Ohio News: Corresponding Responsibility Is Needed More Than Ever

May 18, 2011 12:18 PM

Originally published in the May 2011 Ohio State Board of Pharmacy Newsletter

In last year’s May Newsletter, the Board mentioned that it is having a tremendous problem in Ohio with so-called pain clinics that are doing nothing but providing large amounts of controlled substances, particularly oxycodone and hydrocodone, to people who have no legitimate medical need for them. That problem has, if anything, increased over the last year. The temptation resulting from the large amounts of money that can be made by trafficking in “legal” drugs has been an enticement to doctors, pharmacists, and other criminally inclined individuals. Quite often, these operations are owned by non-health care professionals, many of whom have a criminal record. They then hire temporary physicians to write the prescriptions. Since most of the pharmacists in Ohio have taken their corresponding responsibility requirements seriously, the “patients” of these operations are having more and more problems finding a place to get the prescriptions filled. The Board has had calls from pharmacies as far away as Virginia and South Carolina asking about the legitimacy of these prescriptions! Because of the problem with getting the prescriptions filled at a legitimate pharmacy, many of these operations have begun to directly dispense the drugs to their “patients.” Sometimes the doctor hands out the drugs, sometimes non-professionals are given that task, and occasionally they have even found pharmacists to set up a pharmacy specifically for that purpose, either within the clinic or separately. The Board of Pharmacy, working with other local, state, and federal agencies, has been able to close down or limit the activities of several of these operations. However, more are springing up around Ohio and pharmacists need to be vigilant as patients they may not know present them with prescriptions from doctors they may not know.

The legislature has taken note of the problem and has begun to address it. Shortly after this Newsletter is published, it is expected that HB 93 will pass, be signed by Governor John Kasich, and, due to an emergency clause, become effective almost immediately. This bill will do several things that should help in addressing the problem. First of all, it will require each pain clinic (as defined by the law) to license with the Board of Pharmacy as a Terminal Distributor of Dangerous Drugs, whether or not they possess drugs in the office or are otherwise exempt from licensure. This bill will also require that the pain clinic be owned by one or more physicians to eliminate those that are being run by convicted felons. It requires criminal background checks on the owners and requires the owners to run criminal background checks on their employees. It also limits the amount of controlled substances that a prescriber may personally furnish a patient to a 72-hour supply and it requires those prescribers who do personally furnish these drugs to patients to report those transactions to the Ohio Automated Rx Reporting System (OARRS) program. HB 93 will also require the use of OARRS by prescribers and pharmacists under certain conditions that are to be defined by the individual boards by rule. This does mean that every pharmacy will be required to have Internet access for the pharmacists so they will be able to run the required OARRS reports.

The law will also make some changes to the OARRS program. It will allow the Board to register unlicensed personnel as delegates for prescribers in order to improve efficiency. It adds criminal penalties for the improper use of OARRS reports – penalties that are needed in order for the Board to continue to get federal grants. Again, it will require the use of OARRS by both prescribers and pharmacists under certain conditions.

As stated above, HB 93 should help address the problem of illegitimate pain clinics throughout Ohio. However, just as the Board said in last year’s May Newsletter, please be aware that there are both legitimate and illegitimate pain treatment providers working in Ohio. In addition, there are both legitimate pain patients and people who are trying to obtain these drugs for illegitimate use. The pharmacist is often the last person who has the opportunity to make an independent judgment as to the legitimacy of the prescription and the patient. Both Ohio laws and rules and federal laws and regulations place a corresponding responsibility on the pharmacist to make that judgment and hold the pharmacist accountable for that judgment. Please note that the pharmacist is the one held accountable for making that independent judgment, not the employer, supervisor, or a fellow employee. The fact that the pharmacist called the prescriber and was assured that the prescription was legitimate may not be enough. The pharmacist needs to look at the prescribing habits of the prescriber, the patient and his or her condition, and the dose of the drug or drugs being prescribed. In addition, the pharmacist should take into consideration the distance that separates the patient, prescriber, and pharmacy. Just as in the Florida examples, is it reasonable for a patient to travel long distances, passing by numerous doctors and pharmacies, in order to obtain prescription medications? Sometimes it may be if they are visiting a well known specialist, but usually that long distance traveling is indicative of a problem.

Having said that, please remember that there are legitimate pain specialists and legitimate pain patients out there. Legitimate patients should have their prescriptions filled in a timely fashion and without harassment. People who travel long distances and prescribers whose pain therapy appears to come from a cookbook should receive a little extra review before medications are dispensed. The reports available from the OARRS program will frequently be able to provide assistance in making those judgments.