will I get sued if pt has withdrawl because I didn't early fill her clonazepam?

[fxok425]

I am a newly licensed pharmacist. yesterday, I rejected an early refill of a pt's clonazepam even though the Dr is OK on early refill for two days. the dr was even on the phone trying to persuade me to early refill. I looked at the regular pharmacist's note - NO EARLY RFILL! The pt is on clonazepam 1mg 7ts a day (210 ts for 30 days) and Norco 10 8ts a day . Dr said he approved early refill because he was worried about she will go into withdrawal. I was like: She early refilled every month. They add up! If she needs more, you can increase the dose. But the DR doesn't want to increase the dose, he said it's the maximum already. Then I said I won't fill it. I am not comfortable to do so as a newly licensed floater. She can come back next morning talk to the pharmacy manager.

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[zelman]

You did the right thing. If patient goes into withdrawal it is entirely their fault. If they are taking controlled substances in a manner contrary to their physician's orders, they are probably technically breaking the law.

That being said, you can be sued for anything. You will almost certainly not be found liable for any wrongdoing in this instance. Just document the conversation with the physician and you'll be all set.

 

[BidingMyTime]

if the patient is in that bad of shape, she should go to the ER and be evaluated by a physician. Or for that matter, the doctor/patient can try there luck at another pharmacy. Yes, the pt could sue you if anything went wrong, but that lawsuit would go nowhere. Obviously, there was no reason they should have been out of medicine, with documented, repeated early refills. Continuing to refill early puts you far more at risk with the DEA, then with a lawsuit--obviously this patient is misusing the drug, possibly even selling it.

 

[Old Timer]

You have all the information you needed when the doctor declined to write an order for the patient in the manner the patient was consuming the medication. If they refill early every month then they are consuming more than the order. The doctor is trying to pass the liability on to you. Screw him. I always take a second or two and go back six months or a year and tell them they should still have 83 tablets left, so no I won't renew it early.

 

[Dr Wario]

Wow, why isn't there a class in pharmacy school called how to deal with junkies? It would have been more valuable than 95% of the stuff I learned.

 

[PharMed2016]

Just to put that into perspective ~ clonazepam 7mg daily = lorazepam 28mg daily. That's just plain bad practice.

 

[drcrispmd]

I'm not a pharmacist but you did the right thing. What physician would have someone on 210 Klonopin a month. That is ridiculous. My patients sign a contract that early refills will not be authorized for any reason. This is why there is such a controlled substance issue. If the patient is really getting that many and the doc is authorizing early refills all the time, the dea needs to review the docs records. There have been several docs have their license suspended in the area because of their prescribing and documenting practices.

 

[Digsbe]

If she goes into withdrawal she can go to the ER for treatment. Was there any explanation why she didn't have any especially given the fact that she should have plenty with overlapping early refills? Getting early refills every month isn't acceptable and if you fill it you may get in trouble with the DEA if they see trends of allowing early fills over and over again. You made the right call. A patient can sue you for anything, but whether or not they win in court is the big thing. You acted in professional judgement with no intent to harm and if anything the physician, who is aware of constant early refills and is authorizing early ones with no good cause, should be held liable especially if he's trying to work around increasing the dose and passing on liability to others.

 

[npage148]

It's illegal to prescribe/dispense a drug to maintain a dependency. I've had doctors tell me the patient needs a drug early to avoid withdrawls never mentioning pain/anxiety/etc and that's an instant do not fill on my list. I've also had limp-noodle doctors knowing give morphine rx to an active drug seeker and when pressed about it they said their were basically putting the issue on me and were relieved when I said I would not be filling it.

 

[BidingMyTime]

It's illegal to prescribe/dispense a drug to maintain a dependency. I've had doctors tell me the patient needs a drug early to avoid withdrawls never mentioning pain/anxiety/etc and that's an instant do not fill on my list.

Very true, but dependency is legally not the same as addiction. It is illegal to prescribe/dispense drugs to maintain an addiction (but I think an exception can be made if the doctor is giving a few days supply to hold the pt over until they get to a registered treatment program?) It is NOT illegal to prescribe/dispense drugs that a patient is dependent on (since those drugs would have be to be weaned off by anyone who was taking them.)

 

[txpharmguy]

Perhaps she was nervous because she was getting low and maybe the weekend was coming up and the thought about being potentially out caused her "additional" anxiety. Of course, I don't know the circumstance with this lady, but open communication with pt and prescriber is vital in situations like this. But would I feel 2 days early if it was a first time? Yes, I would

 

[Wheresmyaricept]

Perhaps she was nervous because she was getting low and maybe the weekend was coming up and the thought about being potentially out caused her "additional" anxiety. Of course, I don't know the circumstance with this lady, but open communication with pt and prescriber is vital in situations like this. But would I feel 2 days early if it was a first time? Yes, I would

But I ran out because the pharmacy shorted me and while I was on my way to tell them, I got robbed while I was flushing them down the toilet because I left some on the bus and magically I have an extra 50 dollars now...

 

[marscole]

I wonder if the pt will get withdrawal immediately if he/she didn't take the drug for 1-2 days?

I met a pt who came in for lorazepam. She stated that she didn't have the med for 3 days and really really needed it right now. She was shaking, verbally slow, and looked tired. So, my RPh gave her 1-day emergency and told her to come back tmr.