Patients who fill controls at multiple pharmacies....

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g40631

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Hypothetical and of course, real-world example: Suppose you have a patient who presents with legit Rx's but you have sources (state electronic tracking) that shows the patient has been obtaining those same Rx's at other retail pharmacies at the same time as from your pharmacy. We're talking fills for the same drug at different pharmacies at the same time. What is your feeling on the matter? Would you refuse to fill the Rx, or go beyond that and tell the patient they can't return based on the history you now have available?

Thanks

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Hypothetical and of course, real-world example: Suppose you have a patient who presents with legit Rx's but you have sources (state electronic tracking) that shows the patient has been obtaining those same Rx's at other retail pharmacies at the same time as from your pharmacy. We're talking fills for the same drug at different pharmacies at the same time. What is your feeling on the matter? Would you refuse to fill the Rx, or go beyond that and tell the patient they can't return based on the history you now have available?

Thanks
If it's a control, and it's the same drug, and it's already been filled, you can't fill it. Your state may have a different verdict, however.

But just practically thinking this through, in the exception of a vacation, why would the patient be getting the control at two different pharmacies? If they're taking it as prescribed, they would have a huge stockpile of it and not need to get any more fills for a while. Or they're diverting them....

I would contact the other pharmacies to make sure they were also aware of the fill history, and decline to fill the rx. We have another pharmacy across the street from us and we make calls to each other about patients who try this. If they got 2 month' supply 1 month ago, they have a month left and will have to wait until then.
 
I'm actually talking about not filling controls for the patient any more permanently. Aka, once you have proof that they've been getting multiple fills of the same control at multiple pharmacies, you have evidence of possible addiction/diversion. At that point, you would no longer permit the patient to have controlled substances filled at your pharmacy, or at least under your watch.

The DEA Pharmacist's Manual with the "Corresponding Responsibility Clause" basically makes me believe that should be the only safe route the pharmacist could take from that point forward.
 
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I'm actually talking about not filling controls for the patient any more permanently. Aka, once you have proof that they've been getting multiple fills of the same control at multiple pharmacies, you have evidence of possible addiction/diversion. At that point, you would no longer permit the patient to have controlled substances filled at your pharmacy, or at least under your watch.

The DEA Pharmacist's Manual with the "Corresponding Responsibility Clause" basically makes me believe that should be the only safe route the pharmacist could take from that point forward.
I can see how you don't want to have to deal with a patient like that, so it seems like an easy solution to ban them. However, addiction or not, they're going to get that rx filled somewhere. Better to have it filled where a pharmacist is aware of their refill history and is looking to make sure it's not filled elsewhere, rather than send them searching for a new pharmacy that doesn't care.

I don't think there is anything that says a patient with history of diversion is no longer allowed to have any controlled substances. As soon as their supply officially runs out, their therapy should continue, since the docs are writing it for a reason. However, the doctor who keeps writing these scripts for the patient needs to be aware of the situation, and figure out the reason they keep needing new scripts all the time.
 
I don't think there is anything that says a patient with history of diversion is no longer allowed to have any controlled substances. As soon as their supply officially runs out, their therapy should continue, since the docs are writing it for a reason. However, the doctor who keeps writing these scripts for the patient needs to be aware of the situation, and figure out the reason they keep needing new scripts all the time.

If the patient is diverting, then s/he doesn't need the drugs. If the patient needed the drugs, s/he would be taking them rather than diverting. There is no therapy for this patient. Chances are the pt faked symptoms or has a doc willing to give out the meds fairly easily.
 
If the patient is diverting, then s/he doesn't need the drugs. If the patient needed the drugs, s/he would be taking them rather than diverting. There is no therapy for this patient. Chances are the pt faked symptoms or has a doc willing to give out the meds fairly easily.
Okay, if they're selling them, no, they don't need them at all, and should not get a new rx. Proving that's the case? Next to impossible. Tell the doc if you strongly suspect this, and maybe they won't write so quickly for them.

Taking more than the MDD and getting high rather than treating pain? More likely, also not going to be proven. In this case, you can't pull the plug on their scripts, since they do need them.
 
Okay, if they're selling them, no, they don't need them at all, and should not get a new rx. Proving that's the case? Next to impossible. Tell the doc if you strongly suspect this, and maybe they won't write so quickly for them.

Taking more than the MDD and getting high rather than treating pain? More likely, also not going to be proven. In this case, you can't pull the plug on their scripts, since they do need them.

I think you're working on the assumption that if a patient has the prescription, then he/she needs the drug. That might not be true. Look at all the oxycodone dispensed in FL. I don't think all of those people with rx's really need it, and so does most of the medical community.

In some cases, addict-like behavior is seen in people in true pain and those people certainly need an MD to change the regimen. But I don't really see why a legitimate pain patient would go through the bother of filling scripts for the same drugs at different pharmacies.
 
I'm not in the business of forced detox, so I would contact the provider(s) and go from there. PPs are ignoring that a person who is not a legitimate pain patient will still go through w/d (unless they are selling, of course). That's something I'd rather see done in a controlled environment.
 
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