Beyond the RED FLAGS !

§1306.04 Purpose of issue of prescription.

(a) A prescription for a controlled substance to be effective must be issued for a legitimate medical purpose by an individual practitioner acting in the usual course of his professional practice. The responsibility for the proper prescribing and dispensing of controlled substances is upon the prescribing practitioner, but a corresponding responsibility rests with the pharmacist who fills the prescription.

This is apparently the part of the law where the DEA is hanging their hat on taking Pharmacists/Pharmacies on..  So it would appear that we Pharmacists are expected to be diagnosticians. It has been a while since I was in pharmacy school and the course work has probably changed considerably.. but.. is there now a course on diagnosing with the Pharmacy course work ? There sure wasn’t when I went to school !

I find this “instructional video”  produced by the NABP, somewhat humorous … Was that a HIPAA violation I saw with a Pharmacist talking to the pt in a rather loud tone.. with a couple of other people within ear shot?

One vignette… shows only one RPH working.. no one else in the pharmacy and/or Rx dept.. no phones ringing.. no techs present.. one even shows TWO RPH’s working at the same time with NO TECHS…  Was the name of this place “Fantasy Pharmacy “?

Did you notice how easy it was to pull up a PMP report ?.. I am a registrant of two states’ PMP systems and getting a report from them is very time consuming.. just to get the report and then you have to review it.. and come to a valid conclusion.

Did you notice that the pt handing over the prescriptions for opiate/benzo/muscle relaxant… but.. in the states that I am licensed in… it is ILLEGAL to have more than one drug per Rx form.. and in the states that I am licensed in.. such a order with three  different controls would automatically make it NULL/VOID.

And isn’t it a miraculous that this one young lady was “bottoming out” just as this particular Pharmacist asked some questions and she was “saved”

Unfortunately, it doesn’t always work out that way.. just the other day .. Crazy Rx Man made a post on his blog http://crazyrxman.blogspot.com/2014/05/trust-your-instincts.html

Where he turned down a high quantity of Ambien.. for regular customers… but his turning them down.. only gave them a reason to find another methodology to “end it all”.. which they did.

I recently had a article that I had penned published  in DRUG TOPICS   Filling prescriptions for controlled substances: Establish a protocol

Pharmacist/Attorney also had a article published shortly thereafter    Diversion of opioids: Red flags and green flags

I have been told about PIC’s that have made edicts that their store is no longer going to fill ANY CONTROLS FOR ANYONE.. PERIOD..

Have we forgotten that none of us are perfect?.. Most of us are not diagnosticians… even specialists cannot diagnose everything.. even within their specialty …

One of the online comments was this    “…which is the better alternative? To let a few doses of a controlled substance go? Or to cause a chronic pain patient to go into elevated pain, withdrawal, a possible hypertensive crisis, stroke and/or death?” There are emergency rooms built to help the latter. There are pharmacists in jail for the former. I know what I’d pick

To me this show just how naive that some of us are.. generally, a person showing up at a ER complaining of chronic pain.. will be viewed as a “drug seeker” and will be provided nothing.. Typically, to get a Rx for a opiate out of ER.. you need to show up with something broken or have to have some stitches.  Has the typical Pharmacists become so analytical.. that we have lost all empathy for our fellow man ?

3 Responses

  1. I was going to welcome you to the party, Steve. Posting that video makes it look like you care about curbing drug abuse and diversion. But from your comments, it seems you still have contempt for anybody (or in this case the NABP) who treats suspicious people suspiciously. To state the obvious… The video is not meant to be taken literally. It was not set in a real pharmacy with real pharmacists, real techs and real customers. They are actors who are merely highlighting the problems of abuse, doctor shopping and diversion. By picking on insignificant details, like no phones ringing or the ease with which they accessed the PMP just shows that you are hopelessly biased. It is important to put this type of information out there. Pharmacists need to know that they are the Keepers of the Drugs. We are the last line of defense when it comes to preventing good drugs from becoming bad drugs. We do not want to be lied to. We do not want to be tricked. We do not want to be fooled into filling bogus prescriptions. If this video gives some pharmacist the courage to refuse a bad prescription, I applaud the NABP. I say we need more tools like this.

    • @William.. I do care about curbing drug abuse.. but.. not at the expense of the chronic pain community. We have been spending abt $8,500 per person per year abusing some substance and more than ONE TRILLION over the last FOUR DECADES.. and the per-cent of the population that is abusing some substances remains in the same 1% -2% percent of the population. IMO.. the things pointed out in the NABP’s video should be “common sense” to Pharmacists.. if it isn’t.. then their college and/or preceptor failed them. I have read over and over states like Ohio & KY that have been “hard nosed” about legal drugs getting to the streets.. where Heroin use/abuse/deaths have dramatically increased. 100 yrs officially fighting this war on drugs .. since the Harrison Narcotic Act 1914.. can anyone point out the progress that has been made ? We have proven that prohibition does not work.. it didn’t work with alcohol.. it has not worked with opiates.. it would not work with tobacco.. and I am sure that there are other “addictions” that some in our society have.. that prohibition would not work on either. Those that have an addictive personality.. prohibition is not going to alter their behavior.. BUT.. trying to change their behavior by harming/denying those in the chronic pain community of their medically necessary medication.. I will never go along with.

  2. Most excellent video, its hard to catch a doctor shopper, their the best liars ,they can convince people very easy and seem to just have all the luck in the world.
    But this cant last forever and one day their time will come. I remember being questioned many times at the pharmacy counter, some people just have the worst luck ever and that’s me. Even though I’m a true pain sufferer ,It seems I get the third degree every where I go. But pharmacist have a job to do and its good they check to make sure I truly suffer from chronic pain.

    When I advocated for those suffering in chronic pain I talked to and helped more women than men. I had to have proof they truly suffered from chronic pain and asked for a radiology report from a MRI or Cat Scan. After talking to many people over a 8 year period it seemed abusers where too quick to ask for a doctors name before explaining their pain problem to me. After receiving a copy of true pain sufferers MRI radiology report I was able to help them find a doctor. Some people tried getting over on me and used a MRI radiology report from a different person and whited out their name and typed in their name .I was able to help a lot of pain sufferers find relief for their chronic pain. And the people that where doctor shopping never got a doctors name from me. If your not a true pain sufferer and your doctor shopping your day will come, it might not be this week or this month but down the road it will catch up with you. So do yourself a favor and get off medications you don’t need.This is causing problems for the true pain sufferers of the U.S. The combo Hydrocodone, Soma and Xanax is called the Texas Trio here in Houston. Its a huge Red flag now days.

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