Monday, April 11, 2011

This Is Why Pharmacists Are Suspicious of ALL Narcotic Prescriptions

A couple weeks ago a woman called our pharmacy asking if we had Oxycontin 60 mg in stock. We informed her that we did, but the only tablets we had were of the old formulation.

I swear that she couldn't have been more excited if she shouted Eureka! into the phone. "I'll be right down," she said.

A few minutes later, this perfectly able-bodied woman shows up at our pharmacy counter with a prescription in hand for the Oxycontin. "How much is it for 30 tablets?" she inquired. Surprise, surprise... She wanted to pay cash for them.

We looked it up, and she decided 30 was too expensive for her, and she wanted to know the price for 25. Apparently, 25 tablets wouldn't completely wipe her out, so she then asked us to fill it for 26 tablets.

To enlighten those of you who might be uninformed about drug prices, 26 tablets of Oxycontin cost in the neighborhood of $200. Moreover, the script was from a doctor's office located over an hour away, and she was a new customer to us. There was no way this prescription could be legit. Therefore, we called the office to find out just what was going on.

The nurse gets on the phone and she listens as we tell her how shady this woman appears to be. The nurse checks with the doctor and a couple minutes later, she returns to tell us, "Dr. Dipshit said you can definitely trust her."

OK... Whatever he says. So we document the shit out of the situation, and fill the script for her 26 Oxycontin. Several minutes later, she returns to the pharmacy counter holding about $200 in cash, and proceeds to slap $20 after $20 on the counter as she pays for the prescription.

Yeah... Really trustworthy.

A couple weeks later, the woman calls our pharmacy inquiring once again if we had Oxycontin in stock. Once again, we did, and once again, she gleefully remarked that she'd be down in a few minutes.

Same prescription from the same doctor, only this time, the full 30 tablets would be just fine. Little did she know, she had nearly wiped us out of the old formulation last time, so we had to dispense the new formulation to her. I decided not to tell her this little fact because I was curious to see what would happen when she found out.

The technician went to ring her up at the register, and she almost had a heart attack because the price of the tablets was $22 more expensive than she thought it would be. "That must be some kind of mistake," she proclaimed. "Is that the new formulation?"

I confirmed her suspicion, and she immediately asked whether we had any of the old formulation left. Alas, we only had 10 tablets left, not enough to fill her script.

"No problem. I'll just take the 10," she responded.

Yup... completely trustworthy.

In the end, she did us a favor because she helped us get rid of all the old formulation tablets we had left. In addition, I'm reasonably sure that she'll never come to our pharmacy ever again.

Here's the thing though... All you people out there who have legitimate reasons for taking narcotics don't realize that these kinds of stories are closer to the norm than the exception. We fill ridiculous amounts of Oxycontin and oxycodone prescriptions and a good majority of them are for very sketchy people. However, every time we call the physician, we get the same response. "Yes, fill the prescriptions."

Just recently we had a guy and his buddy come to the pharmacy both presenting prescriptions for 240 tablets of Oxycodone written on the same day by the same out of state doctor. We called the office, and they didn't understand why we'd be questioning it. Yeah... two well built young men who happen to be friends getting the same narcotic prescription for massive quantities from the same out of state doctor on the same day. I have no idea why that's suspicious at all.

How about the woman who takes Percocet 7.5, Avinza (extended release morphine), and Exalgo (extended release hydromorphone) twice daily? We called the office wanting to know not only why she's taking two different 24 hour extended release narcotics, but also why she's taking one of them twice daily. Moreover, she has a sister that goes to the same office, and the doctor writes Avinza, Percocet, and Tylenol with Codeine prescriptions for her as well. The nurse didn't take too kindly to us questioning these pain management regimens. In fact, she was quite annoyed.

How about the woman who was getting 120 Vicodin a month from one doctor and also getting 90 Percocet a month from another doctor? We called to let one doctor know she was getting pain meds from another doctor, and we were told that they were aware of the situation. You see... She's taking the Vicodin during the day, and the Percocet when she needs pain relief at night. Oh, I see... I totally should have figured that one out. After all, it's not at all unusual for someone to chew through 120 Vicodin and 90 Percocet per month, especially if the Percocet is only supposed to be taken at night. Completely normal.

See... the biggest drug dealers in this country aren't slinging dope on the streets or cooking up meth in a basement laboratory. They're actually the doctors who will write for whatever narcotic patients ask for as long as they say they're in pain. As pharmacists, we're told that we have to be constantly vigilant for signs of drug abuse and misuse. We're forced to keep tabs on pseudoephedrine because it's apparently OUR job to stop meth junkies and sellers from cooking up meth in their basement laboratories. We're encouraged to use controlled substance databases to help reduce doctor shoppers and people who pay with cash at multiple pharmacies. Our license could be on the line if we don't document that we at least tried to verify any suspicious prescriptions. However, prescribers have free reign to allow patients to basically write their own prescriptions for narcotics.

My biggest issue is if doctors don't care, then why do I have to care? If they're prescribing habits are going to facilitate drug abuse, then why do I have to try to clean it up? I just can't seem to figure it out.


Anonymous said...

Mike, didn't you realize that many of these rxs from "pain management clinics" have price tags of upwards of $500-600 cash for the Dr.? Where I am five doctors were busted in the last 8 months by the DEA for selling scripts.

Anonymous said...

Got an Rx from a pain clinic from across the state the other day, it read like a sushi menu

They just circled the drug, strength, quantity per dose, doses per day. It was unbelievable. You seriously cannot just write out a prescription, you have to order from a menu. How easy would it be for someone to forge Rxs if they get a hold of a pad? The only thing you have to forge is the signature. We as pharmacists have no way to double check your writing style...stupid docs

Anonymous said...

Doesn't your area have 'centralized' database agencies where pharmacists (and interested physicians) input a patient's (or prescriber's) name to retrieve a very detailed record of every CS filled for that patient (or ordered by the doc) in the last xx days or xx months? Indiana has INSPECT, probably only keeps track of Indiana when there's plenty of crossing state lines from Illinois, Kentucky, Michigan, and Ohio, but it's proven very, very useful so far nevertheless.

bcmigal said...

California has "CURES". Rxs for CS are electronically submitted to the CA DOJ on a weekly basis. Pharmacists can register for the Prescription Drug Monitoring Program to access the database. We told that to one of our docs and he changed his mind about an early refill.
Our chain does not accept an e-script for CS. Nor do we fill CS from out of state prescribers. We actually got an email from our DM saying that we should refuse to fill CS from out of our prescribing "area".
We don't document suspicious rxs, weI just refuse to fill them.

Anonymous said...

I call and document but at the end of the day, I really do not care either. I do not have time to be the drug police for everyone of these scripts. I would rather spend time helping patients who actually need it.

If I have to choose between playing drug police calling around to other pharmacies and doc offices vs helping a an elderly lady figure out her glucose meter or reduce her monthly out of pocket drug expenditures.....I choose helping the elderly lady.

I will do what the law requires but my day is busy and my will focus on areas where I feel I can do the most good.

Danelle said...

Today's drug misuse is completely out of control. There has been so many doctors who have been caught just giving out perscriptions for patient just because. Some patient actually become addicted and think that they really need the medicine because the doctor would not perscribe it if it was not necessary. This is so far from the truth. Pharmacist have to deal with patients who are understanding of the reasons why a pharmacy has to thoroughly check out the prescription with the doctors office. Then you have the patients who are just trying to beat the system. They can be rude and the attitude can reach violent levels. The question is who do pharmacist believe.

C said...

Eventually those patients will get sick and tired of being sick and tired or they will die.

I am so glad that I never have to use another pill to deal with my emotional problems ever again.

pharmacykid said...

Once I read the phrase, "the only tablets we had were of the old formulation", I knew what was gonna happen. She was going to get the old formulation, and only the old formulation.

I gave a presentation on the old vs new formulation of oxycontin a while ago. You see, Perdue recently changed oxycontin so it is now so murch harder to abuse. The new formulation has a special polymer where if you smash it, it doesn't break into powder. Thus, abusers can't ingest or snort. Any pieces that do break retain controlled release properties. If any part of the new oxycontin touches an acqueous medium, it turns into gel. Thus, you can't inject it IV.

If you take a close look at the old oxycontin it has "OC" printed on the tablet. The new ones have "OP" on them. That's why you may get a lot of phone calls asking, "Do you have the oxycontin OCs."

If I was with you, I would have told her, sorry we only have the new formulations. She would have never come. Oxycontins are some of the highest priced drugs on the street. Trust me . . . I know . . .

pharmacy chick said...

Personally I am sick and tired of every single rx I see from the plethora of so called "pain clinics". when the changeover came from oc to op, I made it quite clear, if they ASK what we have, its always OP. End of discussion.

Dawn said...

At the end of the day... the docs need to step up and take care of business. The pain clinics (with the exception of a small percentage) are in this to make money. They don't care and will continue to pull in the cash until the day the DEA comes knocking on the door.

david.shawver said...

Mike, we need more people like you to write about pharmacy. People need to hear the truth about what's really going on in retail. Thank you for what you've done so far. I read your posts and I just nod my head, yup, that's how I feel, yup, that's how it is.

THanks again!
Dave, retail pharmacist in a major chain

saitoTK said...

I'm a pharmacist in Taiwan. I just find out your blogs, and like your article very much. Good stories, good point, same problems(drs errs), annoying patient, and medicore technician.... same as in Taiwan.
But you're workload is much more than us...

sorry for bad english...

Anonymous said...

Ok first to the person who wrote this.You ARE NOT A DR., You ARE NOT A POLICE OFFICER!!! You are a Pharmacist or worse a tech, with too much time on your hands.It isnt your place to question the people who come to you for the service your paid to provide. If you do not like the way Dr.'s do their job, well go study your ass off an put in years of hard work.Then you can turn away as many people as you wish. Of course then you wouldnt be very happy if someone working at the fucking walgreens called you up to question your ability at the profession you trained years for.

Sorry if thats a little harsh or angry sounding. But after years of working to build a small practice, in a rural area, sometimes you take on the bad to help the good.If I cant pay the staff or the utilities, then how do we help the portion of the population that really depends on us being here.Ok maybe you take on a guy who works construction, that says hes got a bum back. He pays $500 a month to get a script, an that pays for a month of lights or water for the facility to be here for when the 80 year old ww2 vet needs to come in for his heart meds.I take the trade, i do now i do it tomorrow no question. In the long term im helping the community,thus doing my job as a healthcare worker, you do what needs to be done so that when the time comes you can be there when it matters. The last thing i need is some Nancy drew pharmacist calling my decisions.

exhaustedrph said...

We don't give out info regarding narcotics at all. I only answer questions regarding quantities if they present a valid script at the pharmacy. No answers over the phone.

the pill pusher said...

I work in a pharmacy in KY, and we do have a monitoring database, kasper, to check out control substance rx. But I work at a big chain, and they dont trust us with the internet (we may waste time!!) so we cannot look up the info. makes a lot of sense to me....