How do you answer "What is this drug" Question

[trinnieoh]

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Hey all,

So this dude calls the pharmacy and asks if I can tell him what this med he found in his daughter's car is, if he describes the markings to me. Now I think about it and figure its not like his infant daughter just ingested some random med, but a father being nosy about his adult or teenaged daughter.

So I ask my pharmacist, and she says no, give him the poison control center number. I tell the dad, "I'm sorry I can't help you but the number to the poison control center is..****"
He says my wife is a pharmacist why can't you tell me? thats bullcrap.

Anyway, how do you answer questions like that? Is patient privacy an issue here?

 

[Farmercyst]

Hey all,

So this dude calls the pharmacy and asks if I can tell him what this med he found in his daughter's car is, if he describes the markings to me. Now I think about it and figure its not like his infant daughter just ingested some random med, but a father being nosy about his adult or teenaged daughter.

So I ask my pharmacist, and she says no, give him the poison control center number. I tell the dad, "I'm sorry I can't help you but the number to the poison control center is..****"
He says my wife is a pharmacist why can't you tell me? thats bullcrap.

Anyway, how do you answer questions like that? Is patient privacy an issue here?

Tell him it's against the law, cite HIPAA. If his wife is a pharmacist he can ask her. If it's so urgent he can call poison control. If she's not, and it's not then quit tying up my line. Besides, at least in California, my understanding is as a tech/clerk you'd have to have the pharmacist talk to them in person anyway. Which means the pharmacist would have to answer that question not you.

 

[All4MyDaughter]

My store doesn't do tablet identification over the phone.
Our local poison control doesn't do it either...they tell people to flush it down the toilet. I guess they would handled it differently if it was an alleged ingestion but the day I shadowed at poison control I heard them decline to identify mystery tablets several times.

 

[sdn1977]

The way you describe this - it appears to be a pt privacy issue (the daughter has a car, etc...)

But....lets move a few circumstances....lets say this tablet was found on the floor of a bedroom. You ask who in the house takes medication - only the dad (you're talking to him) and his 8 yo daughter who takes several for her seizures. Not his wife & he has no other children or family living in the home. He did not pick up the last fill so doesn't know if this is from a recent one or a previous one or not related to rxs altogether. They are pts of yours....

Now what.......???

Poison control won't identify drugs because of liability - they will always refer to an ER & they don't have their "own" pts. But...you know this guy, his wife, his daughter, etc......

Personally, I would identify it over the phone to the best of my ability. But, there are times when I can't - they can't read the tablet markings clearly or what they see as a B really is a sylized logo. Last week, I had a pt bring in two tablets to identify & I couldn't do it - they were too old & had been reformulated & the logos changed. I only had the current ASHP identiguide.

So...yeah, I'd do it depending on the cirumstance, but I'd have to do it as a pharmacist. I wouldn't have my tech to do it.

 

[slimcutt]

I had the same call a couple days ago. Dad calls in saying he found a pill in his 16 year old daughter's backpack and wants to know what it is. I looked it up for him and it turned out to be oxycodone 5mg (what a surprise). Personally, I think he has a right to know that his underage daughter is abusing meds. I don't see what the problem is. Sure he's snooping on his child, but that's a parent's job.
Had his daughter been a legal adult, would I still tell him what the pill was? Ya, probably. It's not in a prescription bottle so it's obviously not something she was legitimately prescribed and therefore it’s not a release of protected health information. Am I right?

 

[sdn1977]

I had the same call a couple days ago. Dad calls in saying he found a pill in his 16 year old daughter's backpack and wants to know what it is. I looked it up for him and it turned out to be oxycodone 5mg (what a surprise). Personally, I think he has a right to know that his underage daughter is abusing meds. I don't see what the problem is. Sure he's snooping on his child, but that's a parent's job.
Had his daughter been a legal adult, would I still tell him what the pill was? Ya, probably. It's not in a prescription bottle so it's obviously not something she was legitimately prescribed and therefore it’s not a release of protected health information. Am I right?

Hmmm....fine line here - most likely you're not wrong in a legal sense (HIPAA protects the confidentiality of those over 18). Likewise, HIPAA protects the actual owner of the rx - not one who might have "shared" it.

But...there is an argument for perhaps being wrong in an ethical sense.

Think about what the result of your choice was - what would any parent's first reaction be - anger, frustration, assumption of guilt & probably not very open to a dialog. Not much comes from this except from now on, she's more likely to be very careful where she puts her stuff.

Now...had you said....hmmm I really can't be sure...but you found it where? Well - have you asked her what it might be? Perhaps thats the first place you (meaning the parent) should begin. It could be something as harmless as an acetaminophen or excedrin or something with much greater side effects & iimplications - or it perhaps could not have been hers at all (not likely, but it would give the girl an "out" which then allows for a dialog). I would have sent him home to have a talk with the daughter (whose parent is going thru their kid's backpacks @ 16 anyway???)

The point here with adolescents is - what is your purpose, particularly those who have never been in trouble before? From my perspective, it is to encourage discussion with a parent - or I'd always offer that the girl could come & ask me (actually in my state, I don't need parental consent for Plan B at any age - so it could have been that in which case I wouldn't have told Dad). Good discusion about drug abuse never takes place in an environment of anger.

I've had this same circumstance occur with adult children who don't feel their parent's medications are being properly taken or prescribed k- same thing - I won't share info unless the parent requests it directly from me.

 

[WVUPharm2007]

I'd just tell him. I don't care if he's a druggie or a nosey parent.

 

[letjin]

HIPPA/legal issues aside, to answer the OP:

If you an access to Clinical Pharmacology, click the yellow tab marked "DRUG PRODUCTS." After you click, right under that tab, there is a menu that says 'product identification.' If you type in the markings on the pill in the search box in the right hand side of the screen, it will tell you what drug it is. (BTW Walgreens subscribe to clin pharm.)

 

[sdn1977]

HIPPA/legal issues aside, to answer the OP:

If you an access to Clinical Pharmacology, click the yellow tab marked "DRUG PRODUCTS." After you click, right under that tab, there is a menu that says 'product identification.' If you type in the markings on the pill in the search box in the right hand side of the screen, it will tell you what drug it is. (BTW Walgreens subscribe to clin pharm.)

I've used this too, but do you know how far back it goes???? ie - when a drug patent changes - new manufact, new ndc, etc....how long they keep the data on the old product?

This is where I often can't ID a drug - one found at the back of the shelf. It may not be that old, but my data bases get "cleaned up" & they drop off the old info. I don't keep the old ASHP identiguides either...so then I just have to tell the person I don't know.

Doesn't Martindale's have a service too? For international ones as well? Its been years since I've used it & really don't know how to access it anymore other than buying the book.

 

[geekinthepink]

We always refer them to the poison control center when we get calls like this. Oddly enough we get them rather frequently.

 

[SELDANE]

I really don't see the HIPPA violation. If someone calls and asks for tablet identification there is no violation in telling them what it is. If the caller then decides to confront another individual or make some sort of judgement based on what you tell them, it is simply beyond your control.
People call the pharmacy on a regular basis and ask questions about medications they have found in their children's back pack or room or wherever. I have no problem telling them what the medication is and generally what it is prescribed for. How they decide to deal with this information is up to them.

 

[sdn1977]

I really don't see the HIPPA violation. If someone calls and asks for tablet identification there is no violation in telling them what it is. If the caller then decides to confront another individual or make some sort of judgement based on what you tell them, it is simply beyond your control.
People call the pharmacy on a regular basis and ask questions about medications they have found in their children's back pack or room or wherever. I have no problem telling them what the medication is and generally what it is prescribed for. How they decide to deal with this information is up to them.

Its a HIPAA thing if the Dad identified it was found in his daughter's possession & the daughter is over 18. Same as if it were a drug found in his wife's, mother's, other adult's possession....

But - if they call without this identifying info or don't volunteer it...then no violation.

 

[SELDANE]

Its a HIPAA thing if the Dad identified it was found in his daughter's possession & the daughter is over 18. Same as if it were a drug found in his wife's, mother's, other adult's possession....

But - if they call without this identifying info or don't volunteer it...then no violation.

I disagree. If someone calls without telling you their name or showing that the person they are calling about is in your data base there is no HIPPA violation. In essence, there can be no privacy if a person is not identified.

 

[sdn1977]

I disagree. If someone calls without telling you their name or showing that the person they are calling about is in your data base there is no HIPPA violation. In essence, there can be no privacy if a person is not identified.

You may be right legally - the OP described the Dad as a "dude" - not as my patient "dude"....

But, ethically....I still would ask you - is this the best way to address drug abuse issues among adolescents? (That's a rhetorical question - no one "right" answer!).

I admit, I'm of a liberal mind here since I'm in CA - not everyone feels the same way & there is certainly no one right way to approach this - otherwise it would not be an issue (still). I'd rather he be encouraged about ways to approach loose, unknown medications which he "stumbled" on - rather than addressing why she has a specific medication - which he obviously had to do a bit of research to find out.

I'll pose a question to all of you who are young enough to know, but old enough to wonder - what do you think your own parents did when they discovered your Playboy, condoms, marijuana, unknown tablets bcps.......just because they didn't say anything, do you think they didn't know?

Please don't get offended - I don't assume everyone had any or all of these or are any of these necessarily "bad" - it all has to do with individual families sense of morality (& in the case of percocet - legality). But...how often could we circumvent unpleasant family situations & escalation if we as pharmacists gave parents tools in how to address the issues rather than confront???

Could that or should that be part of our job?

Certainly no one answer...but....is pushing it off to poison control the answer?? Perhaps.....

 

[WVUPharm2007]

I agree that it isn't a hippa violation. You are giving info about a drug product, not a specific patient.

 

[trinnieoh]

Thanks for the replies, all.

I see that everyone has a different approach to the situation. As a tech, I'd always refer the patients with tablet identification to the pharmacist. But, HIPAA aside, do you think you were violating that patient's (daughters) privacy? On a purely moral level, with no legal implications.

 

[Hibiclens]

I don't see the problem with telling people what a pill is...we are pharmacists and that is a reasonable question for people to ask us. I just am sure to cover myself i.e. "I have no way of knowing exactly what pill you have, but I can tell you Lipitor 20 (or whatever they ask) is an oblong pill with pd155 on it.

What is wrong with IDing a drug for people...in all seriousness I want to know if I should stop doing it.

 

[sdn1977]

I guess it would have to depend on who I'm advocating for. I can't tell from this post.

But....I've had a few of these circumstances and when it comes to a kid - and adolescent.....I'd rather not positively identify the drug for a couple of reasons (these are just my personal opinions only - you can make a completely valid argument for the multiple other positions someone can take.).

First, I'd want to give enough doubt as to what the tablet might be that it would make dad want to have a talk with his daughter about what medications she might be taking, how she gets her medications, how she transports her medications, what the implications might be if she's caught with her own, valid medications loose in a school environment or a car, etc...I'd want to him to have a "conversation" not a confrontation.

Second, I wouldn't want dad to get so angry that he'd fly off the handle & shut her off. That would make her just more secretive.

Finally, I'd encourage him to educate himself of all sorts of drugs of abuse among this age group. They abuse friend's legal drugs, otc drugs & illegal drugs. I'm just not sure confronting on this one tablet solves what may be a bigger issue. He's worried enough to make the call.

So....I guess, if I'm advocating for the pt who perhaps has mixed up his medications in one bottle & needs me to sort them out by identification - sure, I'd do it.

But, if I'm advocating for the child, I'd rather not definitively identify yet I'd have a lenghty & involved conversation about the things it could be & what dad's options & resources are...

So - no, I don't think its wrong.....but what more, what else do you have to offer??? Its "safe" to identify & let the rest happen because you'll never know & its also "safe" to shunt it to poison control. But...can we go outside "safe" and make a bit of a difference in drug abuse or even in the services pharmacists can offer to the community?

 

[golf299]

I'm not sure why you're assuming the worst in that the father will shut the daughter out and "fly off the handle". Perhaps that's how things were handled in your household growing up, but not everyone has the same experience.

I would hope that the father would approach the daughter rationally. He is, in fact, showing a caring side by being interested enough in his daughter's activities to call a pharmacy and find out what his daughter is taking. His daughter is his responsibility and he has the duty to protect her. If I was the father and a pharmacist tried to keep me from getting information as to what my daughter was ingesting, presumably illegally, I would be furious with that pharmacist. I'm not quite sure I understand what makes you think you have the right to deny a parent that information. I understand you're from CA, so that has something to do with it.

As to your last comment, I would not try to become a family counseler, as it seems that is what you're implying. It is not your job to direct how the father approaches the situation after he has the information he needs. You are your own moral compass, no one elses.

Now, if the father said, "I'm going to kill her if it's XYZ", then that's a different story.

 

[Hibiclens]

And again, I plead ignorant, but is that the reason many pharmacists won't ID pills for people...b/c of what the consequences may be (ex. violence). I mean, if thats the only reason thats fine, but I don't share that viewpoint. Will poison control ID drugs for people or do they deny them also??? I do agree with the above post though, I'd be furious at a pharmacist who denied me IDing a med.

 

[Sosumi]

Most people who ask me for a drug ID are junkies trying to confirm whether their Percocet is pure. I only ID if it's for a valid concern, such as the patient wants to make sure they received the right medication dispensed at our pharmacy or from a mail order pharmacy.

It's really an ethical decision, but anything that the technician or student does such as a drug ID using the pharmacy computer will have the pharmacist on duty liable. That's why those kinds of questions should be directed at the pharmacist, and technicians would be operating outside their scope by answering it.

 

[Farmercyst]

I'm not sure why you're assuming the worst in that the father will shut the daughter out and "fly off the handle". Perhaps that's how things were handled in your household growing up, but not everyone has the same experience.

I would hope that the father would approach the daughter rationally. He is, in fact, showing a caring side by being interested enough in his daughter's activities to call a pharmacy and find out what his daughter is taking. His daughter is his responsibility and he has the duty to protect her. If I was the father and a pharmacist tried to keep me from getting information as to what my daughter was ingesting, presumably illegally, I would be furious with that pharmacist. I'm not quite sure I understand what makes you think you have the right to deny a parent that information. I understand you're from CA, so that has something to do with it.

As to your last comment, I would not try to become a family counseler, as it seems that is what you're implying. It is not your job to direct how the father approaches the situation after he has the information he needs. You are your own moral compass, no one elses.

Now, if the father said, "I'm going to kill her if it's XYZ", then that's a different story.

The same mentality is used successfully to fight against parental notification of minors seeking abortion. (another controversial topic) I can see the validity of the "not every parent is an understanding/non-abusive parent" argument, but as you say I'd be furious if information was withheld in a situation that would arm a parent with correct information that would be very useful in terms of conversation/confrontation(non-abusive type). Though quite frankly I'm resourceful enough that I wouldn't ask a pharmacist. I'd just pull a PDR or other pill book or look on the web and self-ID.

 

[sdn1977]

Everyone here is so concerned about id'ing a drug....my 87yo mother can do that online on about 15 different websites!!!!

The point is - what is your purpose in educating about drug abuse & taking the opportunity presented????

No one seems to have any comments on how to proceed there - I've done it lots & lots. It sometimes is productive & sometimes not. But - again - what is your purpose as a pharmacist if the only answer you can get is one which is easily obtainable online???? (oh - btw....I had a very, very liberal upbringing & I was a teenager in the 70's with very easy going parents - a different time & place!).


That's why we ask - why retail?????? Can you even see yourself outside the box which has been built around you?

 

[aphistis]

btw....I had a very, very liberal upbringing & I was a teenager in the 70's with very easy going parents

I think this forms the crux of the question. You clearly turned out OK, but a lot of kids in that kind of situation end up in a lot of trouble.

Maybe it's just the backwards Midwestern hick in me, but there are times when teenagers need parental discipline more than they need to rap with a 50-year-old best friend. Finding diverted OxyContin in your daughter's backpack is one of those times.

 

[sdn1977]

I think this forms the crux of the question. You clearly turned out OK, but a lot of kids in that kind of situation end up in a lot of trouble.

Maybe it's just the backwards Midwestern hick in me, but there are times when teenagers need parental discipline more than they need to rap with a 50-year-old best friend. Finding diverted OxyContin in your daughter's backpack is one of those times.

Nope - this is the crux of this question for you as a PARENT - not for us as PHARMACISTS. One of our roles is education - not just identification or dispensing. Sorry, I don't see how talking openly with parents about drug abuse is "rapping" - but well - heh, I'm not in the midwest. Perhaps you don't talk openly about that stuff.

Let me put it to you in a "dental sense" since I've lived with that most of my life....

Lets take a pt you've seen for 2-3 years....she's had her wisdom teeth extracted as a teenager & had orthodontics in the 70's...now she has a lower second molar which needs a post & core & crown. Her molars are tipping forward & due to the "older" model of ortho done in those days, her teeth are migrating & tipping lingually. But, she's been doing well with her perio & she seems dedicated to maintaining her dental health since she's had insurance & has been seeing you.

Now...she's got some issues with her first molar & has already had a the second bicuspid pulled at some drill & fill & pull place a couple of years ago (prior to insurance).

She wants this one pulled too. But...you know if you pull that tooth - which you very might likely retain & it looks on x-ray that she might very well lose that first molar....wouldn't you want to be her educator & explain why she really needs to keep that tooth - to help support a bridge which might be down the road????

Well...our role is not just a lick & stick just as yours is not to drill, fill & pull. Sometimes, the best you can do for the pt is to educate them....give them some time to think it over....'cause once the tooth is gone, if she didn't want a p&c & crown she sure won't go for an implant. Likewise with us....we know - once Dad starts to yell, ground, rant - the daughter's behavior is unlikely to change (look up the studies on drug abuse & how well different approaches work) & she's much more likely to be secretive, her drug abuse will be more likely to escalate & her potential morbidities increase dramatically.

Bah - no changing midwestern attitudes toward "parental discipline" ... make it easy for yourself - go online & ID the drug yourself then you can rant all you want to your 16 yo & not involve any pharmacists who want to educate you. What do we know about drugs, drug abuse or being parents for that matter????🙄

Likewise...your pt may just go down the road to have the tooth pulled because you didn't want to take the time to educate?????

See......just because the pt wants something - that may not be what we give them - its our choice (some of us might say our responsibility,but I fear that is a small minority😳 ).

 

[golf299]

It is not your responsibility to educate the parent on how to parent. Perhaps you don't feel strict discipline would be necessary for a child abusing drugs, but that secular-progressive/ultra-liberal attitude is contributing to the moral decline of our society. Thankfully, you're still in the minority.

 

[sdn1977]

It is not your responsibility to educate the parent on how to parent. Perhaps you don't feel strict discipline would be necessary for a child abusing drugs, but that secular-progressive/ultra-liberal attitude is contributing to the moral decline of our society. Thankfully, you're still in the minority.

I might point out it IS your responsiblity to educate all persons who access your professional services on responsible drug use - this included, if you're a pharmacist.

But...go ahead - close your eyes - what you're promoting hasn't worked yet & still won't work.

Thankfully, it won't matter what mine or your morality is...the profession will require MTM so unless you're skilled enough to use it - you go check the robot, someone else with educational & clinical skills will interface with the patients (or their representatives).

 

[golf299]

I look forward to MTM, should widespread use ever occur. I'll be the first to implement it into my pharmacy. However, my practice will not include overstepping pharmaceutical information. How a parent decides to discipline their child is up to them.

It stings to know that there are people out there who would allow their child to knowingly continue self-abusive behavior. After all, they are "little adults" right? If 15 year old Susie wants to come home with a tatoo or experiment with drugs, that's fine by me; she's just expressing herself. 🙄