What checks stop people from fraudulently writing their own prescriptions?

Yeah, that’s where the money is. But I do a lot of pain management in my practice, too. Just not with a lot of prescribing of opioids.

I plan to end my career as I started, a generalist, family physician. Even if I don’t do a lot of peds or gyn anymore. :smiley:

I do have a few 16 and 17 year olds in my practice, a few trans females, and consult occasionally on pregnant patients who are opioid dependent.

It makes a funny story, but no one ever gets a prescription for marijuana and only someone hopelessly ignorant about the whole situation would even think that you do.

For the uninformed: In states that have medical marijuana laws, what you get is a “recommendation” (not a prescription) and you take that to a “medical marijuana dispensary”, not a pharmacy.

That being said, recommendation letters can also be checked to make sure they’re legitimate and as one would expect, some dispensaries are more concerned with staying legit than others and so the level of scrutiny varies.

Beta-blockers are abuseable? In what sense?

Yeah this is news to me too. Ive taken a beta-blocker (nadolol) for several years as part of my migraine treatment plan. It’s lowered my blood pressure. And I don’t have high blood pressure. So i get woozy now and then. Woo-hoo! Paaaar-taaaay! :cool:

Not to get high, but as an off label anxiety medication. It’s stretching the term a bit, but there are people who see their use as a “performance enhancing drug.” Not kidding: http://articles.philly.com/2010-08-16/news/24973169_1_beta-blockers-graduate-student-performance-anxiety

My pharmacist acquaintance mentioned lower dosages of propranolol as a drug he gave extra scrutiny to when I asked him the OP’s question many moons ago. Apparently it sees a lot of use for " nerves".

I know diddly about pharmacy regulation. But you obviously don’t work in an area involving compliance with state law across multiple states.

Almost regardless of regulatory area, 50 states (plus DC and the territories) are moving in at least 60 different directions. A huge amount of effort is spent nationwide by multi-state businesses trying to comply with differing state-level mandates. A large portion of the growth in Federal regulation since roughly WWII has been a direct response by Congress to pleas from big corporations for them to standardize at the Federal level the patchwork of 50+ contradictory sets of rules.

I like how it’s done in South Korea:

[ol][li]Doctor types out the prescription on his computer (handwritten prescriptions are illegal).[/li][li]Doctor or nurse employed by doctor prints the prescription on the special prescription form.[/li][li]Instead of signing the prescription, the doctor stamps it with his personal name seal:[/li][list=a][li]The name seal must first be registered at the municipal district office where the doctor resides.[/li][li]The district office furnishes the doctor a typed certification that the name seal is, in fact, registered.[/li][li]The doctor presents that certification to the pharmacist for the pharmacist’s records.[/ol][/li][li]The patient takes the prescription to one of the pharmacists to which the doctor has presented his name seal certification.[/li][li]The pharmacist then prepares the prescription very much like this outfit does.[/li][li]The patient then goes about his business, taking the medicines on the day and time written on each little packet of pills.[/list][/li]
I was on vacation in Busan last month and had to see an ENT doctor. The doctor prescribed some a five-day course of medicines for me. I didn’t have to worry about illegible writing or if the pharmacy had to wait to fill anything, nor did I have to worry if I was taking the wrong pills at the wrong time; I just had to take the pills on the day and at the time written on the packets. I wish the pharmacies in China–heck, everywhere!–would do their dispensing this way.

When I spent a month in the hospital in Busan, of course I had to take some medicines. The procedure was roughly the same, except the doctors and nurses did the paperwork drill and getting the medicines to me in my room. And the pharmacy concerned was the hospital’s own pharmacy. When I was released from the hospital, I was shown all the prescription forms for my stay.

Isn’t it a felony to alter, forge prescriptions? That is a show stopper for me.

Beta-blockers can enhance performance at some sports, e.g. snooker or darts, and are banned in professional competition.

Snooker star Neal Foulds was accused of cheating in 1987, despite that his beta-blocker was prescribed for a heart condition and that this was before the particular drug Foulds used was banned by the World Professional Billiards and Snooker Association.

Depends on the jurisdiction. In Florida it’s a second degree felony (a “pedigree paper” is a written prescription.)

Wait, so if it were only a misdemeanor, you’d be forging or altering prescriptions all day long?

No. I would be too “high” to do it all day long.

Beta Blockers are also banned at the Olympics. Apparently it provides a performance advantage in the biathlon, where shooting accuracy is paramount, and having a lowered blood pressure/heart rate is an advantage.

The first half is pretty much the case with me too. However, things like Vicodin now require a written triplicate prescription that has to be carried to the pharmacy, along with a picture ID and current address. After presenting that documentation, I have to sign for the Vicodin in front of the pharmacist.

Must be a different state from me. I used to pick up my wife’s morphine prescriptions at the drive up pharmacy window.

The FDA (or DEA, whoever oversees this sort of thing) changed that about 2 months ago. I know, I used to call the office and get the prescription filled by mail too.

A friend of mine was the project manager years ago for a prescription management system for one of the provinces in Canada. The idea was that all prescriptions were entered into a database by the pharmacist. Since all licensed doctors (pretty much) were members of the provincial Medicare system, it was easy to match doctor number; also almost everyone had a Health Care number too. The next step was to run checks against the data for who was prescribing abnormal amounts of the 'wrong sort" of medications.

I heard of one of the older, less cynical doctors getting a visit from the authorities telling him he could no longer prescribe certain drugs without permission. (He’d also been told at one he could no longer issue doctors’ notes for motorcycle helmet law exemptions.)

I assume a number of provinces have similar set-ups - 99% of patients and doctors are in the system, and any who are not or who are new get special scrutiny; plus software can pick out unusual patterns - doctors who are easy marks (or worse), patients who doctor-shop, pharmacists that manage to order more supplies than their prescriptions indicate, etc. I imagine a lot of US states are in roughly the same position.

I don’t do narcotics or anything worth stealing but there have been times when I wished I had the guts to steal my doctor’s prescription pad. When I was taking birth control pills was really the big one. I resented having to get a pelvic exam before every rx renewal (once a year). I know it’s no big thing, but I was healthy and it really seemed intrusive - no pokie proddie, no pillie for you little girl!

More recently I’ve noticed that with the move to rx by mail there is a gap that’s no longer being filled compared to the walk in pharmacy days. I take arthritis medications and there’s been many a time I’ve had to go without my meds because of a snafu with the stupid online pharmacy (that my insurance REQUIRED I use) and once because my doctor was an idiot (and summarily fired, but that was after I went unmedicated for a couple weeks). In the old days your flesh and blood pharmacist could ask you if you had enough meds to cover you for a few days and if not would give you a few either for free or subtracted from the bottle he eventually filled for you.

A similar gap exists with home-administered injectables. The instructions say to inject your thigh (one of several locations) pull back the plunger to see if you hit a vein and if you did throw the syringe away and try a different location with a new one. Well, when my online, specialty pharmacy only sends me exactly the number of pre-filled syringes that I’m supposed to have, I can’t afford to throw one away simply because I hit a vein. So, good hygiene or not, I have occasionally inserted the same needle in several locations. And it’s never happened to me yet, but if I ever drop the darned thing on the floor after uncapping it… I will wipe the needle with the alcohol pad and yell Geronimo!

Anyway, with those last two scenarios, I can’t help thinking it sure would be nice to get my meds from two pharmacies so that I have backups when I need them!

seriously, I imagine many people who need opiates are post-surgical and in no shape to go to the pharmacy themselves. Aren’t there provisions for such situations? Thankfully I haven’t been post-surgical in quite some time.