Perfect example of why it is challenging for pharmacist in FL

[PharmacistFl12]

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On average day, I reject/fill tons of controls. I think something like 80% of controlled substances are written/dispensed in FL (I forget where I read this).

So here's the scenario:
2 teenage girls (perfectly healthy looking) comes to pharmacy together both with Rx for high quantity of Percocets & Vicodin and no other meds. They're in a rush and will be waiting for their meds and doctor is not from local city and no past profile in our system. Before reading forward, what would immediately cross your mind?


So I did my research on PDMP and it showed patient filled meds at multiple pharmacies but couple of weeks ago. Last step, I called doctor and doctor confirmed both girls have diagnosis of Sickle-Cell Anemia (they're both related to each other). So I decided to dispense their medications.

 

[cycloketocaine]

On average day, I reject/fill tons of controls. I think something like 80% of controlled substances are written/dispensed in FL (I forget where I read this).

So here's the scenario:
2 teenage girls (perfectly healthy looking) comes to pharmacy together both with Rx for high quantity of Percocets & Vicodin and no other meds. They're in a rush and will be waiting for their meds and doctor is not from local city and no past profile in our system. Before reading forward, what would immediately cross your mind?


So I did my research on PDMP and it showed patient filled meds at multiple pharmacies but couple of weeks ago. Last step, I called doctor and doctor confirmed both girls have diagnosis of Sickle-Cell Anemia (they're both related to each other). So I decided to dispense their medications.

SCD is an awful disease. Patients often present with severe pain. I know that FL has a controlled substance issue, but please do not discount the pain of a sickler. It can be debilitating.

 

[BrightLight]

I thought OP was going to talk about hurricanes.

 

[joetrisman]

I thought OP was going to talk about hurricanes.

I imagine myself working at a Wags down in FL getting a narc RTS call and the pt saying, "But the hurricane will be here on the day I'm due to get filled, can't you fill it early?"

 

[npage148]

One time I was super suspicious of a #120 Percocet from the ER (!!!). Called to confirm and it was for a sickle cell patient. Looking at her profile, she was on Pen VK chronically but no hx of narcotics aside from a few scripts for low qty. I was 100% ready to not fill it assuming it was fake.

 

[PharmacistFl12]

LOL! Our governor just declared state of emergency. We could legally dispense early refills up to 30 day supply for non-CIIs instead of standard 3 days.

 

[rph3664]

SCD is an awful disease. Patients often present with severe pain. I know that FL has a controlled substance issue, but please do not discount the pain of a sickler. It can be debilitating.

And it's not limited to blacks, either. People of Greek descent are at a somewhat higher risk than other Caucasians.

 

[gmuskie]

It is an awful disease with high pain med requirements...but I had a sickle cell patient who had multiple visits to the ER, came in for surgery, said she took all these meds...

Turns out she's selling them all and gets completely snowed after surgery thinking she has this huge tolerance to pain meds.

 

[Ackj]

I imagine myself working at a Wags down in FL getting a narc RTS call and the pt saying, "But the hurricane will be here on the day I'm due to get filled, can't you fill it early?"

That hurricane blew away all my pills, now I need more. Good thing Midyear isn't in nola this year.

 

[Hope1974]

And it's not limited to blacks, either. People of Greek descent are at a somewhat higher risk than other Caucasians.

The sickle cell developed for a reason. It's shape doesn't allow the blood cell to carry very much oxygen, as a result it prevents the plasmodiums associated with different types of malaria, to develop, thereby protecting the host from malaria. Those who are heterozygotes for the allele (those with the sickle cell trait) benefit. However, those who are homozygous for the the alleles and have sickle cell suffer.

You can expact inhabitants of regions, or descendants of people from regions with malaria to carry the sickle cell trait. Which is why it's not a disease associated with the amount of melatonin in your skin(well statistically speaking you could draw some correlations, as people in the tropics where you find malaria often have dark skin(these genes were selected as a measure to protect people from the sun-but thats another topic)however this is variable is not dependant on having the sickle cell trait).

 

[pezdispenser]

Please be EXTREMELY CAUTIOUS in Florida. The narcotics traffickers will go to great lengths to trick you, even faking a diagnosis such as sickle cell anemia, which would be perfect for them because they can look young and healthy on the outside. Calling the prescriber to verify the script or the diagnosis is useless because they are in on the scam as well. A lot of the doctors are from Caribbean medical schools with no hope of making an honest living, so they resort to setting up a shady pain clinic to make a fast buck.

The following are red flags:
- Doctor not from local area
- Assuming patient not from local area. You need to record photo ID for narcotics in Florida if the patient is not known to you, so look at the address on their driver's license.
- PDMP shows multiple pharmacies, and recent fills.
- Patient only getting narcotics
- No history at own pharmacy

Any of these would be an instant rejection in my books. Sorry if the patient is actually legit, but the situation in Florida has just gotten out of hand. If they are legit, they need to establish a relationship with one local pharmacy, and that pharmacy needs to be sure that the prescriber is legit as well, and not some fly by night pain clinic.

Oh and heads up in Georgia because I heard the pain clinics are moving up to Valdosta.

 

[VA Hopeful Dr]

Please be EXTREMELY CAUTIOUS in Florida. The narcotics traffickers will go to great lengths to trick you, even faking a diagnosis such as sickle cell anemia, which would be perfect for them because they can look young and healthy on the outside. Calling the prescriber to verify the script or the diagnosis is useless because they are in on the scam as well. A lot of the doctors are from Caribbean medical schools with no hope of making an honest living, so they resort to setting up a shady pain clinic to make a fast buck.

The following are red flags:
- Doctor not from local area
- Assuming patient not from local area. You need to record photo ID for narcotics in Florida if the patient is not known to you, so look at the address on their driver's license.
- PDMP shows multiple pharmacies, and recent fills.
- Patient only getting narcotics- No history at own pharmacy

Any of these would be an instant rejection in my books. Sorry if the patient is actually legit, but the situation in Florida has just gotten out of hand. If they are legit, they need to establish a relationship with one local pharmacy, and that pharmacy needs to be sure that the prescriber is legit as well, and not some fly by night pain clinic.

Oh and heads up in Georgia because I heard the pain clinics are moving up to Valdosta.

In my area, some pharmacists will refuse to dispense narcotics to sicklers without a valid, active Rx for hydroxyurea as well.

 

[Its Z]

The sickle cell developed for a reason. It's shape doesn't allow the blood cell to carry very much oxygen, as a result it prevents the plasmodiums associated with different types of malaria, to develop, thereby protecting the host from malaria. Those who are heterozygotes for the allele (those with the sickle cell trait) benefit. However, those who are homozygous for the the alleles and have sickle cell suffer.

You can expact inhabitants of regions, or descendants of people from regions with malaria to carry the sickle cell trait. Which is why it's not a disease associated with the amount of melatonin in your skin(well statistically speaking you could draw some correlations, as people in the tropics where you find malaria often have dark skin(these genes were selected as a measure to protect people from the sun-but thats another topic)however this is variable is not dependant on having the sickle cell trait).

Ehh...we know...

 

[awval999]

In my area, some pharmacists will refuse to dispense narcotics to sicklers without a valid, active Rx for hydroxyurea as well.

So they buy the cheap hydroxyurea and then dump it down the drain when they leave? You cannot police the world and you can't make people use the medication correctly. Pharmacists are not the narcotics police. If it's forged then refuse to dispense. If they have multiple fills in the last 30 days at other pharmacies then refuse to dispense. But it's is not the job of the pharmacist to approve/deny based on a whim. You are not the DEA police. If you think a physician is shady then contact the medical board.

But personally, and imo, if the patient comes up clean on the records search, has ID, and if the MD confirms the Rx and provides the Dx you are operating outside the scope of your practice if you deny the patient the medication.

 

[IlDestriero]

So they buy the cheap hydroxyurea and then dump it down the drain when they leave? You cannot police the world and you can't make people use the medication correctly. Pharmacists are not the narcotics police. If it's forged then refuse to dispense. If they have multiple fills in the last 30 days at other pharmacies then refuse to dispense. But it's is not the job of the pharmacist to approve/deny based on a whim. You are not the DEA police. If you think a physician is shady then contact the medical board.

But personally, and imo, if the patient comes up clean on the records search, has ID, and if the MD confirms the Rx and provides the Dx you are operating outside the scope of your practice if you deny the patient the medication.

👍 👍

 

[pezdispenser]

But personally, and imo, if the patient comes up clean on the records search, has ID, and if the MD confirms the Rx and provides the Dx you are operating outside the scope of your practice if you deny the patient the medication.

Unfortunately, pharmacists have been doing all these things but it didn't stop the DEA from revoking or restricting the stores' licenses. The DEA even revoked the distributor licenses of a Cardinal and Walgreens warehouse. So if the DEA wants to play 'guilty until proven innocent' that's the same attitude we have to have with the customers.

 

[Carboxide]

So they buy the cheap hydroxyurea and then dump it down the drain when they leave? You cannot police the world and you can't make people use the medication correctly. Pharmacists are not the narcotics police. If it's forged then refuse to dispense. If they have multiple fills in the last 30 days at other pharmacies then refuse to dispense. But it's is not the job of the pharmacist to approve/deny based on a whim. You are not the DEA police. If you think a physician is shady then contact the medical board.

But personally, and imo, if the patient comes up clean on the records search, has ID, and if the MD confirms the Rx and provides the Dx you are operating outside the scope of your practice if you deny the patient the medication.

Disagree. That physician may have the ability to prescribe that med, but we are AUTONOMOUS and have full ability to refuse to fill for any reason. Does that make it a GOOD reason? Maybe not. But there is nothing wrong or bad about a pharmacist that doesn't dispense based on what you call a "whim." What that "whim" really is is EXPERIENCE. The vast majority of patients who REALLY have a valid need for the drug have established a relationship with one pharmacy for that med. The situation described by the OP is suspicious as all get-out and was rightfully evaluated in depth by the pharmacist.

End story - if we don't want to fill, we don't have to and you can't make anybody do it.

 

[abc1234567]

Disagree. That physician may have the ability to prescribe that med, but we are AUTONOMOUS and have full ability to refuse to fill for any reason. Does that make it a GOOD reason? Maybe not. But there is nothing wrong or bad about a pharmacist that doesn't dispense based on what you call a "whim." What that "whim" really is is EXPERIENCE. The vast majority of patients who REALLY have a valid need for the drug have established a relationship with one pharmacy for that med. The situation described by the OP is suspicious as all get-out and was rightfully evaluated in depth by the pharmacist.

End story - if we don't want to fill, we don't have to and you can't make anybody do it.

👍

When it comes to medicines YES we do have the right and responsibility. If we do not have the right or responsibility than why not make a vending machine and put all the meds in it?
Start differentiating yourself from a machine . Most of the retail pharmacist are brainwashed in to thinking they are robots and they start to act like robots, who just follows order

 

[ethyl]

Unfortunately, I would have probably dismissed it pretty quickly due to the prescriber being out of area. Need to fill it at one of the 3-4 dozen pharmacies local to the MD's office.

 

[Craigular]

A lot of the doctors are from Caribbean medical schools with no hope of making an honest living, so they resort to setting up a shady pain clinic to make a fast buck.

I'm pretty sure most the big name Caribbean schools do clinicals in US hospitals and become a board certified physician by experiencing the same grueling residency since it is a US residency they get placed in that makes them a board certified physician.

Maybe that attitude is why you are a cynical pharmacist.

 

[rxlea]

The sickle cell developed for a reason. It's shape doesn't allow the blood cell to carry very much oxygen, as a result it prevents the plasmodiums associated with different types of malaria, to develop, thereby protecting the host from malaria. Those who are heterozygotes for the allele (those with the sickle cell trait) benefit. However, those who are homozygous for the the alleles and have sickle cell suffer.

You can expact inhabitants of regions, or descendants of people from regions with malaria to carry the sickle cell trait. Which is why it's not a disease associated with the amount of melatonin in your skin(well statistically speaking you could draw some correlations, as people in the tropics where you find malaria often have dark skin(these genes were selected as a measure to protect people from the sun-but thats another topic)however this is variable is not dependant on having the sickle cell trait).

So the melatonin doesn't make the plasmodium sleepy??

 

[BenJammin]

On average day, I reject/fill tons of controls. I think something like 80% of controlled substances are written/dispensed in FL (I forget where I read this).

So here's the scenario:
2 teenage girls (perfectly healthy looking) comes to pharmacy together both with Rx for high quantity of Percocets & Vicodin and no other meds. They're in a rush and will be waiting for their meds and doctor is not from local city and no past profile in our system. Before reading forward, what would immediately cross your mind?


So I did my research on PDMP and it showed patient filled meds at multiple pharmacies but couple of weeks ago. Last step, I called doctor and doctor confirmed both girls have diagnosis of Sickle-Cell Anemia (they're both related to each other). So I decided to dispense their medications.

I'm sorry but if I was the pharmacy manager and you told me that, I'd fire you on the spot. You are a NOBODY when it comes to judging who is and isn't in pain. People taking narcotics have to be dragged in so you can believe them or something? Two words for you and you know what those are.

But personally, and imo, if the patient comes up clean on the records search, has ID, and if the MD confirms the Rx and provides the Dx you are operating outside the scope of your practice if you deny the patient the medication.

+1

 

[PharmacistFl12]

I got 3 words for you are you know what they are!

 

[Dr Wario]

Here is my problem with all of these narcotic issues lately. I honestly couldn't give two ****s about what people put into their bodies, however the DEA has made it clear that it is my JOB and RESPONSIBILITY to make sure that the narcotics I fill are for legitimate medical purposes even if they come from doctors with unrestricted licenses. An independent pharmacy near me lost his DEA license about 1.5 years because he filled scripts from mills. You can all have your holier than thou attitudes about not denying pain medication, but tell me that when you livelihood has been taken away from you.

 

[awval999]

Here is my problem with all of these narcotic issues lately. I honestly couldn't give two ****s about what people put into their bodies, however the DEA has made it clear that it is my JOB and RESPONSIBILITY to make sure that the narcotics I fill are for legitimate medical purposes even if they come from doctors with unrestricted licenses. An independent pharmacy near me lost his DEA license about 1.5 years because he filled scripts from mills. You can all have your holier than thou attitudes about not denying pain medication, but tell me that when you livelihood has been taken away from you.

I just don't see the DEA's argument if the hard copy Rx has the time and date of the phone call to the office confirming the quanity and diagnosis and the RPh signature. I don't understand what else they can argue you should do. The pharmacist does not have the medical knowledge to diagnosis. How can I know if the patient has Sickle Cell or Cancer or whatever from looking at them?

 

[All4MyDaughter]

I just don't see the DEA's argument if the hard copy Rx has the time and date of the phone call to the office confirming the quanity and diagnosis and the RPh signature. I don't understand what else they can argue you should do. The pharmacist does not have the medical knowledge to diagnosis. How can I know if the patient has Sickle Cell or Cancer or whatever from looking at them?

So we are having a little pain clinic problem here currently. And what we've been told is that we should recognize "problematic" or "potentially abusive" prescribing patterns from certain prescribers and report them if we think they aren't legit. Not always easy to ascertain, though. How do you tell the difference between someone who is just negligent or a pushover with the controlled RXs and someone who is actually trading RXs for money (or whatever)? It's not always easy to know with certainty.

 

[pezdispenser]

I just don't see the DEA's argument if the hard copy Rx has the time and date of the phone call to the office confirming the quanity and diagnosis and the RPh signature. I don't understand what else they can argue you should do. The pharmacist does not have the medical knowledge to diagnosis. How can I know if the patient has Sickle Cell or Cancer or whatever from looking at them?

Unfortunately, the DEA just expects us to know whether a prescription was written for a legitimate medical purpose. Calling the office to verify the script and document the diagnosis is NOT ENOUGH because they lie, and again, the DEA expects us to know that. FL pharmacists were always verifying every single script and the DEA still revoked their licenses. Basically, the usual pharmacist's thinking of calling the doctor, documenting, and essentially passing the blame onto someone else, does not work here.

The DEA Pharmacist's Manual Appendix D has guidelines and I'll copy the most important points here. http://www.deadiversion.usdoj.gov/pubs/manuals/pharm2/appendix/appdx_d.htm

The following criteria may indicate that a prescription was not issued for a legitimate medical purpose:
•The prescriber writes significantly more prescriptions (or in larger quantities) compared to other practitioners in the area.
•The patient appears to be returning too frequently. A prescription which should last for a month in legitimate use is being refilled on a biweekly, weekly or even a daily basis.
•The prescriber writes prescriptions for antagonistic drugs, such as depressants and stimulants, at the same time. Drug abusers often request prescriptions for "uppers and downers" at the same time.
•The patient presents prescriptions written in the names of other people.
•A number of people appear simultaneously, or within a short time, all bearing similar prescriptions from the same physician.
•People who are not regular patrons or residents of the community, show up with prescriptions from the same physician.

The doctors you need to watch out for are the fly by night pain clinics. They document any slightly abnormal MRI or something as a cause for pain, and prescribe only narcotics for all their patients (1st bullet point). People will drive down to FL all the way from WV or TN or wherever to go to these pain clinics. They then hop in their car and go from pharmacy to pharmacy hoping to find a naive pharmacist to fill their scripts (last 3 bullet points).

The DEA nails you by first looking at your volume. If you do a large proportion of narcotics or there is a big increase, they will come and investigate. If you fill every single narcotic script that comes in your door, even after verifying with the doctor because they will all come back clear, then you can kiss your career good bye. Because the DEA can go back through your records and if they see scripts from doctors who they shut down for running pill mills, you are screwed, even though you had no way of knowing this and the doctor may not even have been under investigation at the time you filled the scripts.

So the current policy in FL is first to simply turn away all customers who do not have a history at your pharmacy, so you can keep your narcotics volume down for your regular customers. Then you have to be absolutely sure that the doctor is not running an illegitimate pain clinic. WHENEVER IN DOUBT, REFUSE TO FILL.

 

[Chris co2012]

An of these "holier than thou" pharmacists in the position where they could lose their license for filling pill mill prescriptions would turn against their beliefs and become the bad guys too.

Fact is, I'm not filling a patient's C-II if it's from an out-of-town MD. If you live here, see a local MD. If you live there, get your script fill there.

Final.

 

[ethyl]

An of these "holier than thou" pharmacists in the position where they could lose their license for filling pill mill prescriptions would turn against their beliefs and become the bad guys too.

Fact is, I'm not filling a patient's C-II if it's from an out-of-town MD. If you live here, see a local MD. If you live there, get your script fill there.

Final.

 

[Pharmavixen]

So we are having a little pain clinic problem here currently. And what we've been told is that we should recognize "problematic" or "potentially abusive" prescribing patterns from certain prescribers and report them if we think they aren't legit. Not always easy to ascertain, though. How do you tell the difference between someone who is just negligent or a pushover with the controlled RXs and someone who is actually trading RXs for money (or whatever)? It's not always easy to know with certainty.

Naive doctors who are being gamed by their patients cause the same problems as those who are actively scamming. Both need to lose their narcotic prescribing license (whatever they call it where you practice).

My (totally anecdotal) method of telling the scamming drs from the ones who are being scammed is their temperament. When you call a scamming physician to verify, they act unprofessionally ie like total a-holes such as, "If you think MY PATIENT is diverting, call the police." OTOH, the naive drs get scammed because they are too nice, so when you phone them they are more likely to offer complex explanations for the patient's drug needs, and may even express sympathy "I know how difficult a patient he can be."

 

[awval999]

That DEA page is such absolute bull**** it is making me rage. Wow. I don't even know what to say. What's next, the FDA pulling this same crap on antimicrobial stewardship?

Appendix E

Pharmacist’s Guide to Antimicrobial Stewardship

The purpose of this guide is to ensure that antibiotics continue to be available for legitimate medical and scientific purposes while preventing the rise in resistant and super-infections from unneccessary antibiotic use. It is not the intent of this publication to discourage or prohibit the use of antibiotics where medically indicated. However, nothing in this guide should be construed as authorizing or permitting any person to conduct any act that is not authorized or permitted under federal or state laws.

Pharmacist’s Responsibilities

The abuse of prescription drugs—especially antibiotics—is a serious social and health problem in the United States today. As a healthcare professional, pharmacists share responsibility for promoting antimicrobial stewardship.
•Pharmacists have a personal responsibility to protect their practice from becoming an easy target for unneccessary antibiotic users. They need to know of the potential situations where unneccssary antibiotic use can occur, and establish safeguards to prevent inappropriate therapy.
•The dispensing pharmacist must maintain a constant vigilance against antibiotic prescriptions from non-Infectious Disease physicians. The FDA holds the pharmacist responsible for knowingly dispensing a prescription that was not issued in accordance with the appropriate IDSA guidelines.

 

[Shnurek]

That DEA page is such absolute bull**** it is making me rage. Wow. I don't even know what to say. What's next, the FDA pulling this same crap on antimicrobial stewardship?

Appendix E

Pharmacist's Guide to Antimicrobial Stewardship

The purpose of this guide is to ensure that antibiotics continue to be available for legitimate medical and scientific purposes while preventing the rise in resistant and super-infections from unneccessary antibiotic use. It is not the intent of this publication to discourage or prohibit the use of antibiotics where medically indicated. However, nothing in this guide should be construed as authorizing or permitting any person to conduct any act that is not authorized or permitted under federal or state laws.

This is very important and I wish every Pharmacist and Doctor only allowed patients to use the simplest antibiotic that would work for a specific bacteria. Not newer drugs that just hasten antibiotic resistance development in bacteria.

 

[pezdispenser]

DEA Revokes Two CVS Retailers' Ability To Sell Controlled Substances

US revoking 2 CVS stores' controlled substance licenses

Walgreen Florida Facility Barred From Shipping Oxycodone Edit to add link for the Walgreens Jupiter distribution center.

 

[JoBreeze]

So the melatonin doesn't make the plasmodium sleepy??

Haha nice catch. Awww he was on a roll though...

 

[eagles22]

This is very important and I wish every Pharmacist and Doctor only allowed patients to use the simplest antibiotic that would work for a specific bacteria. Not newer drugs that just hasten antibiotic resistance development in bacteria.

Hasn't anyone told you that newer, more expensive drugs work better than the old ones? Levaquin for everything.

 

[kvl1027]

As a pharmacist in Florida who works at an independent, we have to be very careful. While it may not really affect one's job if the CVS they work for loses its DEA license or gets shut down, because they can just be transfered somewhere else, if my store gets shut down I'm toast.

I turn down anyone who is from out of town or using an out of town doc, unless it is written on an MD Anderson Cancer Center or Moffit Cancer Center blank. If they have been coming to us for a long time, but use an out of town doc I will fill the Rx.

If they bring in the "Holy Trinity" or "Trinity" (yes that is the street name; Holy Trinity=Oxy 30mg, Soma 350mg, Xanax 2mg; Trinity=Lortab, Soma 350mg, Xanax 2mg) I tell them to take a walk.

Unfortunately, calling the Dr's office to verify does not protect us fromt the DEA. I was talking with a pain management doc at a Drug Rep Dinner (with education of course) and he said he never writes OXY 30mg......ever. All chronic pain patients should be on a long acting analgesic.....period. Someone who has a diagnosis of chronic pain whould not be only on Oxy30, there should be some basal pain control there with an IR for breakthrough and that IR should not be Oxy30, it's just complete overkill. Patients with chronic pain should be given realistic goals of pain control and getting to a 0 of 10 on the pain skill should not be the goal of treatment, unless the patient is terminal.

The amount of extra work I have to do in CYA practices to try to prevent getting a visit from the DEA is ridiculous. I run a PDMP report on every C-II and scan it into the the RX profile. I make copies of every script I deny with the patients ID and file it in "Did not fill folder" so I can show that we turn away more than we fill. I purposely run low on stock so that my ordering habbits are below the norm. It's dumb...and the problem lies mostly with physicians running BS clinics or physicians with not enough back-bone to tell them too bad.

 

[Fade to Black]

This is ridiculous, I knew FL had a significant problem, but not like this from these personal accounts.

 

[Doctor M]

Florida is bad. we have reduced our inventory and dispensing tremendously of Narcs. We focus now on LTC and compounding. Not worth the risk anymore. DEA is lurking and looking....do not want any part of that!

 

[21PharmD]

This is one of the most necessary threads considering the current situation in florida. It is unbelievable how big a problem this is. My question is what is a new floater pharmacist to do who is unfamiliar with most of the patients that come in with CII prescriptions. What i have been saying is that we cannot fill them unless they are verified by the doctor, but now with all the pain mill doctors they all confirm a diagnosis of some ruptured or herniated disk, and to me it really doesnt give much info. PDMP seems to only let you know whether the patient is doctor shopping, or shopping at different pharmacies. I really wish there was a better way to identify legitimate pain patients (and prescribers). When i communicate my discomfort with filling a CII prescription the patients always make a scene which make it difficult to serve other patients. Is there some ideal way to approach this? I have been told by some to just say we dont have "this medicine" in stock, but i would not be able to sleep at night knowing i sent this patient to the poor unsuspecting pharmacist down the street it just doesnt sound right to me. Also it doesnt help that the pharmacists dont seem to speak with a consistent voice. So if the pharmacist that is normally here on tuesdays fills them without adequate review and the tech's have established a relationship with these patients, the patients wonder why cant I fill them. This is definitely a challenging area that needs to be further addressed.

 

[Shnurek]

This is one of the most necessary threads considering the current situation in florida. It is unbelievable how big a problem this is. My question is what is a new floater pharmacist to do who is unfamiliar with most of the patients that come in with CII prescriptions. What i have been saying is that we cannot fill them unless they are verified by the doctor, but now with all the pain mill doctors they all confirm a diagnosis of some ruptured or herniated disk, and to me it really doesnt give much info. PDMP seems to only let you know whether the patient is doctor shopping, or shopping at different pharmacies. I really wish there was a better way to identify legitimate pain patients (and prescribers). When i communicate my discomfort with filling a CII prescription the patients always make a scene which make it difficult to serve other patients. Is there some ideal way to approach this? I have been told by some to just say we dont have "this medicine" in stock, but i would not be able to sleep at night knowing i sent this patient to the poor unsuspecting pharmacist down the street it just doesnt sound right to me. Also it doesnt help that the pharmacists dont seem to speak with a consistent voice. So if the pharmacist that is normally here on tuesdays fills them without adequate review and the tech's have established a relationship with these patients, the patients wonder why cant I fill them. This is definitely a challenging area that needs to be further addressed.

Just put up a sign: "No ghetto people"

 

[joetrisman]

I really wish there was a better way to identify legitimate pain patients (and prescribers).

Wong-Baker Facial Grimace Scale

 

[Chris co2012]

Just put up a sign: "No ghetto people"

You know, I've worked in the ghetto and I've never had a "ghetto" person bring by a prescription that was from out of town or from a pain clinic doc. I've had plenty of narcs from ERs, but no pain clinics or "wellness centers." And I live in Georgia.

Why don't you just worry about your prescribing and we'll worry about catching the illiget prescribers/patients?

 

[owlegrad]

http://articles.orlandosentinel.com..._distribution-center-dea-miami-field-division

 

[Doctor M]

http://articles.orlandosentinel.com..._distribution-center-dea-miami-field-division

Yeah, it is getting real for sure. DEA is not messing around and I for one do not want to see them ever. I would say 95% of our narcos are insurance. Our percent controls we buy from our wholesaler is 19%. This includes C2-C5. We dispense a little above the national avg for oxy (includes 5, 10, 15, 30's and oxycontin). With a huge population in Pinellas park, we try to limit Oxy but there truly are people who need it. it is a catch 22 with these drugs. You are damned if you dispense them and damned if you dont. We try to just fill Insurance but then there are those who are self employed, unemployed and don't qualify for medicaid etc etc... We do what we can, cautiously.

 

[Mila T]

That DEA page is such absolute bull**** it is making me rage. Wow. I don't even know what to say. What's next, the FDA pulling this same crap on antimicrobial stewardship?

Appendix E

Pharmacist’s Guide to Antimicrobial Stewardship

The purpose of this guide is to ensure that antibiotics continue to be available for legitimate medical and scientific purposes while preventing the rise in resistant and super-infections from unneccessary antibiotic use. It is not the intent of this publication to discourage or prohibit the use of antibiotics where medically indicated. However, nothing in this guide should be construed as authorizing or permitting any person to conduct any act that is not authorized or permitted under federal or state laws.

Pharmacist’s Responsibilities

The abuse of prescription drugs—especially antibiotics—is a serious social and health problem in the United States today. As a healthcare professional, pharmacists share responsibility for promoting antimicrobial stewardship.
•Pharmacists have a personal responsibility to protect their practice from becoming an easy target for unneccessary antibiotic users. They need to know of the potential situations where unneccssary antibiotic use can occur, and establish safeguards to prevent inappropriate therapy.
•The dispensing pharmacist must maintain a constant vigilance against antibiotic prescriptions from non-Infectious Disease physicians. The FDA holds the pharmacist responsible for knowingly dispensing a prescription that was not issued in accordance with the appropriate IDSA guidelines.

Totally agree with FDA on this one.