Sketchy C-II Scripts from South Florida

[kvl1027]

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Has anyone else been getting an excessive amount of really sketchy C-II scripts from South Florida? In one day I will get up to 3 or 4 patients coming in for Oxy-15's and Oxy-30's all of them have scripts that all look the same, with respect to the blanks and the layout of the scripts, but all are from different clinics, cities, and all different patients. The scripts really just look too good. What physician puts their DEA, ST#, and NPI on a script?

 

[Tenor CS]

I'm in the Orlando area as well, and I've seen a ton of that. It always sets off red flags for me, when I think, "Why is someone filling a script written today or yesterday, in a town that's a 4-5 hour drive from where the rx was written?"

Another trick I've seen: some hospital ER's print rx's on 8.5x11" forms that have perforations that can be broken into 2 or 4 smaller pieces of paper, so 2-4 rx's can be printed on one page. Fakers are getting legit scripts for say, an antibiotic, that uses 1 of the 4 blanks, but the hospital is giving them the whole page. Then the fakers copy the font and layout of the legit script, run the paper through their own printer, and print their own narcotic scripts.

They do a pretty good job of the attempted forgery, but usually mess something up that gives it away. Their other biggest downfall is that they get greedy and write for ridiculous amounts, like 80mg OxyContin q3h disp #240.

 

[Tenor CS]

I don't know if other states have places like these, but a pain clinic in Tampa (and it is just one of MANY) was shut down a few months ago. Watch the video and see how sketchy the crowd is.

http://www.myfoxtampabay.com/dpp/ne...ies-raid-pain-clinic-exposed-by-fox-13-052010

 

[aboveliquidice]

Why not call and verify? Not from contact info on the script. Florida really has a big problem now - 3 or 4 months ago, there was a huge Rx narcotics bust. It netted 80ish cirminals, but that is really a small dent in the problem.

 

[Tenor CS]

Why not call and verify?

In my (admittedly limited) experience) calling to verify from a doctor's office is pretty easy. Calling to verify from a hospital can be a nightmare. Especially if it was from the ER, the doctor is either busy or not in the building anymore.

In our little store, it is also the unwritten policy to only fill narcotic scripts for regulars with reasonable quantities. New patients who come through the drive-thru 10-20 minutes before closing with ridiculous quantities get told, "Sorry, we're out of stock."

 

[aboveliquidice]

In my (admittedly limited) experience) calling to verify from a doctor's office is pretty easy. Calling to verify from a hospital can be a nightmare. Especially if it was from the ER, the doctor is either busy or not in the building anymore.

In our little store, it is also the unwritten policy to only fill narcotic scripts for regulars with reasonable quantities. New patients who come through the drive-thru 10-20 minutes before closing with ridiculous quantities get told, "Sorry, we're out of stock."

In certain parts of the country (read south Florida), that is a perfectly legitimate response.

I agree that verifying ER scripts can be difficult. Contacting each hospital and asking for the appropriate way to verify scripts is a must-do. As an intern, I was required to update the "verification SOP binder". It's solo purpose was to explain how to verify scripts for each hospital / clinic. It takes time on the front end, but saves a boatload on the tailend.

 

[Tenor CS]

I once floated at a store in a really bad neighborhood. The "good" name-brand and store-brand PSE were hidden under the counter. Anybody who looked like an "after" photo from a "faces of meth" article was denied.

 

[ethyl]

The typical conversation:

"Sorry these are on back order and we don't fill controlled substances from out of this area"

[insert 5 minute long sob story with slurred speech from the C-II seeker, which usually involves their medicine being stolen or anything else that seems ridiculous]

"No I don't know anyone else who carries them."

"No I don't know when our order will come in."

"No we don't carry the 15's or the 30's"

 

[ethyl]

They're even putting diagnosis codes on sometimes, just so pharmacies are less apt to call because they get swamped all day by pharmacy calls.

I just got licensed this summer and moved to West Palm Beach from Ohio to work.. the oxycodone problem is so out of control. My store is a very small one that does low volume, and although we have tons of 15s and 30s in the safe I spend all day telling people we just don't have it in stock.

Just comes down to discretion... some stores in our chain north of us in Juno/Jupiter fill any and all Roxy scripts that come through the door no problem. They're notorious for being pummeled by hoardes of junkies every day and recently had some DEA investigation.

For me, I only fill for a) a handful of regulars who get it from us every month for reasonable quantities (#60,90), or b) for people who go to other branches of our chain and have a profile history including drugs that are non-narcotics and who use insurance (along with being a reasonable quantity).

For this mass amount of 20-30 year old, cash paying, new profile patients with their 3 scripts from a pain clinic for xanax 2mg, roxy15 and roxy30, I'll offer to fill the Xanax but the others we don't have in stock. Hate to stereotype but down here it's so easy, you just know what their scripts are for when they bring their sketchy self up to the counter.

No doubt must be pretty difficult because you're in the heart of the problem. I would encourage you to reconsider filling the xanax as well, since we all know it's going to be abused just as much.

 

[kvl1027]

They're even putting diagnosis codes on sometimes, just so pharmacies are less apt to call because they get swamped all day by pharmacy calls.

I just got licensed this summer and moved to West Palm Beach from Ohio to work.. the oxycodone problem is so out of control. My store is a very small one that does low volume, and although we have tons of 15s and 30s in the safe I spend all day telling people we just don't have it in stock.

Just comes down to discretion... some stores in our chain north of us in Juno/Jupiter fill any and all Roxy scripts that come through the door no problem. They're notorious for being pummeled by hoardes of junkies every day and recently had some DEA investigation.

For me, I only fill for a) a handful of regulars who get it from us every month for reasonable quantities (#60,90), or b) for people who go to other branches of our chain and have a profile history including drugs that are non-narcotics and who use insurance (along with being a reasonable quantity).

For this mass amount of 20-30 year old, cash paying, new profile patients with their 3 scripts from a pain clinic for xanax 2mg, roxy15 and roxy30, I'll offer to fill the Xanax but the others we don't have in stock. Hate to stereotype but down here it's so easy, you just know what their scripts are for when they bring their sketchy self up to the counter.

Yes, they always come in with a XANAN, OXY 15, and OXY 30. When you offer to fill the xanax, they always say they would rather have them all filled in the same place. I consider myself to be a decent and pleasant pharmacist, but the thought that someone would travel 130 miles just for me to fill their prescriptions is absurd.

I have tried to call and verify the scripts and the person who answers the phone just says "Dr's Office". I think with all the problems down here with the recent pain clinic busts, my policy has been to only fill C-II from docs that are in town or from patients who are regulars and I know their issues.

For the most part I will always fill a C-II from say Moffit Cancer Center or MD Anderson, but I just find it very odd that all of these docs from different towns and practices would all use the same blanks and all decide to put too much information on them.

I always love when people call me to ask If I have Oxy's in stock. You are just asking to have someone come in and stick a gun in your face or to have a plethora of C-II's within the hour. You always no when you answer the phone if they are going to be asking you for Oxy's, when the patient gives you the story before they ask the question.

 

[Farmercyst]

Got a call yesterday asking if they still made the old formulation because the new formulation gave the pt nausea. Preceptor said that because the new formulation is gummy when ground and put in solution (can't get into a syringe) that this may be a common occurrence until the old formulation is out of the marketplace entirely.