My first forged OxyContin script?

[Tenor CS]

This past weekend, I (a pharmacy tech) subbed at a very busy 24-hour store with a 24-hour pharmacy in a rough neighborhood right across the street from a hospital.

For reference, my home store is only moderately busy, in a luxury neighborhood surrounded by 3 golf resorts, so it was definitely a change of scenery for me.

They warned me that there were a lot of problems with addicts trying to get PSE products, and to be on the lookout for fake narcotic scripts.

2 hours into my shift, I got a script that just didn't look right.

It was for OxyContin (spelled correctly, at least)
But the home address of the patient was over 2 hours away
Disp #240 (written out as Two Four Zero, not Two Hundred Forty)
Sig Take 1T PO q1-2h prn pain

I looked at it and thought, "riiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiight"

Obviously, the RPh had me get rid of her.

Now, I know this question is maybe impossible to answer, because the best answer is "the lowest effective dose."

But, what IS a "reasonable" disp # and sig for OxyContin?

I was thinking maybe 60-90 would be a month's supply, if the dosing is BID or TID.

The people who sound strung out who call the pharmacy always want to know if we have 180 or 210 in stock. Isn't that an awful lot?

(Please bear in mind, I am a very new tech, only about 2 months of experience. And I don't work again until Friday, so I can't ask my RPh until then).

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[lobelsteve]

Oxycontin 20-80mg bid or tid.
Anything else should prompt you to call the MD.

 

[olafa]

I have seen q6 hr commonly in residency training and sometimes q4 - which would put disp: #180
The bigger tip off is more the way 2-4-0 is written. If you are at a location consistently you can get an idea of the prescribing patterns of certain physicians and anything extraordinary should be a tip off. Best to err on the side of caution, contacting the physician to clarify. I am sure they would grateful to not have someone forging one of their scripts.

This past weekend, I (a pharmacy tech) subbed at a very busy 24-hour store with a 24-hour pharmacy in a rough neighborhood right across the street from a hospital.

For reference, my home store is only moderately busy, in a luxury neighborhood surrounded by 3 golf resorts, so it was definitely a change of scenery for me.

They warned me that there were a lot of problems with addicts trying to get PSE products, and to be on the lookout for fake narcotic scripts.

2 hours into my shift, I got a script that just didn't look right.

It was for OxyContin (spelled correctly, at least)
But the home address of the patient was over 2 hours away
Disp #240 (written out as Two Four Zero, not Two Hundred Forty)
Sig Take 1T PO q1-2h prn pain

I looked at it and thought, "riiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiight"

Obviously, the RPh had me get rid of her.

Now, I know this question is maybe impossible to answer, because the best answer is "the lowest effective dose."

But, what IS a "reasonable" disp # and sig for OxyContin?

I was thinking maybe 60-90 would be a month's supply, if the dosing is BID or TID.

The people who sound strung out who call the pharmacy always want to know if we have 180 or 210 in stock. Isn't that an awful lot?

(Please bear in mind, I am a very new tech, only about 2 months of experience. And I don't work again until Friday, so I can't ask my RPh until then).

 

[jsaul]

Oxycontin 20-80mg bid or tid.
Anything else should prompt you to call the MD.

agree with steve

 

[powermd]

It was for OxyContin (spelled correctly, at least)
But the home address of the patient was over 2 hours away
Disp #240 (written out as Two Four Zero, not Two Hundred Forty)
Sig Take 1T PO q1-2h prn pain

"I don't know whut tuh say doc. That's what works for me."

 

[lobelsteve]

Writing it q6h or q4h in Georgia will get you a visit from the Medical Board.
Trust me.

 

[olafa]

Writing it q6h or q4h in Georgia will get you a visit from the Medical Board.
Trust me.

Yeah- I certainly wasn't fan of it either, but that's how that particular attending practiced and I was just a resident. I don't plan to practice that way either. His theory was that "every metabolizes drugs differently and and that if titratted up to get the max benefit with minimal side effects"... yeah no wonder people would travel- wasn't like he was doing something miraculous. The good thing about residency is that you learn what you want to incorporate or not into your practice- and in this case NOT.

 

[lobelsteve]

Yeah- I certainly wasn't fan of it either, but that's how that particular attending practiced and I was just a resident. I don't plan to practice that way either. His theory was that "every metabolizes drugs differently and and that if titratted up to get the max benefit with minimal side effects"... yeah no wonder people would travel- wasn't like he was doing something miraculous. The good thing about residency is that you learn what you want to incorporate or not into your practice- and in this case NOT.

Just to re-iterate: your former attending was an idiot and was in violation of the medical practice act of your state. Making a 12hr medication q8h is reasonable based on an AUC, but then making that same medication q4h because some people are rapid metabolizers is BS and bad practice. Let's hope he is not doing it any longer...and especially not in my state.


And who the heck am I to be saying stuff like this anyhow?


Please don't find out.

 

[PMR 4 MSK]

QID - should be extremely rare. Maybe a cancer pt.
BID-TID common.

Anything over 80 mg/dose needs very close scrutiny, IMHO.

 

[deleted185747]

I hope you kept the script.

 

[Tenor CS]

I hope you kept the script.

In my home store, we probably would. But I've never had such a blatantly forged script in my home store.

In this store, where I was subbing, their mindset was more, "Don't create a scene, just deny them the medicine and send them away."

Their meth-head problem is so bad that they don't even keep the Sudafed visible on the shelf behind the pharmacy counter. They keep it hidden in a drawer. When someone approaches wanting to buy Sudafed, it is the tech or RPh's call to allow/deny the purchase. People who have that "meth look" are denied.

Very hard to quantify, and I don't even know how legal that is.

 

[olafa]

From what I understand some states require copy of ID prior to purchase- and record of purchase also. Takes the guess work out -

If you suspect a prescription is forged, isn't it the responsibility of the pharmacist to NOT return it to the patient. Sounds irresponsible esp if you know/think is been altered to return it. Just my opinion, but sure others share it too. Correct me if I am wrong.

In my home store, we probably would. But I've never had such a blatantly forged script in my home store.

In this store, where I was subbing, their mindset was more, "Don't create a scene, just deny them the medicine and send them away."

Their meth-head problem is so bad that they don't even keep the Sudafed visible on the shelf behind the pharmacy counter. They keep it hidden in a drawer. When someone approaches wanting to buy Sudafed, it is the tech or RPh's call to allow/deny the purchase. People who have that "meth look" are denied.

Very hard to quantify, and I don't even know how legal that is.

 

[Tenesma]

there was an interesting presentation at ASIPP by DEA guy ... he mentioned that a Northwestern state (i can't remember if it is Oregon or Washington - i think it is Oregon) made pseudo-ephedrine products a controlled substance... since making that change they saw a drop from 400-500 busted meth labs per year to something ridiculous like 3-5 meth labs busted per year... and significant decrease in meth use... i am guesstimating the numbers but it gives you an idea...

 

[Tenor CS]

there was an interesting presentation at ASIPP by DEA guy ... he mentioned that a Northwestern state (i can't remember if it is Oregon or Washington - i think it is Oregon) made pseudo-ephedrine products a controlled substance... since making that change they saw a drop from 400-500 busted meth labs per year to something ridiculous like 3-5 meth labs busted per year... and significant decrease in meth use... i am guesstimating the numbers but it gives you an idea...

Interesting. I wonder if the meth users:

a. quit
b. moved away
c. switched to another drug

If they quit, it would be awesome.

 

[Tenesma]

i bet they get supplied by the meth labs in neighboring states and have to pay higher prices...