Do you take back Control Substances?

[Tregaron]

Do any of you take back control substances? My DM said to take back control and swap for customer because she did not want round alprazolam but Greenstone (footballs) instead. He said that we were not breaking the law or company policy by swapping control meds that she had taken home and then brought back. Any opinions?

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[Stripe15]

Yeah I'm pretty sure thats not what your supposed to do. After any drug leaves the pharmacy it should not be taken back.

 

[owlegrad]

I hate ordering custom manufacturers for control substances. Such a red flag IMO. Not to mention a pita. Having said that, I have let patients swap out meds when they want a certain manufacturer. It's not their fault we ignored all the notes in their profile saying GREENSTONE ONLY!!!!!!!!!!!!

This assumes that they told us in advance they wanted a certain manufacturer.

 

[Old Timer]

Yeah I'm pretty sure thats not what your supposed to do. After any drug leaves the pharmacy it should not be taken back.

NO, NO, NO...... you can take back anything you want. You just can't sell it to anybody else.......

 

[ancienbon]

NO, NO, NO...... you can take back anything you want. You just can't sell it to anybody else.......

So true.

 

[zelman]

NO, NO, NO...... you can take back anything you want. You just can't sell it to anybody else.......

Not unless you're a law enforcement officer, or have a dedicated receptacle per last year's DEA rule change:

The final rule, called the Disposal of Controlled Substances, allows community pharmacies to conduct take-back programs and provides patients the option of mailing their unused, unwanted, or expired prescription medications or placing them in a pharmacy-maintained collection receptacle in addition to the currently authorized receptacles found at various local law enforcement agencies. The rule also grants community pharmacies the authority to maintain receptacles at long term care facilities they service.

 

[catalyzt]

NO. It's a red flag. I tell the patient the shape has nothing to do with the efficacy and safety of the medication. If they are persistent, they can go somewhere else. Period.

 

[Dr Wario]

I would take it back and replace once pill for pill and let the customer that we will no longer be providing service.

 

[npage148]

Straight out illegal with the dea to take back CS but that's never stopped a pdm from telling you to do it

I also don't play that games with CSs, I give you what I have and I won't order you a special one. I can only take the bars, DANs, watsons because the others don't work (sell for as much). Unless the FDA removes the AB rating you're getting what you get unless the doctor DAWs a specific genric

 

[Sine Cura]

It is obviously illegal but you could do it and say "who is going to catch me" and haz waste it. But if a dea agent or board inspector finds out somehow you have no valid excuse. Saying well this is not part of a take back program but due to a dispensing "error" is probably not going to fly

 

[owlegrad]

The DEA ruling is concerning take back programs. Show me where it says you can't exchange meds due to patient preference. You're just making up laws that don't exist. It might be a bad idea or against your professional judgement but it's not illegal.

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[npage148]

The DEA ruling is concerning take back programs. Show me where it says you can't exchange meds due to patient preference.

(a) The following persons are authorized to collect controlled substances from ultimate users and other non-registrants for destruction in compliance with this chapter:

(1) Any registrant authorized by the Administration to be a collector pursuant to §1317.40; and

(2) Federal, State, tribal, or local law enforcement when in the course of official duties and pursuant to §1317.35.

(b) The following non-registrant persons in lawful possession of a controlled substance in Schedules II, III, IV, or V may transfer that substance to the authorized persons listed in paragraph (a) of this section, and in a manner authorized by this part, for the purpose of disposal:

(1) An ultimate user in lawful possession of a controlled substance;

(2) Any person lawfully entitled to dispose of a decedent's property if that decedent was an ultimate user who died while in lawful possession of a controlled substance; and

(3) A long-term care facility on behalf of an ultimate user who resides or resided at such long-term care facility and is/was in lawful possession of a controlled substance, in accordance with §1317.80 only.

If you take back the medication you are legally required to dispose it, as most state laws dictate (some may allowing restocking of medication in a sealed stock bottle). A retail pharmacy does not meet any of part a unless they are registered as a collector (I would assume most are not). So how would you get around this? Give them the brand they want w/o taking the other one back (dispensing w/o an rx) or take back the medication (unathorized collection from a non-registrant)

 

[owlegrad]

If you take back the medication you are legally required to dispose it, as most state laws dictate (some may allowing restocking of medication in a sealed stock bottle). A retail pharmacy does not meet any of part a unless they are registered as a collector (I would assume most are not). So how would you get around this? Give them the brand they want w/o taking the other one back (dispensing w/o an rx) or take back the medication (unathorized collection from a non-registrant)

So what would you do if you had a dispensing error and gave them the wrong controlled substance medication?

How is collection defined? I would argue that exchanging is not the same as collecting.

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[Sine Cura]

If you want to consider dispensing an undesired generic a dispensing error and risk incurring any civil and/or criminal penalties that arise from dispensing errors, go for it.

http://www.deadiversion.usdoj.gov/faq/prescriptions.htm
Question: Can an individual return his/her controlled substance prescription medication to a pharmacy?
Answer: No. An individual patient may not return his/her unused controlled substance prescription medication to the pharmacy. Federal laws and regulations make no provisions for an individual to return the controlled substance prescription medication to a pharmacy for further dispensing or for disposal. There are no provisions in the Controlled Substances Act or Code of Federal Regulations (CFR) for a DEA registrant (i.e., retail pharmacy) to acquire controlled substances from a non-registrant (i.e., individual patient).

The CFR does have a provision for an individual to return his/her unused controlled substance medication to the pharmacy in the event of the controlled substance being recalled or a dispensing error has occurred.


http://www.deadiversion.usdoj.gov/fed_regs/rules/2010/fr0331.htm

The Controlled Substances Act is unique among criminal laws in that it stipulates acts pertaining to controlled substances that are permissible. That is, if the CSA does not explicitly permit an action pertaining to a controlled substance, then by its lack of explicit permissibility the act is prohibited.

 

[owlegrad]

If you want to consider dispensing an undesired generic a dispensing error and risk incurring any civil and/or criminal penalties that arise from dispensing errors, go for it.

http://www.deadiversion.usdoj.gov/faq/prescriptions.htm
Question: Can an individual return his/her controlled substance prescription medication to a pharmacy?
Answer: No. An individual patient may not return his/her unused controlled substance prescription medication to the pharmacy. Federal laws and regulations make no provisions for an individual to return the controlled substance prescription medication to a pharmacy for further dispensing or for disposal. There are no provisions in the Controlled Substances Act or Code of Federal Regulations (CFR) for a DEA registrant (i.e., retail pharmacy) to acquire controlled substances from a non-registrant (i.e., individual patient).

The CFR does have a provision for an individual to return his/her unused controlled substance medication to the pharmacy in the event of the controlled substance being recalled or a dispensing error has occurred.


http://www.deadiversion.usdoj.gov/fed_regs/rules/2010/fr0331.htm

The Controlled Substances Act is unique among criminal laws in that it stipulates acts pertaining to controlled substances that are permissible. That is, if the CSA does not explicitly permit an action pertaining to a controlled substance, then by its lack of explicit permissibility the act is prohibited.

What would you call dispensing an undesired generic, again assuming the patient had expressed the desire beforehand and had been told they would receive their preferred generic?

 

[rxlea]

What would you call dispensing an undesired generic, again assuming the patient had expressed the desire beforehand and had been told they would receive their preferred generic?

That's not really an error. An error is when it could lead to inappropriate use of a medication or patient harm. So unless they were legitimately allergic to some excipient in that generic and it was noted as such, I don't think "preference" is going to hold up under the law.

 

[owlegrad]

That's not really an error. An error is when it could lead to inappropriate use of a medication or patient harm. So unless they were legitimately allergic to some excipient in that generic and it was noted as such, I don't think "preference" is going to hold up under the law.

You said you were going to dispense one product and you dispensed another (hypothetically). What in the law prevents you from fixing that mistake?

 

[rxlea]

You said you were going to dispense one product and you dispensed another (hypothetically). What in the law prevents you from fixing that mistake?

But if on the bottle all the information for the selected manufacturer is correct even though it's not the preferred one (not misbranded), I don't see how it's an error leading to inappropriate use/harm. It's a mistake for sure, but I'm not sure it would hold up as an error under the Federal law if you're looking specifically at returning dispensed controls.

 

[owlegrad]

But if on the bottle all the information for the selected manufacturer is correct even though it's not the preferred one (not misbranded), I don't see how it's an error leading to inappropriate use/harm. It's a mistake for sure, but I'm not sure it would hold up as an error under the Federal law if you're looking specifically at returning dispensed controls.

How does having an allergy to one of the excipients change anything about the legality of switching out the product?

 

[rxlea]

How does having an allergy to one of the excipients change anything about the legality of switching out the product?

If you dispense a drug to a patient and you know they are allergic to it, that's an error because it can lead to patient harm. If the patient was (hypothetically) allergic to some filler of XY generic and it's in their profile but your tech picks that generic and you dispense it, it's an error. And based on that, according to the above cited law, I think you could take it back to give them the brand or whatever other generic they aren't allergic to.

 

[npage148]

You said you were going to dispense one product and you dispensed another (hypothetically). What in the law prevents you from fixing that mistake?

What sine quoted. "Federal laws and regulations make no provisions for an individual to return the controlled substance prescription medication toa pharmacy for further dispensing or for disposal."

You can fix the mistake in a manner satisfactory to all parties involved as long as doesn't involve accepting CS back

 

[owlegrad]

What sine quoted. "Federal laws and regulations make no provisions for an individual to return the controlled substance prescription medication toa pharmacy for further dispensing or for disposal."

You can fix the mistake in a manner satisfactory to all parties involved as long as doesn't involve accepting CS back

They cannot return the medicine, but it doesn't say they cannot exchange the medicine.

 

[rxlea]

They cannot return the medicine, but it doesn't say they cannot exchange the medicine.

Exchange implies you're taking something back.

 

[owlegrad]

If you dispense a drug to a patient and you know they are allergic to it, that's an error because it can lead to patient harm. If the patient was (hypothetically) allergic to some filler of XY generic and it's in their profile but your tech picks that generic and you dispense it, it's an error. And based on that, according to the above cited law, I think you could take it back to give them the brand or whatever other generic they aren't allergic to.

So all the patient has to do is say they are allergic to any manufacturer except greenstone? OK, no problem, that's what most of them say anyway. Problem solved!

 

[owlegrad]

Exchange implies you're taking something back.

Nope, returning and exchanging are not the same activity.

 

[rxlea]

So all the patient has to do is say they are allergic to any manufacturer except greenstone? OK, no problem, that's what most of them say anyway. Problem solved!

Then you have to look at the definition of true allergy lol which is a whole other argument. And I guarantee if you're on trial and their trying to hang you up, they would probably bring it up.

 

[rxlea]

They're* . One of the things I struggle with at the hospital is all those bogus allergies. Cuz some nurses just put in literally whatever the patient says when it's not an allergy. Then we have to classify it as an intolerance vs allergy.

 

[rxlea]

Nope, returning and exchanging are not the same activity.

Well, when I go to a store to exchange something, I give the old product back. And then I get something else. I think the Federal law says you can't take anything back, exchange/return whatever. Basically once that drug leaves your pharmacy, it's never supposed to go back behind the counter unless you follow the aforementioned guidelines/rules.

 

[owlegrad]

Well, when I go to a store to exchange something, I give the old product back. And then I get something else. I think the Federal law says you can't take anything back, exchange/return whatever. Basically once that drug leaves your pharmacy, it's never supposed to go back behind the counter unless you follow the aforementioned guidelines/rules.

That isn't what the law says though. It just says it can't be returned. If it can be exchanged due to an error, it can be exchanged due to giving the wrong product. And every patient who wants a certain manufacturer is going to claim that it either doesn't work or makes them sick, so that falls under your definition of an error anyway.

 

[trailerpark]

We don't advertise we take back drugs, but if the rx manager approves the return then we do a refund and the patient gets their money back then we dump the pills I'm a Baggie and label it and it goes in the haz waste container just like all the broken tablets or pills we find on the floor or whatever. So technically we can take back anything, but then we lose the money. It's a decision for the manager to make. I say no and if they keep pressing the issue I say they can speak to the manager about it.

 

[Old Timer]

So, if a controlled substance is recalled, you can't take it back? You people need to get a life. You all suffer from reading comprehension problems. If it's not the brand the patients want's it's an error. This question is about returning unused medication for disposal. No you can't except the extra 103 Vicodin when aunt sally dies. But if you have to exchange one brand for another you can (some states prohibit taking back any medication), you just can't resell it.

 

[trailerpark]

If a medication is dispensed and it's an error if it's not their favorite brand then wouldn't we be required to ask every last person what brand they want? If you don't like the brand I give you, good luck going to the board of pharmacy with your pharmacy "error" to get me in trouble.

 

[zelman]

People need to chill out. Nobody here thinks it should be illegal for us to take back CS that were dispensed in accordance to the written prescription. It just happens to be explicitly illegal. Everyone arguing that it won't result in negative consequences is probably right. You are free to break all the laws you like. However, the injustice of the law and low likelihood of enforcement does not mean that it is legal, nor does it mean anyone SHOULD violate that law based on your evaluation of those factors.

 

[sosoo]

there's no right or wrong way about it. use your professional judgment. but if you got the DM involved or any of your superior involved. document it and do as they say.

 

[Sine Cura]

It's been a long time but the CVS policy and procedure manual (RxNet) addresses dispensing errors. As I recall, the policy states that controlled substances are not to be taken back even if a dispensing error occurred (back out any paid claim, zero it out, dispense the correct product on a reassigned Rx), but reading comprehension takes a hit when you work 13 hours a day all the time. One time I had to deal with incorrect CII dispensed caused by another pharmacist (at least it was a discharge Rx for small quantity and not pain management Rx). I didn't take back the wrong drug but I ultimately dispensed the right drug. I was hesitant to do this, which is why I consulted the policy and procedure on dispensing errors. So anyone who still works for CVS please feel free to check the policy. Maybe I did expose myself to disciplinary action by the board for allowing a CII to be dispensed twice, who knows.

It's disappointing that the CSA or DEA doesn't address this explicitly.

As for recalls, when was the last time the FDA required pharmacies to take back dispensed prescriptions, much less dispensed controlled substances? If it was the manufacturer's fault, usually the manufacturer takes back the product directly from the end user, like with Auvi-Q.

 

[Ackj]

The local police department accepts all prescriptions Monday - Friday and the recycling center accepts them during regular business hours as well. That doesn't help much in the case of the "wrong brand dispensed." You certainly aren't going to just re-dispense the full amount, and let the patient have a double supply and trust that they will dispose of the unwanted one to the police. If the CVS policy does in fact state that, I am really surprised.

Everyone else who has said, "No way; we won't take them back or exchange," do you just tell the patient "Yes, I know you asked for that brand, but too bad, legally we dispensed the prescription correctly, so better luck 30 days from now," and hope that satisfies them? I can't imagine them doing anything aside from going berserk.

We typically do not do take backs, controlled or otherwise. We used to do it all the time (like a really excessive, annoying amount) but we've instituted the policy of "check your bag and bottle before you leave the store" and it's worked pretty well so far.

 

[Sine Cura]

You tell them to take some responsibility and check the product before you leave the pharmacy. (If) we are working with you, (then) you should work with us to achieve the desired outcome. Or find another pharmacy to coddle you.

 

[Old Timer]

It's been a long time but the CVS policy and procedure manual (RxNet) addresses dispensing errors. As I recall, the policy states that controlled substances are not to be taken back even if a dispensing error occurred (back out any paid claim, zero it out, dispense the correct product on a reassigned Rx), but reading comprehension takes a hit when you work 13 hours a day all the time. One time I had to deal with incorrect CII dispensed caused by another pharmacist (at least it was a discharge Rx for small quantity and not pain management Rx). I didn't take back the wrong drug but I ultimately dispensed the right drug. I was hesitant to do this, which is why I consulted the policy and procedure on dispensing errors. So anyone who still works for CVS please feel free to check the policy. Maybe I did expose myself to disciplinary action by the board for allowing a CII to be dispensed twice, who knows.

It's disappointing that the CSA or DEA doesn't address this explicitly.

As for recalls, when was the last time the FDA required pharmacies to take back dispensed prescriptions, much less dispensed controlled substances? If it was the manufacturer's fault, usually the manufacturer takes back the product directly from the end user, like with Auvi-Q.

Question: Can an individual return his/her controlled substance prescription medication to a pharmacy?
Answer: No. An individual patient may not return his/her unused controlled substance prescription medication to the pharmacy. Federal laws and regulations make no provisions for an individual to return the controlled substance prescription medication to a pharmacy for further dispensing or for disposal. There are no provisions in the Controlled Substances Act or Code of Federal Regulations (CFR) for a DEA registrant (i.e., retail pharmacy) to acquire controlled substances from a non-registrant (i.e., individual patient).

The CFR does have a provision for an individual to return his/her unused controlled substance medication to the pharmacy in the event of the controlled substance being recalled or a dispensing error has occurred.

An individual may dispose of his/her own controlled substance medication without approval from DEA. Medications should be disposed of in such a manner that does not allow for the controlled substances to be easily retrieved. In situations where an individual has expired, a caregiver or hospice staff member may assist the family with the proper disposal of any unused controlled substance medications.

I swear to GOD, I can't believe some some of you have trouble reading English. You can't take back the medication if it means you increase your inventory. SO:

You have 2oo Alprazolam Greenstone
You have 200 Alprazolam Mylan
===============================
You sell 100 Alprazolam Mylan and switch it to Greenstone and you still have only 300 left and one script for 100 to account for it.......

 

[Sine Cura]

No one is disputing the take-back part (unless the pharmacy is a DEA-authorized collector). And actually upon further review I didn't find anything in the CFR that mentions dispensing errors. So the recent discussion on "exchanging" pursuant to a dispensing error is based on what seems to be a false assumption (that there is a CFR provision that permits returns due to dispensing errors).

I did ask someone to check the CVS pharmacy operations manual (on RxNet), and I was told the document on "customer dissatisfaction" specifically mentions that controlled substances already dispensed should not be returned. I didn't get a chance to find out if there is similar language in the dispensing error document.

 

[wagrxm2000]

Sounds like a bunch of people here give bad customer service. You make a mistake, you take it back. If it's not your fault, you don't.

 

[zelman]

I swear to GOD, I can't believe some some of you have trouble reading English. You can't take back the medication if it means you increase your inventory. SO:

You have 2oo Alprazolam Greenstone
You have 200 Alprazolam Mylan
===============================
You sell 100 Alprazolam Mylan and switch it to Greenstone and you still have only 300 left and one script for 100 to account for it.......

You're going to sell those Mylan tabs that have left the pharmacy to someone else?

Or are they "in your inventory" awaiting disposal?

 

[zelman]

I swear to GOD, I can't believe some some of you have trouble reading English. You can't take back the medication if it means you increase your inventory. SO:

You have 2oo Alprazolam Greenstone
You have 200 Alprazolam Mylan
===============================
You sell 100 Alprazolam Mylan and switch it to Greenstone and you still have only 300 left and one script for 100 to account for it.......

... Also note that patient preference is not mentioned in this definition of dispensing error:

Definition of a dispensing error. A dispensing error is a discrepancy between a prescription and the medicine that the pharmacy delivers to the patient or distributes to the ward on the basis of this prescription, including the dispensing of a medicine with inferior pharmaceutical or informational quality [1–6].
Medication errors: the importance of safe ...
www.ncbi.nlm.nih.gov › PMC2723208

 

[Old Timer]

You're going to sell those Mylan tabs that have left the pharmacy to someone else?

Or are they "in your inventory" awaiting disposal?

No, they are in your inventory until you damage them.

 

[Old Timer]

No one is disputing the take-back part (unless the pharmacy is a DEA-authorized collector). And actually upon further review I didn't find anything in the CFR that mentions dispensing errors. So the recent discussion on "exchanging" pursuant to a dispensing error is based on what seems to be a false assumption (that there is a CFR provision that permits returns due to dispensing errors).

I did ask someone to check the CVS pharmacy operations manual (on RxNet), and I was told the document on "customer dissatisfaction" specifically mentions that controlled substances already dispensed should not be returned. I didn't get a chance to find out if there is similar language in the dispensing error document.

Only a 24 carat solid gold ***** would leave an errant prescription with a patient. You want any wrong prescription out of circulation so as to ensure nobody is injured by the errant prescription. I quoted from the DEA web site. As for CVS policy ask your pharmacy supervisor for guidance. There is no way they would not authorize you to take back an errant prescription.

 

[Sine Cura]

In the case above the patient claimed she ingested all the tablets before "realizing" it was the wrong medication so if she was telling the truth there was nothing to take back. It was a 2 day supply minimum and she came back three days later. So I could have refused to dispense the right medication until she surrender the misfill (I would have no way of knowing she still had it or not) or fix the mistake. Whether she had a bad history was immaterial to the fact that an error occurred. I then spent some time looking at the policy and procedure manual and found that part not returning controlled substances, albeit under the customer dissatisfaction policy and not under the dispensing error policy.

In reality most pharmacists (including me) would insist on taking what's left of a misfill back just because of the liability associated with of someone having more controlled substance than they should have. Intuitively the "unlawfulness" of a misfill is more severe and more likely to incur discipline than the unlawfulness of taking a controlled substance from the ultimate user because at least there will (should) be a paper trail of disposal.

Going back to the OP's situation, if someone did not state any preference before getting Sandoz or Actavis alprazolam (don't know if that's the case for OP's scenario) then came back and insisted on getting Greenstone, I wouldn't exchange it. It wasn't a mistake. Just like someone complaining they got Mallinckrodt Norco 10/325 instead of Qualitest even though they didn't say anything. A sup directing you to do that probably isn't even aware of the customer dissatisfaction document. Why have a policy and procedures manual if no one follows it?

Also a sentence in a DEA FAQ without a supporting citation is not exactly a regulation or final rule sanctioning the act, but an indication the DEA doesn't care. If there is something in the CFR, where is it? FYI CFR search tool: http://www.ecfr.gov/cgi-bin/ECFR?SID=9bcc3fbe46774be9eb9f90e6d095e3b3&mc=true&page=simple

 

[Old Timer]

Look: I don't think one brand for another is an error unless:

• The patient stated up front they wanted X and you gave them Y
• The prescription was written for Brand Necessary and you gave the generic.

So if they want 602's and you gave them 512's, that's tough.

I'm speaking about a dispensing error. You gave Xanax instead of Ativan. You have to take it back. You can't let them keep an incorrect medication. As long as you document everything, you are not going to have an issue.

 

[Rukn]

So if some loud obnoxious customer doesn't specify that he wants brand Percocet to me and my tech who entered his script tells me that he said the generic is OK gets angry that he was dispensed a generic that "doesn't work" and starts a whole commotion about it, should I take it back? Mind you, he was yelling before I even filled the script for him.

Sorry but I'm not going to take it back and I see no proof that what I gave him is an "error".

 

[FarmD711]

So if some loud obnoxious customer doesn't specify that he wants brand Percocet to me and my tech who entered his script tells me that he said the generic is OK gets angry that he was dispensed a generic that "doesn't work" and starts a whole commotion about it, should I take it back? Mind you, he was yelling before I even filled the script for him.

Sorry but I'm not going to take it back and I see no proof that what I gave him is an "error".

Why are you filling a Percocet prescription for someone who is yelling before you even fill it? This is a no go at my pharmacy. If you are yelling you are not staying. I am certainly not filling controlled substances for you.

 

[Rukn]

Why are you filling a Percocet prescription for someone who is yelling before you even fill it? This is a no go at my pharmacy. If you are yelling you are not staying. I am certainly not filling controlled substances for you.

He was being obnoxious. Told him to calm down and I would help him.

Thought maybe getting the medicine would calm him down and make his day better

But, alas, crackheads will be crackheads

 

[wagrxm2000]

So if some loud obnoxious customer doesn't specify that he wants brand Percocet to me and my tech who entered his script tells me that he said the generic is OK gets angry that he was dispensed a generic that "doesn't work" and starts a whole commotion about it, should I take it back? Mind you, he was yelling before I even filled the script for him.

Sorry but I'm not going to take it back and I see no proof that what I gave him is an "error".

You keep brand Percocet on hand? What's that going to cost the patient?