Norco Nightmare, or Victory for Tylenol #3

Started by BeLikeBueller
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BeLikeBueller

BeLikeBueller

Doctor of Comic Relief
10+ Year Member
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I didn't see another thread discussing this - I'm sure I just overlooked it (sorry 😢), but what are you guys doing in the community setting with regards to Hydrocodone/APAP going C-II?

Are you buying more cabinets to keep it locked up, or keeping it with the regular stock?

Are you letting techs continue to count it, or are you going to have pharmacists count?

I can just imagine the logging nightmares that this is going to create, back-counting 1,000 count bottles, and of course, explaining to patients that there are no refills left, even though the bottle says "two refills remaining"...sounds like fun! :scared:

P.S. My conspiracy theory is that tylenol #3 lobbied this through to regain market share :laugh:

Anyways, sorry if this is a repost, I just wanted to see what folks were doing to prepare for the impending... :boom:
 
BeLikeBueller said:
I didn't see another thread discussing this - I'm sure I just overlooked it (sorry 😢), but what are you guys doing in the community setting with regards to Hydrocodone/APAP going C-II?

Are you buying more cabinets to keep it locked up, or keeping it with the regular stock?

Are you letting techs continue to count it, or are you going to have pharmacists count?

I can just imagine the logging nightmares that this is going to create, back-counting 1,000 count bottles, and of course, explaining to patients that there are no refills left, even though the bottle says "two refills remaining"...sounds like fun! :scared:

P.S. My conspiracy theory is that tylenol #3 lobbied this through to regain market share :laugh:

Anyways, sorry if this is a repost, I just wanted to see what folks were doing to prepare for the impending... :boom:
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this makes me glad I am in a hospital - and FYI - Tylenol #3 is only slightly better than darvocet - and you know where that is now
 
Dred Pirate said:
this makes me glad I am in a hospital - and FYI - Tylenol #3 is only slightly better than darvocet - and you know where that is now
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Depends on how rapidly you metabolize it to morphine. May not work at all, may be VERY effective.
 
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zelman said:
Depends on how rapidly you metabolize it to morphine. May not work at all, may be VERY effective.
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hence my point - although I should have made a better statement - that t#3 sucks - not that it is only slightly better
 
Been a CII over a year for NY. It's not all that bad, although we switched to getting 100 count bottles instead of 1000s for the backcounting purposes. Logging all of the Tussionex is a pain though.
 
I noticed that Tylenol #3 was on backorder the other day. I wonder if that had to do with the hydrocodone news?

CYP2D6 polymorphisms were discussed above and it is a very relevant point. Also, what about the large # of opioid users that have codeine in their allergy list due to extreme nausea? It seems that oxycodone and hydrocodone are much better tolerated by many chronic opioid users.
 
Ackj said:
Been a CII over a year for NY. It's not all that bad, although we switched to getting 100 count bottles instead of 1000s for the backcounting purposes. Logging all of the Tussionex is a pain though.
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What doctor is going to write for a C2 cough suppressant?
 
We had a massage from corporate that DEA is going to honor all those refills on hydrocodone which was authorized before Oct....


*****Prescriptions. All prescriptions for HCPs must comply with 21 U.S.C. 829(a) and must be issued in accordance with 21 CFR part 1306 and subpart C of 21 CFR part 1311 as of October 6, 2014. No prescription for HCPs issued on or after October 6, 2014 shall authorize any refills. Any prescriptions for HCPs that are issued before October 6, 2014, and authorized for refilling, may be dispensed in accordance with 21 CFR 1306.22-1306.23, 1306.25, and 1306.27, if such dispensing occurs before April 8, 2015*****
 
There was just an article that came out a few months back that talked about a study that assessed hydrocodone and codeine. Said there was no difference in efficacy between the two. So maybe your conspiracy theory is correct? 🤣
 
I thought codeine was the most nauseating of them all. I wonder how many new codeine allergies we'll see. I've never seen Tylenol #4 at any of the retail places I've been at. I'm assuming it's just 60mg codeine...
 
We are gonna back count the big bottled upon first opening then triple count every script so we don't have to back count every time.

Sent from my HTC One_M8 using Tapatalk
 
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owlegrad said:
OMG who would report one pill? Why would you suspect diversion with one?
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Even 10, as a one time thing, I'm not thinking that somebody stole them. It would have to be a pattern of missing pills for me to question such a small discrepancy.
 
Ackj said:
Even 10, as a one time thing, I'm not thinking that somebody stole them. It would have to be a pattern of missing pills for me to question such a small discrepancy.
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Back in my retail days - 3 of our 4 fastest movers were C2's, when I worked overnight- (we did a complete inventory every week because we were bored) usually one or two items may be off a pill or two - I kept a log of what was missing and emailed it to my manager - over time it adds up, but one or two every couple weeks is not diversion, it is miscounting. We never reported any
 
Ackj said:
"significant loss"

What that means is up to interpretation, but personally, I don't think 1-2 tabs would be.
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My understanding is that reporting is required for a significant amount OR any amount when diversion is suspected.
 
I can tell from my personal experience, one time we shorted 30 pills of one the C2 and all we did was report to our internal system, filled out one page form (Name of drug, NDC , no. tab and etc) and put it in Control box with other Control drug invoices and inventory records. According to my supervisor any thing less than 30 pills is not significant to report to DEA unless of course its happening in pattern.
 
brianuseruser said:
We are gonna back count the big bottled upon first opening then triple count every script so we don't have to back count every time.

Sent from my HTC One_M8 using Tapatalk
Click to expand...


The thing that worries me about this is that you wouldn't be able to tell if there was a miscount (or, heaven forbid, diversion...) until you got down towards the end of the bottle. I was thinking about recommending that my store split out the 1,000 count bottles into 10 x 100 count, so that it would be manageable to back-count & keep a good, up-to-date inventory.

Obviously that's still a pain too, though. Hopefully we'll just start ordering 100 count bottles. Time will tell...
 
owlegrad said:
But what would cause you to suspect diversion for one pill? Obviously if you suspected diversion you would report it but I wouldn't immediately jump to that conclusion.
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Two tablets go missing. One is found underneath the technicians' lab coats in the break room.
 
zelman said:
Two tablets go missing. One is found underneath the technicians' lab coats in the break room.
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true - but a true addict/drug seller, is going to likely steal more than 2 tabs at a time - and FYI -and why you picking on a tech! (jK) from my experience, I see more diversion from RPh's than techs
 
Dred Pirate said:
true - but a true addict/drug seller, is going to likely steal more than 2 tabs at a time - and FYI -and why you picking on a tech! (jK) from my experience, I see more diversion from RPh's than techs
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addicts can be found anywhere, but I've seen far more techs get fired for stealing, then I have seen pharmacists or nurses get fired for stealing. The thing is, if an addict wants to get a job working with drugs, an easy way to do that is get a job as a pharmacy technician--I think that is why more techs tend to get fired for stealing, some of these people had their addictions pre-job and specifically looked to get a job that would give them access to drugs.
 
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Dred Pirate said:
true - but a true addict/drug seller, is going to likely steal more than 2 tabs at a time - and FYI -and why you picking on a tech! (jK) from my experience, I see more diversion from RPh's than techs
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It's a slight variation on an actual occurrence.
 
MountainPharmD said:
I'm counting the days until October! I can't wait! Patients will no longer have a need to call the pharmacy every 20 minutes all day long asking if the doctor authorized their Norco refill.
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Yeah, now you just have to deal with filling 10 profiled "C-II's" within five minutes of opening the doors, because your norco patients will be waiting at the door, screaming, "You told me it would be today! Why isn't it ready?!? You said it would be ready today!!!" That sounds much better... 😉
 
MountainPharmD said:
I'm counting the days until October! I can't wait! Patients will no longer have a need to call the pharmacy every 20 minutes all day long asking if the doctor authorized their Norco refill.
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"Did it come in the mail yet? " "Did it come in the mail yet? " "Did it come in the mail yet? " What's the difference?
 
Ackj said:
"Did it come in the mail yet? " "Did it come in the mail yet? " "Did it come in the mail yet? " What's the difference?
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I wonder how pharmacies will react toward direct mail prescriptions (non-mail order). We would previously not accept mailed Rxs except as a response to a emergency fill. They had to be mailed to the patient and then brought to us.

Anyone already regularly accept prescriptions in the mail that doesnt work for mail-order?
 
KidPharmD said:
I wonder how pharmacies will react toward direct mail prescriptions (non-mail order). We would previously not accept mailed Rxs except as a response to a emergency fill. They had to be mailed to the patient and then brought to us.

Anyone already regularly accept prescriptions in the mail that doesnt work for mail-order?
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I didn't know that everybody didn't accept them. We always have, but maybe that's because of how strictly NY operates. Have needed to get a new written RX every month for benzos for a long time, so some offices will put them in the mail rather than have the patient come pick them up every month. The practice isn't limited to those, however, we get all sorts of "maintenance" controls mailed in.
 
I have no issues with mailed in C-2 rx as long as it looks legit. I already have some come in like that. I don't like holding C-2 rx because it causes a lot of problems.
 
I don't think Tylenol # 3 or 4 will be the "hot" drug- I think it will now be tramadol.
 
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