Opiod abuse

[labcoatguy]

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I'm rather new at retail so I would appreciate some advice. What do you do when a patient claims his oxycodone was "lost" and wants his fill 10 days early? I know you shouldn't but when they're very aggressive and the manager takes their side, what should you do?

 

[FlavyFlav]

I'm rather new at retail so I would appreciate some advice. What do you do when a patient claims his oxycodone was "lost" and wants his fill 10 days early? I know you shouldn't but when they're very aggressive and the manager takes their side, what should you do?

You say you will have to contact the doctor, inform them of the problem, and obtain permission from them to fill the C-II drug. If the doctor approves, then you will still need a new prescription written from the doctor. Normally, most doctors won't approve an early fill of a C-II when you put the responsibility on them and this should solve your problem.

You can also check the drug database for your state (if you have one) and get a better idea of this patient's refill history and trends. The pharmacy I work for would be very concerned about filling any C-II early and probably still would not fill it even with doctor authorization and a new script. It's is never your responsibility or problem if a patient 'loses' their medicine.

Saying that, no manager strong arm should ever come into the equation unless they want to take full responsibility for possibly divergent activity. Seeing as they don't have the license on the line, they are not at liberty to make the pharmacist do this, and if it gets bad then the incident should be documented, witnessed and reported to your supervisor. There is a massive crackdown of controlled medications by the DEA and your license is not worth giving in to manipulative patients or managers.

This is how I would handle the situation, and how I've seen it handled by my pharmacists, and I'm in Florida (oxycodone central).

 

[zelman]

Exactly. Make it the prescriber's call and document it. In the states where I practice pharmacists are responsible for preventing early fills otherwise.

 

[All4MyDaughter]

You say you will have to contact the doctor, inform them of the problem, and obtain permission from them to fill the C-II drug. If the doctor approves, then you will still need a new prescription written from the doctor. Normally, most doctors won't approve an early fill of a C-II when you put the responsibility on them and this should solve your problem.

I would assume that the patient has already presented a new script from the doctor, since there are no refills on C-IIs, lost or not.

 

[Unchained]

Refuse to fill the script. Call your DM and have him explain to the stuck in the 80's store mgr that there laws and licenses involved. The patient can go to another pharmacy.

 

[All4MyDaughter]

Refuse to fill the script. Call your DM and have him explain to the stuck in the 80's store mgr that there laws and licenses involved. The patient can go to another pharmacy.

Really? You wouldn't do it under any circumstance?

 

[BidingMyTime]

It is totally NOT the store manager's call. Use your judgement, I would contact the physician, and if they are aware of the early refill (don't assume they are just, because they wrote a new RX), then I would document that the physician is aware of the early refill, and why the RX is being refilled early. If the pt says the RX was stolen, then document the police report # (many insurances will want this if doing a refill too soon override for a stolen med anyway.) If the pt loses their medicines every month, that's a different situation--if the store manager is pressuring you, just tell him no and that the pt can come back and talk to your pharmacy manager (hopefully your pharmacy manager would back you up with the store manage) If you are the pharmacy manager, and the store manager is pressuring you, than I would talk with your district pharmacy manager about this situation.

Refuse to fill the script. Call your DM and have him explain to the stuck in the 80's store mgr that there laws and licenses involved. The patient can go to another pharmacy.

Yes, the pt can always go to another pharmacy. But people do honestly lose RX's or get them stolen, and if based on the pt's history there is no reason to suspect they are lying, and you've documented your conversation with the dr, then there is no reason not to fill the RX. People who are on high doses of opoids are going to end up in the ER from withdrawal--they have a legitimate medical need to get an early refill, provided their is no reason to suspect diversion or other misuse.

 

[rxlea]

Really? You wouldn't do it under any circumstance?

Don't you know? Every patient coming in for opioids drives an Escalade. They can just go somewhere else.

 

[Angela1234]

Did you take my old job? What you are saying sounds very familiar of where I used to have to work with a company that makes you work 14 + hours with no breaks. I would refuse to fill it if you don't feel comfortable, and don't let anyone tell you otherwise. And they only gve you the prescription at night when the doctor's office isn't open. Some night I would go home upset and my stomach would hurt me from days from how nasty people were. It's your license, not the manager's. Remember you have the right to refuse to fill any prescription you want. You can always get another job.

 

[SpecterGT260]

I'm rather new at retail so I would appreciate some advice. What do you do when a patient claims his oxycodone was "lost" and wants his fill 10 days early? I know you shouldn't but when they're very aggressive and the manager takes their side, what should you do?

The hydrophilic drugs?

Like others said, put the heat on the doc. Ask him if he is ok w it and its no longer your problem

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[All4MyDaughter]

It is totally NOT the store manager's call. Use your judgement, I would contact the physician, and if they are aware of the early refill (don't assume they are just, because they wrote a new RX), then I would document that the physician is aware of the early refill, and why the RX is being refilled early. If the pt says the RX was stolen, then document the police report # (many insurances will want this if doing a refill too soon override for a stolen med anyway.) If the pt loses their medicines every month, that's a different situation--if the store manager is pressuring you, just tell him no and that the pt can come back and talk to your pharmacy manager (hopefully your pharmacy manager would back you up with the store manage) If you are the pharmacy manager, and the store manager is pressuring you, than I would talk with your district pharmacy manager about this situation.

Yes, the pt can always go to another pharmacy. But people do honestly lose RX's or get them stolen, and if based on the pt's history there is no reason to suspect they are lying, and you've documented your conversation with the dr, then there is no reason not to fill the RX. People who are on high doses of opoids are going to end up in the ER from withdrawal--they have a legitimate medical need to get an early refill, provided their is no reason to suspect diversion or other misuse.

👍👍

 

[SpecterGT260]

....Uhhh, "take my old job"?? This is the same scene at a greater majority of pharmacies, so you definitely are not alone. Today alone I had 3 customer complaints (not just "hey I need a refill and PS, your store sucks", but simply just phone calls of "hey your store sucks"), the last one of which ended with me (what I would consider) yelling and telling the customer to never call again after he began swearing and using racist remarks when talking about my technicians. It's an every day thing.

To answer the original question, if it's a first time offender and there have been no previous issues with this customer, I'd take the aforementioned steps (contact MD, document on hard copy, dispense) and I'd add a note to the customer's file summarizing, just in case they decide to "lose" it again. In that case, sorry 'bout ya.

How does this play out? Now that I think of it I am not aware of any laws or mandates that compel pharmacists to serve any particular person (comparing to the laws that require physicians to perform services in emergency situations, for example). Are you guys able to turn someone away in a "we reserve the right to refuse" sort of situation?

 

[zelman]

How does this play out? Now that I think of it I am not aware of any laws or mandates that compel pharmacists to serve any particular person (comparing to the laws that require physicians to perform services in emergency situations, for example). Are you guys able to turn someone away in a "we reserve the right to refuse" sort of situation?

As long as there is a legit documented reason. You can refuse to let shoplifters into the pharmacy, but not people of a particular race.

 

[Unchained]

Really? You wouldn't do it under any circumstance?

I work in a high crime city environment. People try to scam me daily whether it be nurses on the take, crooked docs etc.... The particular area I practice in leaves me in no position to give people the benefit of the doubt. I don't like practicing like this but I can't fool myself.

 

[SpecterGT260]

As long as there is a legit documented reason. You can refuse to let shoplifters into the pharmacy, but not people of a particular race.

well yes, obviously. I didn't mean to imply any prejudiced reasons. I was more trying to get at treatment of the pharmacy as a private business. Can you refuse to serve someone who is a pain in the ass? If a physician were to do this in some situations he may receive disciplinary action from his or her state's licensing board. I didn't know if it was as simple as "my shop my rules" for pharmacists or if there are potentially consequences to firing a patient like this.

 

[SpecterGT260]

Really? You wouldn't do it under any circumstance?

I don't think it is that unreasonable with sch. II drugs. I think it depends on your state. I believe where I live a pharmacist is barred by law from filling scripts too frequently. In other situations I wouldn't think it is that unreasonable to tell the pt to go back to the GP for a new script and cancel the old if they need meds immediately. This can sometimes be done walk-in or via phone consult with the doc, I believe (but then again some pharmacies or laws are making that tough and require a physical piece of paper for opioid scripts). What are the drug dynamics here? Would it be reasonable to do a quick urine test to see if they are stoned out of their minds while claiming their pills are missing?

 

[All4MyDaughter]

I don't think it is that unreasonable with sch. II drugs. I think it depends on your state. I believe where I live a pharmacist is barred by law from filling scripts too frequently. In other situations I wouldn't think it is that unreasonable to tell the pt to go back to the GP for a new script and cancel the old if they need meds immediately. This can sometimes be done walk-in or via phone consult with the doc, I believe (but then again some pharmacies or laws are making that tough and require a physical piece of paper for opioid scripts). What are the drug dynamics here? Would it be reasonable to do a quick urine test to see if they are stoned out of their minds while claiming their pills are missing?

There is no old script to cancel. C-II scripts are valid only once with no refills. In this scenario, it's likely that the patient is already presenting a new script from his physician. The law already requires hard copy scripts for C-II medications (though not all opioids).

 

[SpecterGT260]

There is no old script to cancel. C-II scripts are valid only once with no refills. In this scenario, it's likely that the patient is already presenting a new script from his physician. The law already requires hard copy scripts for C-II medications (though not all opioids).

Is that federal or state?
I ask because I am aware of some controlled substances that will be written out at once time with more than 1 script and post dated or marked "do not fill before ____". Here the pharmacy will hold all scripts that were issued and will fill them at the specified dates. But my overall point was that if this was similar to the situation for the OP it wouldnt be unreasonable to ask them to go get a new script from the doc to replace the one being held (either by the pharmacy or by the patient himself). But if the script was issued by the same doc within the last couple days I wouldn't have any issues filling it barring some federal or state law prohibiting it.

 

[All4MyDaughter]

Is that federal or state?
I ask because I am aware of some controlled substances that will be written out at once time with more than 1 script and post dated or marked "do not fill before ____". Here the pharmacy will hold all scripts that were issued and will fill them at the specified dates. But my overall point was that if this was similar to the situation for the OP it wouldn't be unreasonable to ask them to go get a new script from the doc to replace the one being held (either by the pharmacy or by the patient himself). But if the script was issued by the same doc within the last couple days I wouldn't have any issues filling it barring some federal or state law prohibiting it.

Federal.

Yes, the doctor can issue up to 90 days of sequential prescriptions for C-II medications with "do not fill before" on the 2nd and 3rd script. Each must be on a different prescription blank and is treated like a new RX. If the patient lost the medication from script #1 and the pharmacy is holding script #2, why require the patient to go to the doctor and get a new script? Just call the doctor and verify that it's OK to fill script #2 early.

 

[SpecterGT260]

Federal.

Yes, the doctor can issue up to 90 days of sequential prescriptions for C-II medications with "do not fill before" on the 2nd and 3rd script. Each must be on a different prescription blank and is treated like a new RX. If the patient lost the medication from script #1 and the pharmacy is holding script #2, why require the patient to go to the doctor and get a new script? Just call the doctor and verify that it's OK to fill script #2 early.

Right. I thought we were in agreement there. I was under the impression you were asking the other poster if he or she would ever consider just filling it.

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[All4MyDaughter]

Right. I thought we were in agreement there. I was under the impression you were asking the other poster if he or she would ever consider just filling it.

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Nope. Not what I said at all.

 

[SpecterGT260]

Really? You wouldn't do it under any circumstance?

then I misunderstood

 

[zelman]

Federal.

Yes, the doctor can issue up to 90 days of sequential prescriptions for C-II medications with "do not fill before" on the 2nd and 3rd script. Each must be on a different prescription blank and is treated like a new RX. If the patient lost the medication from script #1 and the pharmacy is holding script #2, why require the patient to go to the doctor and get a new script? Just call the doctor and verify that it's OK to fill script #2 early.

You would be changing the date on a prescription. Not allowed where I practice(d).

 

[All4MyDaughter]

You would be changing the date on a prescription. Not allowed where I practice(d).

Not true. The multiple C-II prescriptions all have to be dated with the date they were written (so they all have the same date on them). You would not need to change the date in order to fill script #2 or #3 early. You'd just cross out the "Do not fill until XX-XX-XXXX" and document who gave you permission for the early fill (prescriber or his/her agent).

EDIT: Here's a source that should help - http://www.deadiversion.usdoj.gov/faq/mult_rx_faq.htm All RXs written under this rule must have the same date and post-dating is NOT allowed.

 

[Digsbe]

Contact the physician's office, let them know about the situation. Document everything if the physician approves and use your professional judgement if you feel that the medication is being abused and deny to fill in that scenario.

Some pharmacists are naive and some physicians are naive. Do what is comfortable and legal under your professional judgement.

If the patient was one of my regulars and this was a one time occurrence I would fill it early after alerting the physician and having them agree with me on an early fill. If it was someone who did this constantly (which in most cases is what happens) or is a first time patient wanting something filled early I probably wouldn't do it unless there were extreme circumstances (like the patient is from out of town and will go through withdrawal).

If I ever work retail or become a pharmacy manager I probably wouldn't even stock methadone and suboxone, from my experience these are the drugs that cause the most early fill problems compared to the other usual culprits.

 

[zelman]

Not true. The multiple C-II prescriptions all have to be dated with the date they were written (so they all have the same date on them). You would not need to change the date in order to fill script #2 or #3 early. You'd just cross out the "Do not fill until XX-XX-XXXX" and document who gave you permission for the early fill (prescriber or his/her agent).

EDIT: Here's a source that should help - http://www.deadiversion.usdoj.gov/faq/mult_rx_faq.htm All RXs written under this rule must have the same date and post-dating is NOT allowed.

Not not true. In MA, we treat the "Do not fill before" date as the date written for expiration purposes. Date written cannot be changed. In NY, this federal law does not apply at all. That's why I prefaced with "where I practice(d)". In your state, maybe you can do it.

 

[Carboxide]

Not not true. In MA, we treat the "Do not fill before" date as the date written for expiration purposes. Date written cannot be changed. In NY, this federal law does not apply at all. That's why I prefaced with "where I practice(d)". In your state, maybe you can do it.

That makes no sense. With that logic, you could write a year's supply of CII rxs (or more!) with Do not Fill dates for every month...and they are all valid, even the ones that are 12 months away!

 

[WVUPharm2007]

I'm rather new at retail so I would appreciate some advice. What do you do when a patient claims his oxycodone was "lost" and wants his fill 10 days early? I know you shouldn't but when they're very aggressive and the manager takes their side, what should you do?

By manager, do you mean the front store manager? If so, I'd tell the manager to piss off and go stack up a Coke display. Then I'd tell the patient its too soon.

 

[WVUPharm2007]

I work in a high crime city environment. People try to scam me daily whether it be nurses on the take, crooked docs etc.... The particular area I practice in leaves me in no position to give people the benefit of the doubt. I don't like practicing like this but I can't fool myself.

YUP.

I don't play, either. I would personally demand a police report be filed, the physician notified, I would require the physician to tell me how often this has happened, and THEN, if all that checks out, I might do it. And it would be one time thing. Maybe like once every 5 years or something.

 

[zelman]

That makes no sense. With that logic, you could write a year's supply of CII rxs (or more!) with Do not Fill dates for every month...and they are all valid, even the ones that are 12 months away!

Find me a pharmacy law professional who claims that pharmacy laws all make sense.

And, prescribers still have the same 90 day restriction as outlined by federal law. But if they write three 30-day Rx's on 1/1/14 dated 1/1/14 with instructions "Do not fill before 1/1/14" and "Do not fill before 1/31/14" and "Do not fill before 3/2/14" and the patient brings you the second prescription on 3/15/15 it cannot be filled because it is over 30 days "old" (older than the do not fill before date). Just because the patient could have received a valid prescription when they saw the prescriber, does not mean you can change the date on the prescription to make it so.

 

[Carboxide]

Find me a pharmacy law professional who claims that pharmacy laws all make sense.

And, prescribers still have the same 90 day restriction as outlined by federal law. But if they write three 30-day Rx's on 1/1/14 dated 1/1/14 with instructions "Do not fill before 1/1/14" and "Do not fill before 1/31/14" and "Do not fill before 3/2/14" and the patient brings you the second prescription on 3/15/15 it cannot be filled because it is over 30 days "old" (older than the do not fill before date). Just because the patient could have received a valid prescription when they saw the prescriber, does not mean you can change the date on the prescription to make it so.

Federal law says that the CII Rx is good for 90 days from date it was written, not 30...is your state different?

The date in the sig is NOT the date it was written. It is part of the sig. Directions may be changed on a CII according to the discretion of the pharmacist and at the direction of the physician.

 

[owlegrad]

Federal law says that the CII Rx is good for 90 days from date it was written, not 30...is your state different?

Really? I need to brush up on my federal law.

 

[All4MyDaughter]

Really? I need to brush up on my federal law.

No.

 

[owlegrad]

No.

Something on the internet is not true?! 😱

 

[Sparda29]

What's with these damn store managers thinking they have any power over the pharmacist?

 

[WVUPharm2007]

What's with these damn store managers thinking they have any power over the pharmacist?

I know. If the front store people where I work even tried to display power over me, I would probably just laugh at the dude.

 

[Sparda29]

I know. If the front store people where I work even tried to display power over me, I would probably just laugh at the dude.

Yeah man, when I was an intern the store manager would try to write me up for wearing jeans, or not scanning CVS cards, I'd just tell him to take it up with the pharmacist.

 

[Carboxide]

Really? I need to brush up on my federal law.

Oops. Guess that must be state by state. Keeping state vs fed laws apart is kind of hard... 😳

 

[owlegrad]

Yeah man, when I was an intern the store manager would try to write me up for wearing jeans, or not scanning CVS cards, I'd just tell him to take it up with the pharmacist.

Dress code violations are no where near the same category as filling narcotics early. But I think you know that. 😉

 

[owlegrad]

Oops. Guess that must be state by state. Keeping state vs fed laws apart is kind of hard... 😳

No worries friend! Believe me, with MPJE staring me down....I feel your pain!

 

[zelman]

Federal law says that the CII Rx is good for 90 days from date it was written, not 30...is your state different?

The date in the sig is NOT the date it was written. It is part of the sig. Directions may be changed on a CII according to the discretion of the pharmacist and at the direction of the physician.

My state(s) give 30 days only. If we didn't treat the Sig as the date written, this multiple rx 90 day scenario wouldn't work. And NY doesn't allow it at all.

 

[Sparda29]

Dress code violations are no where near the same category as filling narcotics early. But I think you know that. 😉

Yeah, they aren't the same. IMO, a pharmacy intern outranks a store manager.

 

[owlegrad]

Yeah, they aren't the same. IMO, a pharmacy intern outranks a store manager.

Well you can believe whatever you want, but I don't see a problem with him telling you not to wear jeans. This is pretty hypocritical of me to say though - I am out of dress code basically every time I go into work.

 

[Ackj]

My state(s) give 30 days only. If we didn't treat the Sig as the date written, this multiple rx 90 day scenario wouldn't work. And NY doesn't allow it at all.

Yeah, Federally you can't post date, and NY gives 30 days from written date. That combination means you can't do multiple RX to reach beyond a 30 day supply.

Q. How is the issuance of multiple schedule II prescriptions different than issuing a refill of a schedule II prescription? A. It isn't, we're giving a BS answer here and dodging your question.

The difference is, we allow this, but not that. That's the difference, duh.

 

[Carboxide]

Is that federal or state?
I ask because I am aware of some controlled substances that will be written out at once time with more than 1 script and post dated or marked "do not fill before ____". Here the pharmacy will hold all scripts that were issued and will fill them at the specified dates. But my overall point was that if this was similar to the situation for the OP it wouldnt be unreasonable to ask them to go get a new script from the doc to replace the one being held (either by the pharmacy or by the patient himself). But if the script was issued by the same doc within the last couple days I wouldn't have any issues filling it barring some federal or state law prohibiting it.

With the number of pill mill docs, it is not always down to "does the doc say it is okay?"

I guess what I would do is run a report (if your state has it) of the electronic dispensing of all controls for this patient. See if he's been with one doc/one clinic (ours says address of the office, I think) and if he's been regularly filling early. If you go back six months/a year and see that he fills on time or one or two days before he is out, and he doesn't have an extra 15 days that he should have at home BESIDES his lost Rx, then I'd fill it. Once. After talking to the doc. And make a note in his profile that he's gotten it once already.

Some patients are always filling right when insurance allows it...30 day supply, fill at 26 days...fill the next at 26 days...fill the next at 26 days...all the sudden they are 12 days up.

PS: RPhs don't have authority to order a drug test, Spector, so it would have to be by the doc and he almost certainly wouldn't do that.

 

[SpecterGT260]

With the number of pill mill docs, it is not always down to "does the doc say it is okay?"

I guess what I would do is run a report (if your state has it) of the electronic dispensing of all controls for this patient. See if he's been with one doc/one clinic (ours says address of the office, I think) and if he's been regularly filling early. If you go back six months/a year and see that he fills on time or one or two days before he is out, and he doesn't have an extra 15 days that he should have at home BESIDES his lost Rx, then I'd fill it. Once. After talking to the doc. And make a note in his profile that he's gotten it once already.

Some patients are always filling right when insurance allows it...30 day supply, fill at 26 days...fill the next at 26 days...fill the next at 26 days...all the sudden they are 12 days up.

PS: RPhs don't have authority to order a drug test, Spector, so it would have to be by the doc and he almost certainly wouldn't do that.

actually, your doctor can't run the test either. It is not a waived lab test in most states and requires a technician with special certification.

When I wrote that post I was implying you send them back to the clinic if they have not made any contact with their physician and the office (which would hopefully have a certified tech on staff) would run the screen. Obviously this is time dependent (although I'm not sure exactly how long after use such drugs are still detectable in the urine) and this isn't by any means the accepted norm. I was just proposing it as a solution to the problem. If it is someone abusing the meds they will likely just sit and wait for their script to mature (or maybe try to go scam someone else), and if not they would likely pass the screen and get a new script (which was the part of the post which implied they return to their physician, but as it came at the end of the post I can see where the confusion lays).

In my future practice I wouldn't consider this to be all that unreasonable. Some people may raise a fuss and try to cite things about unreasonable search and seizure protection (which has occurred in other cases where drug testing has been brought up) but IMO people are not entitled to narcotics and are certainly not entitled to refills after irresponsible behavior with their current batch. With another script ripening it would be hard to make any case that someone is trying to compel a drug test. It is an opt in situation. I only mention this because it is the only counter argument I can think of to sending the patient back to the clinic for a quick screen and a fresh script if clean. Perhaps the physician wouldn't want to do any testing and would just write a new prescription It is likely that the patient's doctor has a deeper personal understanding of the patient than the walgreen's pharmacist in most cases and would be a reasonable decision to make. Now, in cases where there is a law barring the issuing of a new script I would call it a "valuable life lesson" for the patient and be done with it

As far as the other part goes, if the doctor signs off on it (I believe) you absolve yourself of any liability. Sure, there are "pill mill" docs out there. I wouldn't begin with the phrase "With all the...." it sounds biased and a little jaded, although you may live in an area where it happens more often But on the other hand, refusing to fill a script on your own opinion or suspicion of "pill milling" may carry consequences. There are already precedents for job loss or discipline for refusing to fill a doctor's orders. The waters get foggier with opioids, and maybe there are some laws or rulings which cover this already that I am not aware of. But from my point of view, I know that a physician can be successfully sued for pain and suffering in denying a patient pain meds who they wrongfully suspect of seeking, so I would assume a pharmacist who suspects either the doc or the patient is also not immune.

 

[owlegrad]

As far as the other part goes, if the doctor signs off on it (I believe) you absolve yourself of any liability.

That pretty much flies in the face of corresponding liability. The concept of "the doctor said it was ok" as a legal defense has gone away (or at least is going away). Not that I can speak from personal experience, that's just the way it was taught to us.

 

[Carboxide]

actually, your doctor can't run the test either. It is not a waived lab test in most states and requires a technician with special certification.

When I wrote that post I was implying you send them back to the clinic if they have not made any contact with their physician and the office (which would hopefully have a certified tech on staff) would run the screen. Obviously this is time dependent (although I'm not sure exactly how long after use such drugs are still detectable in the urine) and this isn't by any means the accepted norm. I was just proposing it as a solution to the problem. If it is someone abusing the meds they will likely just sit and wait for their script to mature (or maybe try to go scam someone else), and if not they would likely pass the screen and get a new script (which was the part of the post which implied they return to their physician, but as it came at the end of the post I can see where the confusion lays).

In my future practice I wouldn't consider this to be all that unreasonable. Some people may raise a fuss and try to cite things about unreasonable search and seizure protection (which has occurred in other cases where drug testing has been brought up) but IMO people are not entitled to narcotics and are certainly not entitled to refills after irresponsible behavior with their current batch. With another script ripening it would be hard to make any case that someone is trying to compel a drug test. It is an opt in situation. I only mention this because it is the only counter argument I can think of to sending the patient back to the clinic for a quick screen and a fresh script if clean.

As far as the other part goes, if the doctor signs off on it (I believe) you absolve yourself of any liability. Sure, there are "pill mill" docs out there. I wouldn't begin with the phrase "With all the...." it sounds biased and a little jaded, although you may live in an area where it happens more often But on the other hand, refusing to fill a script on your own opinion or suspicion of "pill milling" may carry consequences. There are already precedents for job loss or discipline for refusing to fill a doctor's orders. The waters get foggier with opioids, and maybe there are some laws or rulings which cover this already that I am not aware of. But from my point of view, I know that a physician can be successfully sued for pain and suffering in denying a patient pain meds who they wrongfully suspect of seeking, so I would assume a pharmacist who suspects either the doc or the patient is also not immune.

Wrongy wrong wrong. In oh so many ways, wrong.

Your employer may choose to fire or discipline you, but the board will NEVER take away your license for refusing to fill an Rx that you believe to be for not legitimate purposes. In fact, it's part of the pharmacist's responsibility to refuse in such a case.

I also think you're a little naive about the amount of diversion that happens in the United States. Pill mill docs are there and aside from those, you get ER drug seekers, doctor hoppers, etc. You have NO IDEA what we see every day.


As far as drug testing and addict vs dependent behavior, it's often hard to distinguish that behavior. There's a lot of patients who are not abusing their meds who show addict-like behavior because of the high stress they experience when in pain or afraid that they are not getting their meds. Someone who is on Oxycontin 90 mg BID plus 10 mg q3 PRN who is legitimately without their meds could have some serious withdrawal.


Regardless, here is a good takehome point for you: Your opinion about whether it is okay to fill early/fill for cash does not mean that we have to do it and it does not mean that we will do it. It is within our rights to tell you NO and tell that patient to go home and wait til it's time to fill. Don't ever think that your word is the final one with prescriptions, because it never is.

 

[SpecterGT260]

That pretty much flies in the face of corresponding liability. The concept of "the doctor said it was ok" as a legal defense has gone away (or at least is going away). Not that I can speak from personal experience, that's just the way it was taught to us.

That may be. I don't (and probably won't ever) deal with pharmacy policy in the way that you guys do. I am not aware of any pharmacists being sued or getting in any trouble for filling a valid script. There was a pain doc that went down awhile ago who had been writing tons of scripts and a few people (including someone in the band Slipknot, which... sadly is probably the only reason this case got anywhere... celebrity deaths) and as far as I know he was the only one that went down for it. Not exactly the same thing, but as I said I am just not aware of cases where pharmacists are getting into legal trouble for filling individual scripts with valid sign-offs. If you know of some I would appreciate it if you could link me to them 👍

 

[SpecterGT260]

Wrongy wrong wrong. In oh so many ways, wrong.

Your employer may choose to fire or discipline you, but the board will NEVER take away your license for refusing to fill an Rx that you believe to be for not legitimate purposes. In fact, it's part of the pharmacist's responsibility to refuse in such a case.

I also think you're a little naive about the amount of diversion that happens in the United States. Pill mill docs are there and aside from those, you get ER drug seekers, doctor hoppers, etc. You have NO IDEA what we see every day.


As far as drug testing and addict vs dependent behavior, it's often hard to distinguish that behavior. There's a lot of patients who are not abusing their meds who show addict-like behavior because of the high stress they experience when in pain or afraid that they are not getting their meds. Someone who is on Oxycontin 90 mg BID plus 10 mg q3 PRN who is legitimately without their meds could have some serious withdrawal.


Regardless, here is a good takehome point for you: Your opinion about whether it is okay to fill early/fill for cash does not mean that we have to do it and it does not mean that we will do it. It is within our rights to tell you NO and tell that patient to go home and wait til it's time to fill. Don't ever think that your word is the final one with prescriptions, because it never is.

See, based on your first response I had you pretty much pegged for someone with a chip on your shoulder and an "us vs them" attitude when it comes to pharmacists and doctors.

This is why I made it a point to speak in generalizations and to highlight all of the areas that I am not certain in. I put "(I believe)" in the very sentence you highlighted specifically to admit up front that I am not well read in this area and express in a forward manner that I am in unknown territory. I even acknowledged the part of my other post which was worded confusingly in order to not call out your arbitrary correction. Yet you still lead in guns a-blazing 🙄

I didn't imply that you must obey a doctors orders. I said that if the patient were to return and get the go-ahead by their physician that you were unlikely to get into any trouble. I went further to state that there are already cases where healthcare providers get into trouble for denying meds to patients in need and stated there is a chance it may apply. No certainties, just input and *ahem* a lot of open questions 🙄 So thank you for your "take home" but it is entirely misplaced to the point that I wonder a little if you even read the post or simply skimmed it for things you could get bent about.

Listen, if your only purpose here is to call out the slight inconsistencies, preemptively admitted-to ignorances, and statements which you don't seem to fully understand yourself, I'll just put you on mute to save us both and everyone else the irritation of a derailment. But if you instead think you are coming in a little bit hot then I would welcome a real discussion 👍