Early Refills on psych meds?

[CetiAlphaFive]

Hi everyone, I want everyone's opinion on something.
We have a few patients who always ask for their meds 1-2 weeks early.
This is stuff like seroquel, abilify, Lithobid, etc...
They always say they're out.
It's bizarre.
Their physicians are no help at all and don't seem interested in responding to phone calls or faxes.

I'm getting concerned with one lith patient, since it's a notorious clinic. The nurse told me, "Oh crap... we haven't done a level in like a year."
They're also taking an A.R.B.

So, what would you do?

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[BigBoss]

Is insurance denying it?


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[owlegrad]

Well that lithium patient is certainly concerning.

I would fill it as early as the insurance company will allow or let the patient fill it for cash. I would probably ask the patient why they need it early so often just to see what they say. Maybe ask if they have ever tried to use their medication to attempt suicide or if it was somehow possible that someone is accidentally mixing up your pills with their own.

 

[CetiAlphaFive]

*updated poll choices*

Well that lithium patient is certainly concerning.

I would fill it as early as the insurance company will allow or let the patient fill it for cash. I would probably ask the patient why they need it early so often just to see what they say. Maybe ask if they have ever tried to use their medication to attempt suicide or if it was somehow possible that someone is accidentally mixing up your pills with their own.

I never thought of that angle, thanks. They usually say "I'm out of it. I don't know why. I don't take extra"

One of them has OCD and will semi-intentionally drop them on the floor, then refuse to take them.
We've come to an agreement to blister pack their meds. Cheaper than 20 phone calls a day.

 

[Sabril]

Hi everyone, I want everyone's opinion on something.
We have a few patients who always ask for their meds 1-2 weeks early.
This is stuff like seroquel, abilify, Lithobid, etc...
They always say they're out.
It's bizarre.
Their physicians are no help at all and don't seem interested in responding to phone calls or faxes.

I'm getting concerned with one lith patient, since it's a notorious clinic. The nurse told me, "Oh crap... we haven't done a level in like a year."
They're also taking an A.R.B.

So, what would you do?

I called the doctor on a patient once because she always said she ran out of seroquel and wanted to pay for it cash. After checking that the dose was correct, I told the office to keep an eye on this one. She is not confused so she is probably either abusing it or selling it. After being told that we won't give it to her early, she transferred out. That was easy cash to make but oh well.

Yeah yeah yeah seroquel is not a controlled but so was tramadol before. I think the problem especially with the psy population is that they are not being monitored closely as they should and their compliance is already crappy to begin with.

 

[wucool33]

I had a lot of patients selling them. Are they asking for the meds to be in the original bottles?

 

[CetiAlphaFive]

I had a lot of patients selling them. Are they asking for the meds to be in the original bottles?

Hahaha, are you serious?
Psych meds?

No, not in stock bottles

 

[Rockinacoustic]

Hahaha, are you serious?
Psych meds?

No, not in stock bottles

Urban dictionary "Suzie-Q"

 

[BidingMyTime]

Hahaha, are you serious?
Psych meds?
No, not in stock bottles

Depends what psych meds. There was a thread here with people posting that Seroquel was being abused. There are also certain anti-depressants that people seem to think "more is better" on.

My take for the OP, for a non-controlled, I would probably fill early 1x, but after that I would treat is like a control and not do early refills unless their was a highly unique extenuating reason.

 

[johnpharm01]

I would be concerned for a few reasons. As Owlegrad said their is potential for the customers to be stockpiling to get enough to suicide (I believe this is more common in women then men) and with antipsychotics, lithium this is quite possible. The second would be self medicating. Psychiatric illnesses carry a terrible burden and unless you have a good therapeutic relationship with the customer, they won't admit (if possible) to what they are doing. Finally, they could be the victims of theft or could be losing their meds. I would communicate closely with their psychiatrist.

 

[beautifulrobot]

For quetiapine and bupropion I would be a bit concerned about diversion/recreational use/abuse, and would be more likely to treat those as controls.

Aripiprazole is associated with causing impulse control problems, usually manifesting in the form of compulsive gambling, eating, shopping, etc. but theoretically could also result in a compulsion to take more medication - maybe counsel and ask if they have experienced any unusual urges to gamble, eat, shop, take more medication than prescribed, etc.?

The lithium case doesn't seem straightforward to me... I concur with the concerns Owlegrad and johnpharm01 brought up - they could be stockpiling for suicidal reasons, but they could also be self-medicating, or they may just have anxiety about running out of their medications and so they are hoarding for that reason.

Historically there is a lot of mistrust between patients with mental health diagnoses and the medical establishment, so I wouldn't be surprised if patients are not forthcoming with information unless you've built rapport with them. I would try my best to communicate what my concerns are with refilling too soon, and provide reassurance that I want to help them and get them their medications, but if I can't know if they are using them safely, I can't dispense them early. I would also call the prescriber to see if they can provide any insight to whats going on.