pill identification ethics question

[npage148]

Ive identified many pills for people before and mostly is stupid stiff but. Tonight at work, i had a dad call me and ask me to identify some pills he found in his son's room. It turned out to be hydro/apap 10/325 (M367) After i told him, he told me how his son was giving him the run around about what they were and knew they were something serious. He said his son was in for it now. I felt a little guilty like a snitch, but I also think the dad has a right to know. What are the specifics on the law and practice in the situation like this? How does hippa play into this? How would you have handled it? Would the situtaion be any different if the dad found a pill that the kid had a valid RX for, like his the kid dropped one of his pills for depression?
Thanks
Nate

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[bananaface]

In some states, minors may be able to consent to healthcare without their parents being involved. In those states, the kids may have a valid right to private care. For example, if a 15 year old girl got raped, sought treatment, and was prescribed vicodin for pain, her parent may have no right to know more than she chooses to disclo'ingse. Where those 18 and under have no such rights, you are free to ID if you choose. You should technically refrain when the patient has a right to privacy. If the parent sounds genuinely concerned (as opposed to crazy and paranoid), I have been known to tell parents that I would have been legally comfortable ID the medication had they not told me it was their child's, as a way of hinting that they could get the information from someone else if they refrain from revealing this tidbit.

 

[sdn1977]

In CA the law is pretty clear on this when the child is over 18 - you can't divulge any information. It gets a little cloudy under 18, however, these kids can, as bananaface mentioned, obtain some medical & pharmacy services without parental consent. In this state, a child less than 18 can obtain reproductive services which may or may not result in a pain Rx. I completely understand both the child's perceived right/need for privacy and the parent's concern. So, when this occurs in my practice, I do not identify the medication. However, I engage the parent in a discussion of their concerns, what behaviors, patterns, etc lead them to worry, and resources they can use to help the child avoid or deal with potential drug abuse. Every family has a different dynamic, however, if the child has already avoided information when initially confronted by a parent, having more specific info may not further discussion, IMO. In my experience, a more difficult, but similar situation is when adult children call to get information about an elderly parent who is declining. The parent won't consent so I have to refer the children to the parent's physician. I really don't know what happens after that......Learn what good adolescent drug abuse education resources are available in your area so you have good, definite and specific information to give the parent. Local schools and planned parenthood are good places to begin.

 

[ButlerPharm.D.]

You should have told the father to call the local poison control center if he wanted to know what medication he had found. I work in a hospital pharmacy and I actually received a call quite similar to this where a mother had found a baggy full of medication in her daughter's room and she called us to see if we could tell her what the medications were. We declined and as I stated above, we directed her to call the poison control center.

 

[ultracet]

You should have told to to call the poison control center if he wanted to know, I wouldn't put myself in this situation if I was on the other end of phone.

HAHAHAHA
unless that's where you're rotating....

in the DIC we had certain questions we had to ask prior to tablet identification.....

if it wasn't their tablet we didn't do it....

 

[no-see-um]

HAHAHAHA
unless that's where you're rotating....

in the DIC we had certain questions we had to ask prior to tablet identification.....

if it wasn't their tablet we didn't do it....

IMO. Drug identification should be common knowledge. It is something that could easily be looked up and told to whoever needs the information, unless it's a very extreme case.

 

[gablet]

Ive identified many pills for people before and mostly is stupid stiff but. Tonight at work, i had a dad call me and ask me to identify some pills he found in his son's room. It turned out to be hydro/apap 10/325 (M367) After i told him, he told me how his son was giving him the run around about what they were and knew they were something serious. He said his son was in for it now. I felt a little guilty like a snitch, but I also think the dad has a right to know. What are the specifics on the law and practice in the situation like this? How does hippa play into this? How would you have handled it? Would the situtaion be any different if the dad found a pill that the kid had a valid RX for, like his the kid dropped one of his pills for depression?
Thanks
Nate

I would have identified the tablet (we get in trouble in pharmaceutics if we call it a pill instead of tab/cap).

Then, when he expressed anger I would have asked him to stop and think about the best way to deal with his son instead of simply yelling at him. The dad should want to keep the communication lines open while still expressing his disappointment (in giving him the run around) and concern for his health. Maybe try to diffuse him before talking to his son.

Of course, this is all in hindsight, so I just hope that I'd do that.

 

[ultracet]

IMO. Drug identification should be common knowledge. It is something that could easily be looked up and told to whoever needs the information, unless it's a very extreme case.

its not when you call the drug information center....

they were very specific about what information we could give to whom
especially when it comes to tablet ID

where did they find it...
whose was it...
why do they want to know.. etc...

 

[sdn1977]

IMO. Drug identification should be common knowledge. It is something that could easily be looked up and told to whoever needs the information, unless it's a very extreme case.

Its not a matter of what should or shouldn't be. HIPPA & state laws don't always allow you to do or say what you feel you should. Yes...the info is easily looked up and you can provide those links if you want. You just cannot give out prescription information to those not allowed to access it for privacy protection.

 

[All4MyDaughter]

You should have told the father to call the local poison control center if he wanted to know what medication he had found. I work in a hospital pharmacy and I actually received a call quite similar to this where a mother had found a baggy full of medication in her daughter's room and she called us to see if we could tell her what the medications were. We declined and as I stated above, we directed her to call the poison control center.

Don't know about other states, but the Kentucky Poison Control Center will not do pill identification for the general public. They will do it for healthcare providers, prisons, law enforcement, etc.

If a civilian calls with an unknown pill they tell them to throw it away.

 

[Sosumi]

Where I work, identifying tablets can take time from your busy day and not something we usually do. We have far too many drug addicts around the area, and most of the time, they just want to know if what they bought illicitly either by prescription forgery or from street dealers is what they wanted -- Xanax, Klonopins, Percocets, etc.

We only do it for compelling reasons, such as one patient who was getting blood pressure medicine from his mail order pharmacy and insisted they were sending him the wrong medication.

 

[All4MyDaughter]

Where I work, identifying tablets can take time from your busy day and not something we usually do. We have far too many drug addicts around the area, and most of the time, they just want to know if what they bought illicitly either by prescription forgery or from street dealers is what they wanted -- Xanax, Klonopins, Percocets, etc.

We only do it for compelling reasons, such as one patient who was getting blood pressure medicine from his mail order pharmacy and insisted they were sending him the wrong medication.

Yes, that's why the KPCC won't do it. Too many addicts calling, or teenagers wanting to find out the identity of what they stole from Granny's medicine cabinet.

We do it sometimes in the pharmacy where I work, usually for senior citizens. Or sometimes adult children will bring in a tub of medicine that their declining parent has been keeping. My father in law (who has Alzheimer's) was bad about dumping all his meds into a tupperware container together - no bottles, labels, etc... I needed some help from the pharmacist to straighten that out the first time I found it.

 

[sdn1977]

Don't know about other states, but the Kentucky Poison Control Center will not do pill identification for the general public. They will do it for healthcare providers, prisons, law enforcement, etc.

If a civilian calls with an unknown pill they tell them to throw it away.

Good point All! Here in CA, poison control will refer all pts to their local ER. For providers, the turn around time for a question to be answered is about 48 hours. IMO, if you are a provider & need drug info really fast & know the manufacturer, most of them (not the generics usually) have 24 hr lines so you can speak with either an MD or pharmacist. This is really helpful when you get an OD or idiosyncratic reaction from a really random drug. When I worked in a hospital, emergency medicine would send down tablets for ID about once a week - they usually wanted to ID a foreign medication so they could order something equivalent when they admitted the pt. For everything else, the tox screen was processed fast enough for them to do what had to be done. We had great resources for identification so we never called poison control, but I could see law enforcement perhaps wanting to.

 

[Sosumi]

As far as the OP's ethics question, our pharmacy's policy would have been not to answer the question. It's about protecting the patient's privacy and avoiding getting in the middle of a sticky situation. What if the tablet (hehe our pharmaceutics professors hated it if we call it pills too) were for birth control and the parents didn't know their child was having premarital sex?

It is the same as our counseling policy where we do not answer questions if the person picking up the medication or phoning in is not the patient, unless of course that person is known to be providing care to the patient.

 

[no-see-um]

Its not a matter of what should or shouldn't be. HIPPA & state laws don't always allow you to do or say what you feel you should. Yes...the info is easily looked up and you can provide those links if you want. You just cannot give out prescription information to those not allowed to access it for privacy protection.

How would that be a HIPAA violation? The person who is taking that medicine is not a patient of yours. What makes you duty-bound to that patient, besides a broad law that answers this question? It is not a question of theraputics for that patient. Unless you argue that by answering such a question, you would, in effect, be acting as a provider for the patient- a patient you never met nor even know exists... And what about a duty to the caller? A duty to keep the caller from taking a tablet that is not indicated for him/her.

Still, I don't see it as a question about a patient, but rather as a question about the medication, itself.

But the original poster asked an ethics question. Since it seems to be more of a matter of law that you cannot divulge that information, than a matter of 'what you feel you should do', then once the ethical question is decided and you believe that the information source itself is not exactly top-secret (nor should it be), then you could certainly divulge the source of such information.

With the exception of extreme situations, I would tell the inquirer exactly how to look it up. This would be compliant.

 

[npage148]

I really dont think it would be a hippa violation since its not pertaining to any protected information since the medication is not prescribed to the son. Its not like he called and said he found his son's vial of lexapro and was asking waht it was used for My girlfriend did raise an interesting point, what if the kid was a dealler and had 300 more tabs on him that he was interested in selling to people. She is much more brutal that me though and is more likely to assume people are up to no good.

 

[ultracet]

its a hipaa violation b/c you're saying what medicaiton someone is taking

 

[imperial frog]

For HIPAA to apply you have to be somewhere in the chain of providing healthcare to the patient. Look at the slew of medical people in the media who comment on people's condition and treatment. As long as they are not the ones providing care (or paying for it or processing information, etc.) they are outside the HIPAA boundaries. Sort of the same situation can be applied to the pharmacist here. Providing that the son is not a customer of the store, there is nothing in HIPAA to prevent identification of the tablet.

I have been wrong in the past though. Twice.

 

[sdn1977]

Yeah...you are right...when you don't know if your pharmacy was actually the dispensing pharmacy, it is not actually a HIPPA violation. But...do you ever really know???? Then...this is where ethics becomes a matter of judgement, IMO.....Does this child have a right to privacy??? Some very vehemently argue no - they do not. Are there extenuating circumstances in which the child might arguable have a right to privacy??? or not...in the case of a child who is a potential dealer???? Some argue vehemently for both sides. I guess you need to decide for yourself, using your own background, education and good judgement what is the most you can do for a situation which does not appear to be ideal between this child and parent. Good situation for sure! As in most ethics questions...not sure if there is ever a right or wrong...just the best judgement you have at the time (& be able to back up what you did with the thought process you went through to get there.) Great things to think about before you ever have to face them!

 

[ButlerPharm.D.]

For a bunch of pharmacy students I would expect you guys to know that the law is the Health Insurance Portability and Accountability act, HIPAA not HIPPA!!!!

 

[imperial frog]

For a bunch of pharmacy students I would expect you guys to know that the law is the Health Insurance Portability and Accountability act, HIPAA not HIPPA!!!!

Don't look at me...I got it right.

 

[player0917]

HIPAA the HIPPO!

 

[no-see-um]

HIPAA the HIPPO!

Knock Knock
Who's there?
"HIPAA"
"HIPAA who?!"
"I can't tell you"...

 

[Sosumi]

For a bunch of pharmacy students I would expect you guys to know that the law is the Health Insurance Portability and Accountability act, HIPAA not HIPPA!!!!

sdn1977 isn't a pharmacy student

 

[sdn1977]

For a bunch of pharmacy students I would expect you guys to know that the law is the Health Insurance Portability and Accountability act, HIPAA not HIPPA!!!!

Thanks for the correction!!

 

[Leah27]

I recently did a one day observation at the Maryland Poison Center... we had about 60% of our calls as Drug ID's.. it really takes up time that could be more importantly used. Of these drug ID's 99% were CII's or CIII's... this is indicitive of a much bigger problem, I believe. Not only is it a waste of resources at the poison center, but it shows how much rx drug abuse is out there! I don't think anyone would mind helping an elderly person ID all the drugs that had been dumped together, but I think we get upset b/c we realize that so many people are out there abusing and us, in identifying are aiding them in a way.... this is the problem that needs to be addressed.... how to do so.. i don't know!

 

[bananaface]

Telling someone to call poison control for a simple ID is not cool. That is misuse of a critical service.