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Aug 6, 2012
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The other day I received an oxycodone 10mg script #360 pills. After putting it in our system, the system flags that the DEA # isn't matching to the prescriber. I checked PMP but couldn't find anything on the patient since the Rx was from another state. When I called the hospital, I found out that the DEA number is active but it belongs to the hospital and that the patient has pancreatic cancer. At that point, I didn't feel comfortable filling the prescription because 1) patient is new to us 2) i don't know the doctor (the nurse said he's new to the hospital) 3) large quantity. What would you do in this situation?

How are we as pharmacist supposed to handle these scripts? I mean, I will certainly call the hospital to ask for a ICD code, but I almost always reach someone from front desk or a nurse who's in a hurry to confirm that it's a doctor that works there...but I don't always trust that because It's my license on the line, and i have no idea what kind of a relationship the MD has with that patient.
 

zelman

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Nov 27, 2009
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The other day I received an oxycodone 10mg script #360 pills. After putting it in our system, the system flags that the DEA # isn't matching to the prescriber. I checked PMP but couldn't find anything on the patient since the Rx was from another state. When I called the hospital, I found out that the DEA number is active but it belongs to the hospital and that the patient has pancreatic cancer. At that point, I didn't feel comfortable filling the prescription because 1) patient is new to us 2) i don't know the doctor (the nurse said he's new to the hospital) 3) large quantity. What would you do in this situation?

How are we as pharmacist supposed to handle these scripts? I mean, I will certainly call the hospital to ask for a ICD code, but I almost always reach someone from front desk or a nurse who's in a hurry to confirm that it's a doctor that works there...but I don't always trust that because It's my license on the line, and i have no idea what kind of a relationship the MD has with that patient.
Was the DEA suffix on the Rx?
 
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genesis09

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If the resident does not have his/her own DEA, than you need the suffix. No suffix means it is an illegal Rx.
 
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sosoo

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for such a large quantity, and the number of deaths surrounding this, i would decline. once u accept, they'll keep coming back. and 5-10 years later, they still say they have cancer. and by the time your dog die, they still say they have cancer.
 

Digsbe

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Without a suffix it's not legal. 360 oxycodone for cancer pain isn't likely managing their symptoms properly and puts them at a danger of overdose. I'd want to speak to the attending and get their rational behind giving 360 oxycodone 10mg instead of using an extended release formulation with a lower quantity of oxycodone for breakthrough pain if they have chronic cancer pain (which I'm assuming is the case).

for such a large quantity, and the number of deaths surrounding this, i would decline. once u accept, they'll keep coming back. and 5-10 years later, they still say they have cancer. and by the time your dog die, they still say they have cancer.
If someone has a confirmed diagnosis for pancreatic cancer and has chronic cancer pain I don't care if they live 5-10 more years, they are going to be in serious pain and I'd dispense for them until they passed. Cancer pain is a legitimate reason to fill larger quantities of a CII medication. Such a patient isn't likely an addict or selling their pills, without them they likely can't function due to debilitating pain. Pancreatic cancer has a very poor 5 year survival rate and more than likely the patient will succumb to the disease in just a few years (if not months in some cases). I'd want that person as pain-free as possible and have no reservations filling for them assuming a legit diagnosis.
 
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Sine Cura

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I would deny it depending on what department it came from. For some reason in my area ED prescribers are not shy at all about conducing pain management activities or even writing for multiple scripts for stimulants spanning several months. Clearly this is not in the usual course of practice but perhaps it is an indictment of the lack of access that characterizes health care non-delivery in the US.

Invalid prescriptions could still be considered the personal property of the patient so we do not shred them unless specifically directed by a prescriber.
 
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zelman

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How do you guys handle illegal controlled substance prescriptions? Our outpatient pharmacy shreds them.
Write the reason it's not valid in pen for invalid Rx's. For fake/altered Rx's I'm not giving those back.
 

PharmDBro2017

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Dec 1, 2015
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Working in a LTAC pharmacy, we get these often... although LTAC laws are different vs. retail vs. hospital. To my knowledge, we fill them just like a normal script under the hospital DEA when the resident has written it and has put the hospital DEA next to it.
 
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