Why are junkies surprised when they are caught?

[Old Timer]

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So I open a store yesterday that I haven't been in for months. Waiting for me is a scumbag covered with tattoos and clutching an RX for Percocet 10/325 for the wife/girlfriend/whatever.

So I look up the patient in the computer and see they have filled many Rxs here and not all are for controls. So I go ahead and fill it. After the stoner leaves, I get a bad vibe so I call the doctor using the number on the script and get a cell phone type answering machine/voicemail. I look up the doctor in the computer and the number is not the same. I call the doctor and verify the doctor did not write the prescription.

Now I'm really pissed (mostly at myself) and I can't call the cops. If this was suburbs, they would have come down taken a report and had the jerks arrested within 60 minutes. Since this is Philadelphia where they have murders to deal with on a daily basis, the cops have to worry about real crime.

So now I call the lady on the phone:

ME: Hell is this Mrs Sally Junkies
SJ: Yes it is, who is calling?

ME: It's _____ the pharmacist at the CVS on ___________. I wanted to let you know that I checked with Dr. Jones and he didn't write the prescription you had filled this morning.
SJ: Really, are you sure.

ME: Yes, I'm sure, the secretary said you are not even a patient there.
SJ: I note some anger in your voice.

ME: to myself (Oh really, I sound angry?) Well you can't come to this store anymore. I will be forwarding a copy of the prescription and your name to all CVS pharmacies in the area and if you try this again, you will be arrested.
SJ: Well, I don't understand.

ME: it's illegal to forge a prescription and use said forged prescription to obtain narcotics. You won't be doing it here anymore. Have a nice day.....

 

[Ackj]

SJ: I note some anger in your voice.

I can feel your anger... it gives you focus... it makes you stronger!

 

[Sparda29]

I can feel your anger... it gives you focus... it makes you stronger!

Use your aggressive feelings boy, let the hate flow through you.

 

[J ROD]

So I open a store yesterday that I haven't been in for months. Waiting for me is a scumbag covered with tattoos and clutching an RX for Percocet 10/325 for the wife/girlfriend/whatever.

So I look up the patient in the computer and see they have filled many Rxs here and not all are for controls. So I go ahead and fill it. After the stoner leaves, I get a bad vibe so I call the doctor using the number on the script and get a cell phone type answering machine/voicemail. I look up the doctor in the computer and the number is not the same. I call the doctor and verify the doctor did not write the prescription.

Now I'm really pissed (mostly at myself) and I can't call the cops. If this was suburbs, they would have come down taken a report and had the jerks arrested within 60 minutes. Since this is Philadelphia where they have murders to deal with on a daily basis, the cops have to worry about real crime.

So now I call the lady on the phone:

ME: Hell is this Mrs Sally Junkies
SJ: Yes it is, who is calling?

ME: It's _____ the pharmacist at the CVS on ___________. I wanted to let you know that I checked with Dr. Jones and he didn't write the prescription you had filled this morning.
SJ: Really, are you sure.

ME: Yes, I'm sure, the secretary said you are not even a patient there.
SJ: I note some anger in your voice.

ME: to myself (Oh really, I sound angry?) Well you can't come to this store anymore. I will be forwarding a copy of the prescription and your name to all CVS pharmacies in the area and if you try this again, you will be arrested.
SJ: Well, I don't understand.

ME: it's illegal to forge a prescription and use said forged prescription to obtain narcotics. You won't be doing it here anymore. Have a nice day.....

I never fill if I get that gut feeling....I dont care what the DM says. My license...can get another job...not license.

 

[WVUPharm2007]

In WV, we have a database run by the BOP that allows pharmacists and physicians to look up every controlled drug a patient has filled since 2005. Every pharmacy has to report controlled scripts to the board, so it is comprehensive.

They don't even try it anymore. They go to Pennsylvania to get things filled...

 

[Old Timer]

I never fill if I get that gut feeling....I dont care what the DM says. My license...can get another job...not license.

I hate to ask this, where does the DM come into this? This less than nothing to do with this particular situation. The gut feeling part is true, you should always trust it, but the DM has nothing to do with this. The idea that any superior who has never filled a prescription is going to give me **** over verifying an RX is ridiculous. It has never happened at CVS, though it has happened at independents I worked for...

 

[Momus]

Isn't Pharmacy district manager path normally pharmacist -> pharmacy manager -> district manager? Well, most of them were pharmacists before they get promoted... They just have to act all tough because they have tougher bosses they have to answer too.

 

[Sparda29]

I hate to ask this, where does the DM come into this? This less than nothing to do with this particular situation. The gut feeling part is true, you should always trust it, but the DM has nothing to do with this. The idea that any superior who has never filled a prescription is going to give me **** over verifying an RX is ridiculous. It has never happened at CVS, though it has happened at independents I worked for...

I've heard of DMs who threaten to punish pharmacists who turn away narcotic prescriptions. For example, there was this one floater that used to work in our store like almost every other weekend. She'd never fill any scripts for CIIs. And it would be a pain in the ass for me because I see these patients almost every week, and I know that they are legit prescriptions. It would be like, the patient walks into the pharmacy, they see her there, they look at me, and I just give them a look and they come back on Monday to fill the prescription.

I guess a pharmacist like her deserves to be punished for turning away legit scripts.

 

[Old Timer]

Isn't Pharmacy district manager path normally pharmacist -> pharmacy manager -> district manager? Well, most of them were pharmacists before they get promoted... They just have to act all tough because they have tougher bosses they have to answer too.

Not in my company.

 

[J ROD]

I hate to ask this, where does the DM come into this? This less than nothing to do with this particular situation. The gut feeling part is true, you should always trust it, but the DM has nothing to do with this. The idea that any superior who has never filled a prescription is going to give me **** over verifying an RX is ridiculous. It has never happened at CVS, though it has happened at independents I worked for...

I have had customers call the District Office because I would not fill Rxs I thought that were questionable.

I will fill what I think are legit Rxs for controls....no problem.

Then, I get that call from the PDM asking why I would fill late night controls from the ER from a person trying to fill Percocet with one name on it and a nonmatching ID. It is for a "friend" in the car. Oh, and other were hurt in the car wreck too and they will be here in a minute with Perocet Rxs too...🙄

Guess what I am fresh out of Percocet.....so sorry!!

I told the PDM she could come in at 11:30PM and fill it on her license if she wanted to....I am not.

I guess that may be another reason why I am not getting much work for them PRN....

 

[Ackj]

I told the PDM she could come in at 11:30PM and fill it on her license if she wanted to....I am not.

I hear a lot of people say this. Can the board really take your license if you fill a forged rx? Of course if it's an obvious fake and you fill it, you're a ***** and you're possibly in on the deal.

But I mean, let's say it appears legitimate, valid DEA, doctor's name you've heard before. I know some people you just "get that feeling" and turn them away, but what would the consequence actually be if you don't? I'm not trolling here, honestly trying to learn something.

 

[Sparda29]

I hear a lot of people say this. Can the board really take your license if you fill a forged rx? Of course if it's an obvious fake and you fill it, you're a ***** and you're possibly in on the deal.

But I mean, let's say it appears legitimate, valid DEA, doctor's name you've heard before. I know some people you just "get that feeling" and turn them away, but what would the consequence actually be if you don't? I'm not trolling here, honestly trying to learn something.

I've been told the opposite by a professor. The consequences for turning away a legal legitimate prescription are higher than the consequences for filling a forged prescription.

 

[Old Timer]

I have had customers call the District Office because I would not fill Rxs I thought that were questionable.

I will fill what I think are legit Rxs for controls....no problem.

Then, I get that call from the PDM asking why I would fill late night controls from the ER from a person trying to fill Percocet with one name on it and a nonmatching ID. It is for a "friend" in the car. Oh, and other were hurt in the car wreck too and they will be here in a minute with Perocet Rxs too...🙄

Guess what I am fresh out of Percocet.....so sorry!!

I told the PDM she could come in at 11:30PM and fill it on her license if she wanted to....I am not.

I guess that may be another reason why I am not getting much work for them PRN....

I hate to be a contrarian here, but there is never a reason to refuse an ER script. E.R.'s are open 24 hrs so you can always call and verify if the rx is legit. There is also no requirement in PA and I assume in all 50 states that the patient must be present to present and pick an RX for a controlled substance or any other prescription. If that was the case no home bound person could ever get a controlled drug. When my stepfather had hip replacement, he did not come into the store and present or pick up his Percocet script. I didn't have his ID and nobody asked me for it.

Your license would not be on the line if you filled one phony Rx. If that was the case there would be no pharmacists left in the country. Everybody has been tripped up from time to time.

 

[rph3664]

I have filled two prescriptions that I found out later were fake. They were good fakes, too which was why I didn't pick up on it.

If you fill an RX that you KNOW is fake, that's where you get in trouble.

 

[owlegrad]

I have filled two prescriptions that I found out later were fake. They were good fakes, too which was why I didn't pick up on it.

If you fill an RX that you KNOW is fake, that's where you get in trouble.

Dood that was some awesome comma placement. I had to read that like seven times before I understood what you meant. "too which was why" didn't make any sense to me.

 

[J ROD]

I hate to be a contrarian here, but there is never a reason to refuse an ER script. E.R.'s are open 24 hrs so you can always call and verify if the rx is legit. There is also no requirement in PA and I assume in all 50 states that the patient must be present to present and pick an RX for a controlled substance or any other prescription. If that was the case no home bound person could ever get a controlled drug. When my stepfather had hip replacement, he did not come into the store and present or pick up his Percocet script. I didn't have his ID and nobody asked me for it.

Your license would not be on the line if you filled one phony Rx. If that was the case there would be no pharmacists left in the country. Everybody has been tripped up from time to time.

perhaps, you missed the part where she mentioned to me that several others were in the "accident" and will be here soon to get their Percocet too....

She looked shady and looked the part...once I heard that....she aint getting high off my supply!!

 

[J ROD]

I hear a lot of people say this. Can the board really take your license if you fill a forged rx? Of course if it's an obvious fake and you fill it, you're a ***** and you're possibly in on the deal.

But I mean, let's say it appears legitimate, valid DEA, doctor's name you've heard before. I know some people you just "get that feeling" and turn them away, but what would the consequence actually be if you don't? I'm not trolling here, honestly trying to learn something.

One here and there and a good faith effort to verify the Rx will keep you safe.

I go off my gut....

 

[Old Timer]

perhaps, you missed the part where she mentioned to me that several others were in the "accident" and will be here soon to get their Percocet too....

She looked shady and looked the part...once I heard that....she aint getting high off my supply!!

It's not your supply. You are also not the Percocet Police. This is an ER script. Pick up the phone and verify the RX. That's your job. Using ESP is not. It's one thing if it's 10:30PM and it's from a private practice that is closed. The ER thing blows you away. If the doctor wrote it and didn't sell it to the patient, you fill it.

 

[genesis09]

Everytime I call the ER/urgent care facility for a clarification on a rx, I normally get a result within 10 minutes. You can get into trouble if you always turn away a C-2 rx as a rule. You have to use your judgment to determine its letigimacy. If you get duped, and you did all the proper reviews, you won't get into trouble. If you fill a known fake, you'll have problems.

 

[Doctor M]

It's not your supply. You are also not the Percocet Police. This is an ER script. Pick up the phone and verify the RX. That's your job. Using ESP is not. It's one thing if it's 10:30PM and it's from a private practice that is closed. The ER thing blows you away. If the doctor wrote it and didn't sell it to the patient, you fill it.

agreed...

 

[MountainPharmD]

What the hell is wrong with some of you pharmacists? I have met so many that look for every excuse then can real or imagined to turn away controlled prescriptions. I have seen everything from pharmacists making up fake laws or twisting the law to justify their actions to out right discriminatory actions based on how someone looks.

As Pharmacists we are on the front lines and should be vigilant to prevent prescription drug abuse. That does not mean refusing to fill any prescriptions for controlled substances because 1 out of a 1000 may not be legitimate.

Do your due diligence when filling controls to ensure you are dispensing for a legitimate medical purpose. If you think there is a problem then call the prescriber to get clarification. I would rather take care of 99 acute and chronic pain patients and have one fake rx get by me than turn 99 prescriptions away and fill one because I was afraid someone might get over on me. Controlled meds are the same as other meds. Some people need them because of serious issues and the last thing they need is some ass hat at the pharmacy making their life more difficult.

 

[samuricool]

What the hell is wrong with some of you pharmacists? I have met so many that look for every excuse then can real or imagined to turn away controlled prescriptions. I have seen everything from pharmacists making up fake laws or twisting the law to justify their actions to out right discriminatory actions based on how someone looks.

As Pharmacists we are on the front lines and should be vigilant to prevent prescription drug abuse. That does not mean refusing to fill any prescriptions for controlled substances because 1 out of a 1000 may not be legitimate.

Do your due diligence when filling controls to ensure you are dispensing for a legitimate medical purpose. If you think there is a problem then call the prescriber to get clarification. I would rather take care of 99 acute and chronic pain patients and have one fake rx get by me than turn 99 prescriptions away and fill one because I was afraid someone might get over on me. Controlled meds are the same as other meds. Some people need them because of serious issues and the last thing they need is some ass hat at the pharmacy making their life more difficult.

👍

I wish I could remember the study, it was from the 70's (I think). Essentially some clinician was trying to convince therapists that they were misdiagnosing a certain mental disorder (schizophrenia I think). The therapists were up in arms and did all they could to destroy this persons credibility. Eventually he said that over the next few years he would tell people to go to mental hospitals wishing to be admitted for a certain disease. After a certain period of time he would check in to see how these mental hospitals were handling these fake patients. Once he received all of the data on how many patients that were turned away because they thought that they were faking the disease he told them all that he had actually never sent a single patient to any of these hospitals. So they were turning away sick people just because they didnt want to be proven wrong.

Im sure I butchered the case, but what I am trying to say is that if you dont have evidence that someone is using a fake script and youve done all you could to verify it then you are better off making sure that person is being treated properly then taking the risk that they arent.

 

[Old]

It's not your supply. You are also not the Percocet Police. This is an ER script. Pick up the phone and verify the RX. That's your job. Using ESP is not. It's one thing if it's 10:30PM and it's from a private practice that is closed. The ER thing blows you away. If the doctor wrote it and didn't sell it to the patient, you fill it.

Soooo----it is safe to say that an ER script is like the gold card. So, if the druggie that snoockered you at the start of this thread came in tomorrow with an ER script that you verfied that the MD wrote it you would gleefully fill it?? Ever think the above druggie was forced into doing what they did because they could not get the help they needed? Pharmacists refusing to fill oxy's etc for cash had forced him into this? Md's that just didn't understand their severe pain? You yelled at her/him? If it was from the ER it would have been ok?

Have you ever gotten an ER script from someone who is going to another md or 2 for pain meds and brings in another one to you? Have you ever gotten an Er script for someone you know was arrested multiple times for selling drugs. Ever a script for someone that you know has a substance abuse problem? But, because it was written in the ER its all okay? Seriously? Everyone who goes to the ER tells the doc the truth? They tell them they go to several different doctors for pain meds? The whole truth and nothing but the truth once they walk in the Er doors? The best part is we know the ER docs don't give out these scripts to prevent themselves from being sued in case they missed something, right?

Sorry, but we are still keeper of the gate or the CII safe. All scripts, even ER, have to be given due dilligence and care to make sure we are not harming the patient or the community. Filling scripts to please the cash register is second to everything else.

 

[Sparda29]

Congratulations Old Timer, Roy Halladay has thrown a no hitter in the postseason.

 

[lorain]

Soooo----it is safe to say that an ER script is like the gold card. So, if the druggie that snoockered you at the start of this thread came in tomorrow with an ER script that you verfied that the MD wrote it you would gleefully fill it?? Ever think the above druggie was forced into doing what they did because they could not get the help they needed? Pharmacists refusing to fill oxy's etc for cash had forced him into this? Md's that just didn't understand their severe pain? You yelled at her/him? If it was from the ER it would have been ok?

Have you ever gotten an ER script from someone who is going to another md or 2 for pain meds and brings in another one to you? Have you ever gotten an Er script for someone you know was arrested multiple times for selling drugs. Ever a script for someone that you know has a substance abuse problem? But, because it was written in the ER its all okay? Seriously? Everyone who goes to the ER tells the doc the truth? They tell them they go to several different doctors for pain meds? The whole truth and nothing but the truth once they walk in the Er doors? The best part is we know the ER docs don't give out these scripts to prevent themselves from being sued in case they missed something, right?

Sorry, but we are still keeper of the gate or the CII safe. All scripts, even ER, have to be given due dilligence and care to make sure we are not harming the patient or the community. Filling scripts to please the cash register is second to everything else.

yea we have to be careful....most of the time when i get a ER pain script, from a guy already on pain meds from another doc, (its an automatic call to the ER), they tell me they werent told by the pt that they were getting the pain meds from a doc already, and they tell me to destroy the rx.

the worst part is people who try to call in fake RX....you really have to learn you local doc offices and how they like to leave their VM...it helps to have it memorized so you alert yourself if something seems out of the ordinary....quick story, this one MD office, the nurse says the name of the doc, and then spells it out. one time, i checked the vm, and the lady voice did not spell the name out, which seemed odd to me. So i called the office, and they had no record of calling in the rx I was questioning.

 

[Old Timer]

Soooo----it is safe to say that an ER script is like the gold card. So, if the druggie that snoockered you at the start of this thread came in tomorrow with an ER script that you verfied that the MD wrote it you would gleefully fill it??

No, once you commit a crime at my store, you are done.

Ever think the above druggie was forced into doing what they did because they could not get the help they needed? Pharmacists refusing to fill oxy's etc for cash had forced him into this? Md's that just didn't understand their severe pain? You yelled at her/him? If it was from the ER it would have been ok?

This statement is *****ic.

Have you ever gotten an ER script from someone who is going to another md or 2 for pain meds and brings in another one to you? Have you ever gotten an Er script for someone you know was arrested multiple times for selling drugs. Ever a script for someone that you know has a substance abuse problem? But, because it was written in the ER its all okay? Seriously? Everyone who goes to the ER tells the doc the truth? They tell them they go to several different doctors for pain meds? The whole truth and nothing but the truth once they walk in the Er doors? The best part is we know the ER docs don't give out these scripts to prevent themselves from being sued in case they missed something, right?

No, there are no ER docs that give out Percocet to prevent being sued.

Sorry, but we are still keeper of the gate or the CII safe. All scripts, even ER, have to be given due dilligence and care to make sure we are not harming the patient or the community. Filling scripts to please the cash register is second to everything else.

You seem to have a reading comprehension problem. The reason that ER scripts are easy is because

YOU CAN VERIFY THEM
​

That's your due diligence. By the way, I don't think you have to due diligence. It's the other way around. You don't need to be Sherlock Holmes and prove each Rx is for a legitimate medical purpose. You can call the ER doc and find out what the diagnosis is and if they informed the doc of their other pain meds. You pick up the ****ing phone and call the doctor and don't refuse people because they look shady. Please read my post carefully. Did I ever say, fill anything from the ER no matter what I said was:

E.R.'s are open 24 hrs so you can always call and verify if the rx is legit.

So don't twist what I said into a pretzel.

 

[Old]

Maybe a small town and a large city are different. Where I am at you get to know the junkies and dealers. Many, many times before filling an rx, er or otherwise, in verfication when I pull up a profile(which I am sure you do at CVS) I see the recent and multiple rx for controlled drugs. When calling the prescribing physician, often Er, they were not told about any of other drug use by the patient. Most often cancelling the rx. So, in reality just calling the doc and verifying he wrote it means almost nothing.

So, when you say you can verify the rx- it is often as meaningful as saying it is written on paper. Therefore since it is written and verified you have to fill it. Which is what I thought you said(not using Esp, not the percocet police). That makes no sense what so ever. You still have to use common sense. At least I think its part of your profession or should be.

As far as the liabilty of being a ER doc --I suggest you get to know a few personally. Find out what they are up against and their liability risks. its different than what you think.



As far as twisting things in to pretzels- I like pretzels.


Sounds like you had a bad day. How was the old Triple s score. Hopefully over 85.🙂

 

[Old Timer]

Maybe a small town and a large city are different. Where I am at you get to know the junkies and dealers. Many, many times before filling an rx, er or otherwise, in verfication when I pull up a profile(which I am sure you do at CVS) I see the recent and multiple rx for controlled drugs. When calling the prescribing physician, often Er, they were not told about any of other drug use by the patient. Most often cancelling the rx. So, in reality just calling the doc and verifying he wrote it means almost nothing.

So, when you say you can verify the rx- it is often as meaningful as saying it is written on paper. Therefore since it is written and verified you have to fill it. Which is what I thought you said(not using Esp, not the percocet police). That makes no sense what so ever. You still have to use common sense. At least I think its part of your profession or should be.

As far as the liabilty of being a ER doc --I suggest you get to know a few personally. Find out what they are up against and their liability risks. its different than what you think.



As far as twisting things in to pretzels- I like pretzels.


Sounds like you had a bad day. How was the old Triple s score. Hopefully over 85.🙂

The District SSS has been:

90.4 in August
90.9 September
90.8 so far this month.

I didn;t have a bad day at all until read your stuff. When you call a doctor you give him all the information. It's not your job to turn people away with scripts from an Emergency Room unless you know they are fake or the person is an abuser. And finally, I know plenty of doctors and none of them give out narcotics to avoid being sued.

 

[Ackj]

We had a fake phone-in today. Not even a good fake. They asked for 30 Ambien and then as an afterthought, 10 Percocet 10/325. When I asked what the sig was, they didn't know what a sig was. When I asked for the DEA, they fumbled for a while as if they didn't know it. "It's funny, I should probably know it, since I call in rx all the time... hey, don't you already have me on file...?" After a little while and eventually gave me a number starting with HFC and then 8 digits. They then went on to say "maybe it's just FC, the H might be a number sign." Even better, this was clearly a female with an accent. When we called later called the real doc, he was clearly a male with no accent (sounded like a nerdy white guy, to be honest).

The patient called us about 5 minutes later and asked for a price quote for the two rxs. We said we wouldn't know until she came in. She came in and gave us her medicaid card, phone number, address. We scanned it all and then told her we couldn't accept the phone in. Our buddy from the DEA will be getting a call as soon as he gets into his office tomorrow morning. Maybe they'll even get her for medicaid fraud.

 

[VA Hopeful Dr]

The District SSS has been:

90.4 in August
90.9 September
90.8 so far this month.

I didn;t have a bad day at all until read your stuff. When you call a doctor you give him all the information. It's not your job to turn people away with scripts from an Emergency Room unless you know they are fake or the person is an abuser. And finally, I know plenty of doctors and none of them give out narcotics to avoid being sued.

Generally correct. That being said, since many ED physicians work via hospital contract and those contracts often depend on patient satisfaction scores to get renewed every year, there are ED docs who will often write for opioids to avoid having someone in administration cause a fuss.

Also, sometimes a 2-3 day course of vicodin/percocet will get people out the door without too much fuss whereas refusing may lead to them yelling, getting violent, and needing the police.

I'm not saying I approve of this, but its the reality in many places.

 

[Carboxide]

I hate to be a contrarian here, but there is never a reason to refuse an ER script. E.R.'s are open 24 hrs so you can always call and verify if the rx is legit. There is also no requirement in PA and I assume in all 50 states that the patient must be present to present and pick an RX for a controlled substance or any other prescription. If that was the case no home bound person could ever get a controlled drug. When my stepfather had hip replacement, he did not come into the store and present or pick up his Percocet script. I didn't have his ID and nobody asked me for it.

Your license would not be on the line if you filled one phony Rx. If that was the case there would be no pharmacists left in the country. Everybody has been tripped up from time to time.

I thought of this thread today while studying for an exam. Part of this unit is on professionalism and pharmacy practice, and it was in the notes that part of our professional responsibility is to refuse to fill a script if we believe that it may be used for non-medicinal purposes, REGARDLESS of validity of the script. Just found that interesting considering OldTimer's perspective.

 

[All4MyDaughter]

I thought of this thread today while studying for an exam. Part of this unit is on professionalism and pharmacy practice, and it was in the notes that part of our professional responsibility is to refuse to fill a script if we believe that it may be used for non-medicinal purposes, REGARDLESS of validity of the script. Just found that interesting considering OldTimer's perspective.

I agree with that in principle, but how would you KNOW that the script is being used for "non-medicinal" purposes? Most of the time, I don't see how we could be sure. I would not want to deny a patient medication that they need just because of "a hunch" or "a feeling." I'd want to be sure, and I don't know how you could be.

 

[Doctor M]

I agree with that in principle, but how would you KNOW that the script is being used for "non-medicinal" purposes? Most of the time, I don't see how we could be sure. I would not want to deny a patient medication that they need just because of "a hunch" or "a feeling." I'd want to be sure, and I don't know how you could be.

Theres no way to know. You could call the doctor and they could read off some mumbo jumbo diagnosis that i know nothing about. The script is valid, the doctor wrote it, but now im asking for a diagnosis??

 

[Doctor M]

We had a fake phone-in today. Not even a good fake. They asked for 30 Ambien and then as an afterthought, 10 Percocet 10/325. When I asked what the sig was, they didn't know what a sig was. When I asked for the DEA, they fumbled for a while as if they didn't know it. "It's funny, I should probably know it, since I call in rx all the time... hey, don't you already have me on file...?" After a little while and eventually gave me a number starting with HFC and then 8 digits. They then went on to say "maybe it's just FC, the H might be a number sign." Even better, this was clearly a female with an accent. When we called later called the real doc, he was clearly a male with no accent (sounded like a nerdy white guy, to be honest).

The patient called us about 5 minutes later and asked for a price quote for the two rxs. We said we wouldn't know until she came in. She came in and gave us her medicaid card, phone number, address. We scanned it all and then told her we couldn't accept the phone in. Our buddy from the DEA will be getting a call as soon as he gets into his office tomorrow morning. Maybe they'll even get her for medicaid fraud.

ehh...shes a small fish...good enough for the local cops...but DEA? Most of the DEA around here go after the big fish...the ring leaders for Oxycodone 30mg from pill mills...

 

[All4MyDaughter]

Theres no way to know. You could call the doctor and they could read off some mumbo jumbo diagnosis that i know nothing about. The script is valid, the doctor wrote it, but now im asking for a diagnosis??

Eggsactly. This is why we aren't The Percocet Police (thanks, Old Timer). I also think that a lot of people's "hunches" about patients are rooted in stereotypes and biases... We can't be sure and therefore, we shouldn't be turning away scripts willy-nilly. JMO.

 

[Doctor M]

Eggsactly. This is why we aren't The Percocet Police (thanks, Old Timer). I also think that a lot of people's "hunches" about patients are rooted in stereotypes and biases... We can't be sure and therefore, we shouldn't be turning away scripts willy-nilly. JMO.

The DEA here urged us to call on all narcotic prescriptions to make sure the rx is written for a legitimate medical purpose...Really? So im suppose to call on every single narc to get some BS diagnosis and then the rx is legit? Please...I assume that the patient was seen by the doctor and the doctor has prescribed the rx for a legitimate reason. My job is to make sure the rx is valid ( not a fake rx) fill the rx correctly, and counsel the patient on the medication...I never went to school to be a detective.

 

[owlegrad]

Eggsactly. This is why we aren't The Percocet Police (thanks, Old Timer). I also think that a lot of people's "hunches" about patients are rooted in stereotypes and biases... We can't be sure and therefore, we shouldn't be turning away scripts willy-nilly. JMO.

Agreed. It is not our* place to play Wise King Solomon with people's prescriptions. Valid script? Fill it. I don't know why you wouldn't. If you think someone shouldn't be on pain medication why don't you follow them home and live with them for a week so that you can be sure they are not really in pain. You can't say for sure if someone is in pain.

What is worse, filling 10 "bad" (valid, but not appropriate) prescriptions or turning away one person who really needs their medication? If your spider sense is tingling call the doc. If they say it's real, fill. JMO.

Here in Florida it is hell I must say though. No less than 20 calls a day: "Do you have R/Oxy"? It gets old fast. Still from my prospective our* duty is to dispense, not get around dispensing.

*One day! Can't come soon enough.

 

[owlegrad]

The DEA here urged us to call on all narcotic prescriptions to make sure the rx is written for a legitimate medical purpose...Really? So im suppose to call on every single narc to get some BS diagnosis and then the rx is legit? Please...I assume that the patient was seen by the doctor and the doctor has prescribed the rx for a legitimate reason. My job is to make sure the rx is valid ( not a fake rx) fill the rx correctly, and counsel the patient on the medication...I never went to school to be a detective.

Couldn't agree more M. I haven't yet had a class that teaches us how to discern if someone is legitimately in pain. How would that go?

M: Are you really in pain?
C: Yes
M: Really?
C: Yes, really
M: No, I mean really, really?
C: Yes
M: Alright then here you go...

How does getting a diagnoses from the doc make a script more valid? Ridiculous. If the doctor wrote the script he can come up with a diagnoses to back it up. Just trying to put more responsibility on the pharmacist without giving him any tools to actually curtail the problem.

 

[Doctor M]

Agreed. It is not our* place to play Wise King Solomon with people's prescriptions. Valid script? Fill it. I don't know why you wouldn't. If you think someone shouldn't be on pain medication why don't you follow them home and live with them for a week so that you can be sure they are not really in pain. You can't say for sure if someone is in pain.

What is worse, filling 10 "bad" (valid, but not appropriate) prescriptions or turning away one person who really needs their medication? If your spider sense is tingling call the doc. If they say it's real, fill. JMO.

Here in Florida it is hell I must say though. No less than 20 calls a day: "Do you have R/Oxy"? It gets old fast. Still from my prospective our* duty is to dispense, not get around dispensing.

*One day! Can't come soon enough.

I hear that!!! We have to turn people away, we just dont have enough for everyone that calls. "Do you have Roxis"...Probably not the way to ask me if i have it in stock LOL...The DEA would probably say that filling 10 bad ones is worse than turning 1 legit rx away...It's just impossible to know...But we do fill oxycodone and we feel the same when it comes to filling it...If its a valid rx, we fill it...but currently we are not taking new rx's for the drug...And we are not afraid to fill the rx...DEA agent came in looking for one doctors rx we filled for a total of 2 months and then we stopped cause we just didnt like quantities...I know, seems wrong, but something just wasnt right. The agent was nice but just didnt really know anything about the practice of having to call on every single narcotic...

 

[owlegrad]

I hear that!!! We have to turn people away, we just dont have enough for everyone that calls. "Do you have Roxis"...Probably not the way to ask me if i have it in stock LOL...The DEA would probably say that filling 10 bad ones is worse than turning 1 legit rx away...It's just impossible to know...But we do fill oxycodone and we feel the same when it comes to filling it...If its a valid rx, we fill it...but currently we are not taking new rx's for the drug...And we are not afraid to fill the rx...DEA agent came in looking for one doctors rx we filled for a total of 2 months and then we stopped cause we just didnt like quantities...I know, seems wrong, but something just wasnt right. The agent was nice but just didnt really know anything about the practice of having to call on every single narcotic...

Yeah that used to crack me up. No one ever calls asking is we have Furoses or Lisinis.

Yeah it's sad, but I guess you really do have to draw the line somewhere. If you filled every callers rx you wouldn't do much else. Not to mention how terrible an idea it would be to give that information over the phone. And of course if something seems wrong, you good judgement. I would say most people take that way to far though, in the sense that they use that as a pretext for not fillinf narcs.

I am sorta confused by your statement. You don't accept new prescriptions for Roxy, but you are not afraid to fill them and you do fill valid rx's? Huh?

 

[Doctor M]

Yeah that used to crack me up. No one ever calls asking is we have Furoses or Lisinis.

Yeah it's sad, but I guess you really do have to draw the line somewhere. If you filled every callers rx you wouldn't do much else. Not to mention how terrible an idea it would be to give that information over the phone. And of course if something seems wrong, you good judgement. I would say most people take that way to far though, in the sense that they use that as a pretext for not fillinf narcs.

I am sorta confused by your statement. You don't accept new prescriptions for Roxy, but you are not afraid to fill them and you do fill valid rx's? Huh?

We fill enough oxycodone. We have had increase limits from our wholesaler twice because we are growing at an unbelievable rate. So with increased business comes increased oxycodone...We do not want to increase our limit at this time because we are comfortable now...and when i say we fill oxycodone, we are not a pill mill, but we do fill it...You know what im saying?

 

[owlegrad]

[/B]
We fill enough oxycodone. We have had increase limits from our wholesaler twice because we are growing at an unbelievable rate. So with increased business comes increased oxycodone...We do not want to increase our limit at this time because we are comfortable now...and when i say we fill oxycodone, we are not a pill mill, but we do fill it...You know what im saying?

Yeah I think I get it. It is a tight rope to walk, no one wants to be the go-to place for all narcs in the state of Florida. Well no legitimate pharmacy. Ashame it's gotten this bad.

 

[Doctor M]

Yeah I think I get it. It is a tight rope to walk, no one wants to be the go-to place for all narcs in the state of Florida. Well no legitimate pharmacy. Ashame it's gotten this bad.

Exactly! No referrals, no price negotiation...No BS, No crowds, no nothing...Like I said, we fill it with a valid Rx, and we have our established clientele. We have rules...And it is too bad that it has gotten like this...

 

[All4MyDaughter]

When people call to ask if we have "the blue watsons" I just play dumb and pretend I don't know what they mean.

 

[Doctor M]

When people call to ask if we have "the blue watsons" I just play dumb and pretend I don't know what they mean.

oxybutynin???LOL

 

[Old Timer]

I thought of this thread today while studying for an exam. Part of this unit is on professionalism and pharmacy practice, and it was in the notes that part of our professional responsibility is to refuse to fill a script if we believe that it may be used for non-medicinal purposes, REGARDLESS of validity of the script. Just found that interesting considering OldTimer's perspective.

OK,inspector gadget, how do you know that. I hate to be a pain in the ass but for the simple minded amongst us let's review.

I commented on turning down an ER script because the presenter "looked funny". I felt you could not tell much about a person by the way they looked. I further feel since this is an ER, you can call and verify the validity and the necessity of the prescription. If the patient has an abuse history or has recently received controls from other practitioners, you could discuss this with the prescriber and the two of you could come to a consensus on whether this should be filled or not.

So, if you follow my advice, you will fill prescriptions that are legitimately written and medically necessary and only turn down those prescriptions that do not meet that criteria all without the need of ESP or a private detective.

 

[Doctor M]

OK,inspector gadget, how do you know that. I hate to be a pain in the ass but for the simple minded amongst us let's review.

I commented on turning down an ER script because the presenter "looked funny". I felt you could not tell much about a person by the way they looked. I further feel since this is an ER, you can call and verify the validity and the necessity of the prescription. If the patient has an abuse history or has recently received controls from other practitioners, you could discuss this with the prescriber and the two of you could come to a consensus on whether this should be filled or not.

So, if you follow my advice, you will fill prescriptions that are legitimately written and medically necessary and only turn down those prescriptions that do not meet that criteria all without the need of ESP or a private detective.

I once called a doctor on an rx for oxycontin and they indeed write the rx and she gave me some mumbo jumbo as to why the pt needed it...validity and necessity were verified, therefore the rx was filled...2 months later, the doctor was shut down...hmmmm...

 

[Old Timer]

I once called a doctor on an rx for oxycontin and they indeed write the rx and she gave me some mumbo jumbo as to why the pt needed it...validity and necessity were verified, therefore the rx was filled...2 months later, the doctor was shut down...hmmmm...

Look, anyone can get taken. In our supposed example, this is an ER script. It's harder when it's not. But after a while you see the signs of a pill mill.

• All patients get the same thing.
• They only get controls.
• They come each month like clock work.
• They have a handful of Rxs in different names.
• Skinny people get diet pills.
• They pay cash.
• They come in packs.
• They ask if you "cash" prescriptions.
• They ask for a specific number like 602's
• etc.

People in pain will take a number of non controlled medications. When it's Oxycontin 80, Oxycodone 30 and Xanax 2, it's a RED flag...

 

[Doctor M]

Look, anyone can get taken. In our supposed example, this is an ER script. It's harder when it's not. But after a while you see the signs of a pill mill.

• All patients get the same thing.
• They only get controls.
• They come each month like clock work.
• They have a handful of Rxs in different names.
• Skinny people get diet pills.
• They pay cash.
• They come in packs.
• They ask if you "cash" prescriptions.
• They ask for a specific number like 602's
• etc.

People in pain will take a number of non controlled medications. When it's Oxycontin 80, Oxycodone 30 and Xanax 2, it's a RED flag...

i agree with you...chill

 

[Carboxide]

OK,inspector gadget, how do you know that. I hate to be a pain in the ass but for the simple minded amongst us let's review.

I commented on turning down an ER script because the presenter "looked funny". I felt you could not tell much about a person by the way they looked. I further feel since this is an ER, you can call and verify the validity and the necessity of the prescription. If the patient has an abuse history or has recently received controls from other practitioners, you could discuss this with the prescriber and the two of you could come to a consensus on whether this should be filled or not.

So, if you follow my advice, you will fill prescriptions that are legitimately written and medically necessary and only turn down those prescriptions that do not meet that criteria all without the need of ESP or a private detective.

Wow, calm down. I was just mentioning something I'd learned in class to see what people had to say. I'm not a practicing pharmacist, and I'll be the first to admit I don't know jack **** right now. But there is NO reason to be that snippy.