What to do with a Dr calling in so many controls?

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In the last few weeks, we've had a doctor who has been calling in (only calling in, never faxed, hand written, or e-scribed) prescriptions for controlled medicines:

Norco 10mg #120 with 3 rf
Xanax 2mg #60 with 3 rf

and occasionally

Promethazine-codeine #8oz with 3 rf

All (except for 1 I've seen so far) of his patients pay cash when they come to pickup and usually present their ID cards and not driver's licenses. One guy claimed his only ID was a DL that expired in 2006 🙄 More importantly, they all almost always try to call in for early refills. Not just a week or two early, but like we just filled it 2 days ago early.

Being a corporate ran chain pharmacy, it's hard to just tell the dr and patients "No" (they'll start complaing and we'll end up having to fill them anyways), but what is there to do when the situation is obvious?
 
Repeat after me:

Sorry, I can't help you with these....
 
Are you sure it's the doc calling in? :laugh:

We had a patient pretend to be a PA and try to call in percocet 🤣 needless to say, we said "sorry dude!"
 
Start documenting all of the fills you do per day with that particular doctor. Get a pattern going and report to your pharmacy manager who can take it to the DM. Let them decide if it warrants going to the DEA or not. With enough evidence, they will definitely be interested in this doc's practice.

We have doctors here who specialize in 'pain management' and it's such a bitch dealing with their patients.

Unfortunately, there's not much you can do about it without some hard evidence that the people buying aren't for legitimate reasons. In those instances where you can't do anything, don't let it get you down. Just move on and keep documenting.

DISCLAIMER: I recognize there are individuals who are truly in pain, this post does not in any way cause slander to those people.
 
FlavyFlav said:
Start documenting all of the fills you do per day with that particular doctor. Get a pattern going and report to your pharmacy manager who can take it to the DM. Let them decide if it warrants going to the DEA or not. With enough evidence, they will definitely be interested in this doc's practice.

We have doctors here who specialize in 'pain management' and it's such a bitch dealing with their patients.

Unfortunately, there's not much you can do about it without some hard evidence that the people buying aren't for legitimate reasons. In those instances where you can't do anything, don't let it get you down. Just move on and keep documenting.

DISCLAIMER: I recognize there are individuals who are truly in pain, this post does not in any way cause slander to those people.
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I would start with calling the doctor's office directly to "verify a prescription"...in other words, to check and see if the doctor did indeed call in Xanax or whatever. If he/she didn't, then obviously it is impersonation. If he/she did, then I would do what you suggested.
 
Sparda29 said:
Sounds to me like someone is impersonating a doctor.
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My PIC told me when he was working in Philly he would get a lot of phony controls called in. His way to determine if the doctor on the phone was legit or not was to ask where the islets of Langerhans were. He said you would likely hear a *click* after that.
 
DASicari said:
My PIC told me when he was working in Philly he would get a lot of phony controls called in. His way to determine if the doctor on the phone was legit or not was to ask where the islets of Langerhans were. He said you would likely hear a *click* after that.
Click to expand...

LMAO! Imagine if the answer to that was "In the Bahamas".
 
Sounds like phony calls. Are you getting the written Rx's within 3 days (for C2's), as required? If not, stop filling for that MD, because they are breaking the law. Call them and explain. Also, each time do a call back - get their number and call THEM back to verify.
 
drugdoc said:
Sounds like phony calls. Are you getting the written Rx's within 3 days (for C2's), as required? If not, stop filling for that MD, because they are breaking the law. Call them and explain. Also, each time do a call back - get their number and call THEM back to verify.
Click to expand...

None of the drugs listed in the OP are C2s...
 
DASicari said:
My PIC told me when he was working in Philly he would get a lot of phony controls called in. His way to determine if the doctor on the phone was legit or not was to ask where the islets of Langerhans were. He said you would likely hear a *click* after that.
Click to expand...
Clever, but if it was an actual doctor, they'd probably be like "WTF??"
 
Passion4Sci said:
Wait, Hydrocodone (Norco is APAP+Hydro...) is not a Schedule II, since when?
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Since forever. There are NO hydrocodone products that are C-II though all oxycodone products are C-II.
 
Another approach is to say:

"Doc, I really need to have a written script for that."
 
Passion4Sci said:
Wait, Hydrocodone (Norco is APAP+Hydro...) is not a Schedule II, since when?

Perhaps we should inform the DEA that they're mistaken?

DEA 9193 IIRC...?

Alprazolam is a Schedule IV, though. Still controlled, yes?
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The DEA is not mistaken and neither am I.

Hydrocodone + APAP as well as Hydrocodone + IBU are in Schedule III.

But thanks for assuming I don't know what Norco is. 🙂

I'm not sure I understand your question about Alprazolam.
 
The U.S. Congress placed hydrocodone (bulk or single entity products) in schedule II of the CSA and its products containing specified doses in combination with specified amounts of isoquinoline alkaloid of opium or one or more nonnarcotic substances in recognized therapeutic amounts as schedule III products when the CSA was enacted.
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http://www.deadiversion.usdoj.gov/drugs_concern/hydrocodone/hydrocodone.htm

Since all products on the market contain other ingredients, they are ALL C-III.
 
Thanks for the correction! I had no idea that if it contained something other than simply Hydrocodone that it was no longer a C-II. We keep Norco and Vicodin with Schedule IIs...

Interesting! I love learning new things. 🙂
\
And my question about Xanax wasn't really a question per se - It's Schedule IV, but it's still "controlled" at least at my indy pharmacy.

Fully ready and willing to admit I am but a lowly technician and have a very open and eager mind for starting school this fall. Lots of little "gotchas" are the bread and butter of this field, gotta love it.
 
Passion4Sci said:
Thanks for the correction! I had no idea that if it contained something other than simply Hydrocodone that it was no longer a C-II. We keep Norco and Vicodin with Schedule IIs...

Interesting! I love learning new things. 🙂
\
And my question about Xanax wasn't really a question per se - It's Schedule IV, but it's still "controlled" at least at my indy pharmacy.

Fully ready and willing to admit I am but a lowly technician and have a very open and eager mind for starting school this fall. Lots of little "gotchas" are the bread and butter of this field, gotta love it.
Click to expand...

Next time you count out a Norco or Vicodin, check out the bottle. Should have a C-III on it.

Regarding Xanax, yes it is "still" controlled. Every scheduled drug (I - V) is a controlled substance. I guess that's what you mean by "controlled"? Or are you talking about some sort of special rules used at your pharmacy?

All drugs classified as controlled substances are classifed that way nationwide. Individual states may designate other drugs as controlled within that state. For instance, Ultram and Soma are not federally scheduled drugs but are controlled in some states.
 
Well it's the doc himself alright, everything is legitamate (technically speaking). It's just that the situation isn't legit lol.

One of our pharmacists already talked to the district manager, and as far as we've seen, he doesn't seem to be concerned. I don't know if it's because he doesn't see anything wrong with it, or because he likes the increased script count and $$ coming in (although, it's not like it's big money).

I suppose asking for written scripts should be the next step. If the doctor can supposedly take the time to diagnose a pt. with pain and anxiety, he can take 5 more minutes to write out a script too.👍
 
Old Timer said:
Since forever. There are NO hydrocodone products that are C-II though all oxycodone products are C-II.
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Srsly??

Pharmacologically speaking, aren't hydrocodone and oxycodone basically evil twins?

Where I practice, they are legally classed the same.
 
Pharmavixen said:
Srsly??

Pharmacologically speaking, aren't hydrocodone and oxycodone basically evil twins?

Where I practice, they are legally classed the same.
Click to expand...

What state is this? In NY hydro is a C-III. I thought NY had the strictest laws.

We treat alprazolam like a C-II even though we acknowledge it as a C-IV.
 
I would say that we don't have the medication in stock however this puts the problem on the next pharmacist with no resolution. The best way would be then to call the MD for verification (possibly verify the DEA number is accurate) and then go from there. Suggest to the MD to give the pt a written rx.
 
DASicari said:
My PIC told me when he was working in Philly he would get a lot of phony controls called in. His way to determine if the doctor on the phone was legit or not was to ask where the islets of Langerhans were. He said you would likely hear a *click* after that.
Click to expand...

Sure- the Islets of Langerhans are an archipelago in the North Sea between Germany and Sweden :laugh:

Too funny...did anyone even try to respond to that question?
 
indebtpharmd said:
What state is this? In NY hydro is a C-III. I thought NY had the strictest laws.

We treat alprazolam like a C-II even though we acknowledge it as a C-IV.
Click to expand...

The only state I'm in is overcaffeinated; I live in the province of Ontario in Canada. We have "oral prescription narcotics," which are combination products with codeine, up to 30mg, and can be phoned in. All other opioids have to be faxed or written.

At the same time opioid prescriptions are so tightly controlled, you can also buy codeine 8mg combo products over the counter up here, which I find kind of paradoxical. Pharmacies in border towns keep lots of these in stock for all the Americans coming over to pick them up.
 
Cheratussin is an exempt C-V. Unless state law prohibits it, you can sell it as OTC. Most pharmacies choose not to sell exempt C-Vs, though.
 
If it's a legit doctor, and you've already been to the DM, then you've done everything in your power to handle the situation. For now, all you can really do is just document everything and keep it all in a neat, tidy file for if/when the **** hits the fan.
 
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