What Would You Do | How to Manage Work Challenges

Situation 6: Patient may be abusing narcotics

By: Karine Wong, Pharm. D.

You are a retail pharmacist and one of your regular patients comes in for a new prescription. “Angie” is a 55-year old female patient who is being treated for hypertension and chronic back pain. She is usually gregarious, outgoing, and always asking about your family and sharing stories of her last vacation spot. Today, she looks confused, oblivious to her surrounds, and her appearance is unkempt. Upon reviewing her profile, you notice that for the past 4 months, her refills for Vicodin have been filled earlier and earlier each time. She tells you that the white tablets did not help her back pain. “Angie” pleads you to fill this new medication to relieve her pain so she can cook and clean for her family. The prescription calls for MS Contin 60 mg, with a quantity of 80. The directions are clearly written for 1 tablet every 6 hours. The signature is unrecognizable and illegible. You suspect that this is forged prescription.

What Would You Do?

By: Lois Bui, Pharm. D.

Narcotic medications are heavily regulated by the Drug Enforcement Agency. Every time a Schedule II medication, such as MS Contin,is dispensed,stocked,returned,or wasted,an accurate perpetual inventory is kept. Although pharmacists are not the “narcotic police”, it is their duty to ensure that the patients are taking medications appropriately and not abusing it. Abuse of these medications can result in serious mental and bodily harm, including death.

In this case, you have been alerted that something is amiss with this patient. If an early refill is requested (earlier than 3 to 7 days before a refill was due), then you should contact the prescriber and ask for an approval. It is necessary to document on the profile of the call, name of person you spoke with, and the reason for approval or denial. Generally, insurance companies will not pay for an early refill and subsequently, the entire cost of the medication will be kicked back to the patient. Drug abusers typically do not object to paying for the entire cost and many of them will anticipate it and offer cash immediately. If you still do not feel at ease, despite the prescriber’s approval, then you have the right not to fill the medication. If you suspect that the prescriber is writing for narcotics indiscriminately, then you can report them to the DEA.

Since Angie’s behavior and her refill pattern seem suspicious, you take a closer look at the new prescription. The directions are incorrect for a long-acting medication, the quantity seems overly generous, and the signature looks like scratch marks from a chicken’s feet, rather than a physician’s name. At this point, you should contact the prescriber and verify the prescription. If your suspicions are correct, then be prepared to call for police or security. Inform the patient that you ran out of stock and cannot fill the prescription. Typically, the patient will quickly retract their prescription and move onto the next unsuspecting pharmacy. Notify the police if you feel that the patient may pose a threat to you or your staff. It is difficult to identify which patients are threatening but close observation of their behavior, rate of speech, speech patterns, and appearance will give clues about their mental state.

Falsifying prescriptions is a common practice and can involve phony physician names, DEA numbers, office information, and patient names. It is even more difficult to identify when the prescription pads are legitimate, but stolen from the physician. Either way, misuse of narcotics can be aborted with a simple phone call to the prescriber.

Unfortunately, drug abuse is prevalent in our society. From celebrities to physicians, narcotic drug abuse has been the cause of their failures and ultimate demise. We shall not act as their enablers. We shall act as we were trained to do… to promote better health with the proper use of medications.

About the Authors and Series

What Would You Do is a weekly column highlighting real life cases involving pharmacist-related work challenges. Authors include Karine Wong, Pharm. D. and Lois Bui, Pharm. D. Karine has a 10 year history of working in hospital management, and 2 years as a graveyard hospital pharmacist and outpatient pharmacist. Lois has an extensive history working in HR management prior to her pharmacy career.

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