Reprinted from the January 2006 Montana Board of Pharmacy Newsletter.
Pharmacists have a responsibility to ensure that controlled substances (CS) are dispensed pursuant to legitimate medical needs while preventing their diversion into the illicit market. Prescription pads can be stolen, quantities on legitimate prescription blanks can be altered, and diverters can occasionally attempt to call in their own prescriptions, giving their own number as a call back number. Legitimate prescriptions are occasionally copied, and computers can be used to create prescription blanks for nonexistent practitioners, or legitimate practitioners with a different call back number that is answered by an accomplice to verify the “authenticity” of the prescription. The Board of Pharmacy is considering rule wording that would require prescriptions for CS, if written, to be written on a safety blank which would be resistant to tampering and on which “VOID” or a similar message would appear when the original prescription is photocopied. Many states have passed similar rules to date.
In the meantime, continue to be aware of unusual prescription characteristics such as writing that is too neat, a lack of abbreviations, unusually large quantities, or drugs that do not fit into a practitioner’s usual prescribing pattern, blanks that appear to have been hand-cut or photocopied, and called-in prescriptions that seem unusual or do not feel “right” in some way. If you believe that you have a forged, altered, or counterfeit prescription, do not dispense it – call the police. An obviously forged or altered prescription should be held for the police, not returned to the patient, unless doing so would jeopardize your safety.
When there is a question concerning any part of a prescription, call the prescriber for verification or clarification. It is good practice to consult the phone book or your pharmacy prescriber list rather than dialing the number printed on the prescription blank. Although not presently required, it is wise to ask for identification when an unknown patient picks up any prescription.
A practitioner who writes significantly more CS prescriptions (or in larger quantities) compared to other practitioners in your area is not necessarily “the enemy.” Practitioners who specialize in pain management tend to . . . surprise . . . write large quantities of CS more frequently than most. As long as the practitioner is licensed to prescribe CS and legitimate medical need exists, this should not cause concern. Pharmacists share a corresponding liability with the prescriber to ascertain that CS are not dispensed to patients that do not have a legitimate medical need, and a pharmacist is definitely within his or her authority to call any prescriber to ask about a patient’s treatment plan or offer suggestions regarding drug therapy. The Board of Nursing and the Board of Medical Examiners acknowledge this as well. In legitimate situations, practitioners should be willing to engage with pharmacists whenever a legitimate question or concern exists. The boards of Pharmacy (402/841-2355), Medical Examiners (402/841-2360), and Nursing (402/841-2341) are there to help if you encounter problems. If you believe that you have discovered a pattern of prescription abuse, contact the appropriate board and/or law enforcement promptly.
If patients appear within a short period of time, all bearing similar prescriptions from the same practitioner, that practitioner would appreciate a phone call, just as he or she would if a patient is asking for refills with ever-increasing frequency, even offering to pay with cash if the third-party payer rejects the claim. Consistent requests for early refills could be caused by abuse or diversion, but it is important to remember that the patient who requests refills more frequently than expected could also be suffering from unresolved pain or worsening disease. Avoid knee-jerk reactions. A pharmacist would be wise to talk the situation over with both the patient and the prescriber in such cases, and could make a dramatic difference in the lives of selected patients in doing so.
Pharmacists and physicians within an area should strive to develop a network, or at least a working relationship, to promote teamwork and camaraderie. Discussing potential abuse problems with other pharmacists and physicians in the community is not a violation of the Health Insurance Portability and Accountability Act if done on a need-to-know basis, and such interventions are a vital part of good patient care.