, but he kept writing the scrip for the brand name, anyway.
If the Dr. signs that they can give you generic that is what you get (if one is available and he writes the brand name. ) The Dr. can also sign that you must get the name brand.
I am pretty sure sign on the left = generic OK. Sign on the right = must get brand name. My Dr. always signs on the left.
I’m pretty sure that’s just him, or just your area, or just Rx pads from the same place. Rx forms I’ve seen usually have a check box to specify “no generic substitutions” aka “dispense as written.”
I’ve seen it both ways (separate signature lines for “generic OK” and “dispense as written”, or check boxes). I suspect that it’s a function of whoever printed the Rx pads, and maybe doctor’s preference (i.e. they tell the Rx pad printer how they want it).
ETA: I just looked at my prescription copy again, and on this one there’s no separate signature lines or check boxes. At the bottom of the Rx form, in bold letters, is the statement: "To ensure brand name dispensing, prescriber must write ‘No Substitution’ on the prescription."
Pharmacist checking in. Most of the ways we tell have already been covered. The biggest key is that we get to know the prescribing habits of our area doctors. We know that Doctor X never writes for anything stronger than Vicodin, while Doctor Y won’t touch controls at all, and Practice Z deals with high quantities of the heavy stuff. We know that the local ERs only give out prescriptions in small quantities. We know what information the prescription is supposed to have on it and are required to call the doc’s office if any of it is missing. We generally know what the biggest drugs of abuse in our area are. And sometimes, it’s just a feeling we get and run with. There’s no hard and fast rule, it’s just an intuition you pick up with time.
Undoubtedly some will think that. A smart doctor/pharmacist will realize however, that there’s a reason behind that (opiates, especially those chemically/structurally similar to morphine, can trigger the systemic release of histamine from mast cells which can cause the rash/itching sensation) and document not just the statement of allergy in your profile but also what happened when you took it.
I work in IT/videoconferencing in a pharmacy college with two campuses that telecasts lectures to the distant campus. One day I sat in on the lecture in our drugs of abuse class which dealt with prescription drug abuse (I was monitoring the telecast of that day’s lecture). When the prof was talking about forged prescriptions, he gave statistics about the reasons why pharmacists call physicians to check the legitimacy of prescriptions. IIRC, about 20% or so of the time they said there was no hard evidence of wrongdoing, but the pharmacist just had an intuition that something wasn’t right, so s/he called to check.
Whereas in Florida, the doctor must write “Medically Necessary” on the face in order to bind the pharmacy to dispense the brand. They can write whatever they want – No Substitution, Dispense as Written, Brand Only – but we only have to follow it if it says “Medically Necessary”. If the doctor writes anything else, we ordinarily ask the patient which they’d prefer, and if neither the doctor nor the patient indicates a preference, we will (almost always) fill with the generic.
Why would you ignore the clearly expressed requirement of the prescribing physician just because they didn’t happen to use the right magic words? If they felt a substitution was OK, they wouldn’t have written that it wasn’t. That seems both petty and a lawsuit just waiting to happen.
Because the law very clearly is in our favor in such cases in most states. In Ohio, for example, the law requires the physician to handwrite DAW or “Dispense as Written” on the prescription. Signing a line (which some of them do), or checking off a box (which happen to exist on many pre-printed blanks) doesn’t matter in my state. I can (and will) substitute anyways if the patient is okay with it (or, in the case of state-reimbursed plans, whether the patient likes it or not).
I don’t know about petty, but “lawsuit waiting to happen” seems pretty accurate to what remains of my legal mind. However, the question then becomes who’ll be found liable in that lawsuit: the prescriber who appears to be ignorant of the legally mandated magic words in the state the pharmacy is located in, or the pharmacist who insists on them? (My quick conclusion would be that it depends where the lawsuit is tried, but I’ve been out of law practice so long that I will defer to the conclusion of any duly licensed attorney here who voices it.)
I live in Memphis, and my doctor is located across the river in Arkansas (just because I moved across the river I didn’t think I needed to go through the hassle of changing doctors, especially since I was very satisfied with the one I have). My doc knows that I fill my non-maintenance prescriptions in Tennessee, so I assume that he knows what magic words are required in TN if he wants to make sure there’s no substitution (since it looks like a fair minority of his patients live on the other side of the river). But this has me wondering. My mail order prescriptions are sent to Alabama (and for a while, they were sent to an address in Chicagoland). If Alabama’s magic words are different from Arkansas’s or Tennessee’s, is the mail-order pharmacy then given a free pass if my doctor doesn’t know the Alabama magic words, and uses Arkansas’s or Tennessee’s?
If the pharmacy asks me what I prefer, and my doctor’s made it clear that he doesn’t want a substitution, I’ll go with that, myself, as I trust my doctor’s judgment there. Fortunately, we’ve not had that problem yet.
I cannot think of a single med I prescribe that I specify must be name-brand anymore. Especially since the synthroid data revealed that it was no more effective than generic levothyroxine.
I’ve never been prescribed Dilaudid, but I’ve frequently had doctors write a prescription for “Percocet” or “Lortab” rather than using the generic term. Offhand, I can’t recall any who didn’t.