C2 72 hour emergency supply

[ice cream]

My state pharmacy law says that a pharmacist can accept an oral Rx for a C2 for a 72 hour supply in an emergency situation.

I'm hoping some of you with more experience than me would help me clarify what truly classifies as an "emergency". Where would you draw the line on this? I would love some examples.

Recently I refused an emergency supply of Oxycodone for a patient who has been receiving it every month for a very long time. I felt that since it seems to be a maintenance medication for the patient, it is not really an emergency supply, the doctor should have the foresight to be able to give the patient a hard copy, and I felt uncomfortable accepting it as reason for an "emergency" supply. Of course the doctor was not very happy with me and didn't want to call in an alternative non C2 drug.

In my opinion, it's not an "emergency" just because the doctor says so.

I'd love to hear what other pharmacists/pharmacies do in these situations. Thanks.

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[WVUPharm2007]

I consider legitimate excruciating chronic pain an emergency med. I'd fill it as long as I got that danged script within 7 days, honestly.

 

[Priapism321]

I consider legitimate excruciating chronic pain an emergency med. I'd fill it as long as I got that danged script within 7 days, honestly.

I concur. Unfortunately, whether the physician was irresponsible or not is irrelevant if a patient is sitting in your pill shop at 9pm with no medications and a 9/10 on the pain scale.

 

[ice cream]

Wow you replied fast!

The other pharmacists I worked with also refused to take the oral Rx. Note: the doctor also bragged that he called in C2's ALL the time, which seemed like an odd thing to say. I'm not saying we were right but just looking for opinions.

In what case would you not consider it an emergency? Thanks for the input.

 

[WVUPharm2007]

Wow you replied fast!

The other pharmacists I worked with also refused to take the oral Rx. Note: the doctor also bragged that he called in C2's ALL the time, which seemed like an odd thing to say. I'm not saying we were right but just looking for opinions.

In what case would you not consider it an emergency? Thanks for the input.

Just C-IIs?

Uhhhm....Amphetamines for ADHD. Cocaine topical for "emergency" mucosal anesthesia.

That's about it.

 

[SCCpharm]

I am an intern, but the pharmacists I have talked to have told me that they would never fill a C2 emergency supply because if they don't get the hard copy within 3 days, the doctor and the pharmacist both get into trouble. And 3 days is too short of a time.

If the patient has been bringing in hard copies every single month, he probably should have known.

 

[codeman2012]

I believe that if the situation is a bona fide emergency then you should do your job and dispense the medication, regardless of its schedule. I have to throw this back to a concept always brought up in my school, what if it were your mom needing the emergency prescription? Wouldn't you want the pharmacists to help her with her pain management? In short, your pharmacists seem spineless and have no regard for the patient's needs.

 

[WVUPharm2007]

I am an intern, but the pharmacists I have talked to have told me that they would never fill a C2 emergency supply because if they don't get the hard copy within 3 days, the doctor and the pharmacist both get into trouble. And 3 days is too short of a time.

If the patient has been bringing in hard copies every single month, he probably should have known.

Per the DEA rules, it's 7 days...if SC has more stringent rules, well, that's kinda weird. And if the script isn't there on time, you contact the nearest DEA field office. The pharmacist would be in NO trouble at all as he followed proper procedure.

 

[codeman2012]

Per the DEA rules, it's 7 days...if SC has more stringent rules, well, that's kinda weird. And if the script isn't there on time, you contact the nearest DEA field office. The pharmacist would be in NO trouble at all as he followed proper procedure.

Preach on brotha!



P.S. W T F happened to WVU the other day?

 

[WVUPharm2007]

Preach on brotha!



P.S. W T F happened to WVU the other day?

Well, the defense sucks. The O-coordinator is a ******. The O-line can't block. The WRs can't get open. The punter is freakin' awesome though!

 

[codeman2012]

Well, the defense sucks. The O-coordinator is a ******. The O-line can't block. The WRs can't get open. The punter is freakin' awesome though!

Haha Well ECU is surprising a few teams so no shame in yalls game! I would rather watch pro-football any day! I cannot believe Tom Brady is out! I almost cried.

 

[bananaface]

C2 stimulants cannot be given out under the emergency supply rule per state law in IA.

 

[SpirivaSunrise]

Gov. Rick Perry issued a disaster declaration in response to the significant threat posed by Hurricane Ike to 88 Texas counties. The governor’s declaration allows the state to initiate necessary preparedness efforts, and also requested a presidential emergency declaration for these 88 counties.

Another instance you guys haven't mentioned; when pharmacists are allowed to exercise professional judgment and bend the rules...is when the governor/Pres say so.

 

[tussionex]

. I felt that since it seems to be a maintenance medication for the patient, it is not really an emergency supply, the doctor should have the foresight to be able to give the patient a hard copy, and I felt uncomfortable accepting it as reason for an "emergency" supply.quote]

i agree with other posters....what if it were you or a loved one in pain on "maintenance" medication? maybe the patient had circumstances such that he was unable to get his usual hard copy. if this is a patient that comes in on a consistent basis and is known to you, to not fill an oral rx based on a silly technicality seems mean. on the other hand, if it were a completely UNKNOWN patient to me, i would still fill it - emergencies happen.
if i cared THAT much about the hard copy, i would call the DEA office after 3 days.

 

[ice cream]

Per the DEA rules, it's 7 days...if SC has more stringent rules, well, that's kinda weird. And if the script isn't there on time, you contact the nearest DEA field office. The pharmacist would be in NO trouble at all as he followed proper procedure.

Actually in my state we must receive the written Rx within 72 hours.

It sounds like most of you agree that a maintenance medication can be considered an emergency. I'll talk it over with my partners and probably contact our board of pharmacy to learn their stance, since "emergency" is not defined within the law.

There is no need to call me and my partner pharmacists spineless, perhaps we made a bad judgment call, but we were only trying to follow the law. I posted the question on this forum for advice, not to be name called. Even the best of pharmacists can make a mistake. I care very much about my patients, and I go out of my way for them all of the time. This particular patient has consistently given us trouble with controlled substances, refill too soon etc.

 

[117296]

Haha Well ECU is surprising a few teams so no shame in yalls game! I would rather watch pro-football any day! I cannot believe Tom Brady is out! I almost cried.

I did a happy dance. No more Tom Brady! That is all. Back to the discussion...

 

[Old Timer]

There is no need to call me and my partner pharmacists spineless, perhaps we made a bad judgment call, but we were only trying to follow the law. I posted the question on this forum for advice, not to be name called. Even the best of pharmacists can make a mistake. I care very much about my patients, and I go out of my way for them all of the time. This particular patient has consistently given us trouble with controlled substances, refill too soon etc.

I was tempted to jump in and call you worse than that. I would like you ask a lawyer friend to do a search to see if a a pharmacist was ever prosecuted for this in the history of the country. This must be a pharmacist mentality. To act without compassion for the patient, but reverence for the law.

This was extremely poor judgment. The the federal CSA and I am sure sure state CSA use the word emergency (an unforeseen combination of circumstances or the resulting state that calls for immediate action) and not the word acute (characterized by sharpness or severity <acute pain> (2): having a sudden onset, sharp rise, and short course <acute disease> (3): being, providing, or requiring short-term medical care).

This is a patient known to you and I assume a physician or physician's practice known to you. That means I can reasonably infer from your post the prescriber is not a croaker (sells Rxs for cash). I can't tell about the patient becase you report they exhbit drug seeking behavior. That is a red flag. So if a known patient with some kind of chronic condition causing enough pain (think terminal cancer) to require narctic analgesics comes to you without medication to releive their pain, Your response is tough, suffer and then you hide behind the "law" all the while the law was written with a loophole just for this reason.

I think you need to go back to your partners and come up with a policy you can all live with. Something like this:

• Known patient w/o history of drug abuse
• Known prescriber w/o history of shady prescribing
• Reasonable explaination for the request

You can ask the physician to fax you a copy of the prescription before dispensing so you know it exists and then follow it with the mailed hard copy.

You job as a pharmacist is to serve your patients within the law. You are their advocate and their health care provider. You need to look for ways to get them what they need, not look for ways to deny them what they need and you can legally provide....

 

[codeman2012]

I was tempted to jump in and call you worse than that. I would like you ask a lawyer friend to do a search to see if a a pharmacist was ever prosecuted for this in the history of the country. This must be a pharmacist mentality. To act without compassion for the patient, but reverence for the law.

This was extremely poor judgment. The the federal CSA and I am sure sure state CSA use the word emergency (an unforeseen combination of circumstances or the resulting state that calls for immediate action) and not the word acute (characterized by sharpness or severity <acute pain> (2): having a sudden onset, sharp rise, and short course <acute disease> (3): being, providing, or requiring short-term medical care).

This is a patient known to you and I assume a physician or physician's practice known to you. That means I can reasonably infer from your post the prescriber is not a croaker (sells Rxs for cash). I can't tell about the patient becase you report they exhbit drug seeking behavior. That is a red flag. So if a known patient with some kind of chronic condition causing enough pain (think terminal cancer) to require narctic analgesics comes to you without medication to releive their pain, Your response is tough, suffer and then you hide behind the "law" all the while the law was written with a loophole just for this reason.

I think you need to go back to your partners and come up with a policy you can all live with. Something like this:

• Known patient w/o history of drug abuse
• Known prescriber w/o history of shady prescribing
• Reasonable explaination for the request

You can ask the physician to fax you a copy of the prescription before dispensing so you know it exists and then follow it with the mailed hard copy.

You job as a pharmacist is to serve your patients within the law. You are their advocate and their health care provider. You need to look for ways to get them what they need, not look for ways to deny them what they need and you can legally provide....

Amen.

 

[acetyl]

patient is sitting in your pill shop

LOL dude.

 

[npage148]

Per the DEA rules, it's 7 days...if SC has more stringent rules, well, that's kinda weird. And if the script isn't there on time, you contact the nearest DEA field office. The pharmacist would be in NO trouble at all as he followed proper procedure.

It's 48 hours in NY for all controls but you only need to call the DEA/BNE for C-II. Just need to make a notation on the oral for 3-5. I dont think I've ever refused an oral emergency supply. Emergency is a pretty broad thing. But I've never had a call in for adderall though, I'd probably refuse that

 

[genesis09]

Illinois says you can accept a C-2 oral prescription in cases in which not having the medication will cause severe pain and suffering. You need to receive the prescription within 7 days of dispensing. On day 8, if you haven't received the script, you should call the DEA. This is a judgment issue. In law, the professor actually had a multiple choice question about whether or not you should accept the script. We didn't like that question because it is such a personal question.