By: Sanjay Dave, Supervising Pharmacist, Class of 1985 St. John’s University College of Pharmacy and Allied Health Professions
Mr. Sanjay Dave is a St. John’s University College of Pharmacy and Allied Health Professions Graduate, Class of 1985. Since graduation, he has worked for Pathmark Pharmacies and is currently the supervising pharmacist at Pathmark Pharmacy in Bethpage, New York.
In today’s pharmacy practice it has become very obvious that drug addiction has become issue number one. This issue did not start last father’s day when a person seeking narcotics murdered four people in a pharmacy. It has been an issue forever. However now it is getting a lot of press and therefore seems to be a new problem that the media has discovered. Ask any pharmacist or intern working in community or hospital settings and they will tell you numerous stories of people that come in looking for narcotics to satisfy their addiction.
I graduated in 1985 from St. John’s University College of Pharmacy and Allied Health Professions, and having worked in the community for all that time, I can attest to the increase in the of people seeking narcotics from the pharmacy. A regular phenomenon you see is patients who go to multiple doctors or multiple pharmacies to fill their prescriptions. Pharmacy databases linked to insurance plans, while not perfect, is a great way to see if someone is filling multiple prescriptions for the same or similar medications at other pharmacies. However, the state has to come up with a better way to monitor all controlled drugs in a real time basis so that we can see if a problem truly exists.
Until the implementation of such security measures, there are certain things you can do to protect yourself from filling dubious and questionable prescriptions. The following are some tips I can suggest after having been practicing for so long. To start with, very rarely will I fill a narcotic prescription for a patient that my staff or I do not know without double-checking with the prescriber. If the prescription is dropped off on a Sunday afternoon, it will not be filled until Monday when I have has a chance to speak to the prescriber. Also very rarely will I fill a telephone prescription for a narcotic called in by a “doctor” unless I know that prescriber or patient or until I verify authenticity of the prescription. The same holds true for prescriptions called in late in the evening on a weekday.
Another clue is the excessively talkative patient. They will hand you a prescription for Hydrocodone with Acetaminophen tablets (Vicodin®) and not leave your sight or engage you in an extensive conversation while you fill this prescription. This is to make sure that you do not pick up the phone to call and verify the prescription with the prescriber. The same is true when a patient insists that we not bill their insurance plan but put the prescription thru as “cash.” Most pharmacists will first run it thru the insurance anyway to see if duplicate prescription fills exist elsewhere. Chances are very good that they do.
Never tell someone over the phone if you have a particular narcotic drug in stock. Insist on seeing the original Rx in before committing to fill it. Also with the rash of pharmacy robberies, it seems odd to me how most of these robbers knew where the pharmacist kept the drugs that they wanted to steal. When a new prescription is brought to the pharmacy, the pharmacy staff checks with the pharmacist to verify the authenticity of a prescription written for a controlled medication. Then the pharmacist checks to see if the item is in stock. We check our computer on hand quantity of the item instead of walking over to the item so as not to tip off where we stock the item on our shelves. I try to keep most of the wanted narcotics like Hydrocodone with Acetaminophen tablets (Vicodin®, Vicodin ES®, Norco® etc.) out of the line of sight of customers. Another suspicious sign is when the patient lives nowhere near your pharmacy and the prescriber is nowhere near your pharmacy either.
Finally do not be afraid to get involved. My wife, who is a practicing dentist, would always get upset with me when I came home and told her of an encounter with a patient with a phony prescription or a doctor calling in a suspicious script. “Why do you have to get involved” and “you are not the pharmacy policeman,” she would always say. That was until one December four years ago when her office started getting calls from pharmacies all over Long Island asking her to send a follow up prescription to a telephone order she supposedly had called in. She received calls from 35 stores until finally one pharmacist realized something was not right and called my wife’s office to confirm that she indeed had called in the prescription. He had the patient arrested and that led to the busting of an organized ring filling phony narcotic Rx’s. So be careful when filling any prescription especially with narcotics, as you do not want to be that pharmacy that everyone knows is carrying “the good stuff” and become a target.