The Pharmacist’s Role in Preventing Prescription Drug Abuse

December 3, 2013 by Smart Retailing Rx
sr-imag-ftr-drugabuse

With numerous studies highlighting the many aspects of prescription drug abuse, the topic is receiving more attention than ever. 

Controlled Substance Headlines

Headlines such as “Sharp Rise in Drug Overdoses Among US Women: CDC,” “Prescription Drug Abuse Up Among US Teens: Survey” and “Prescription Drug Problem” are just a few of the study titles listed on the National Institute of Health’s (NIH) US Library of Medicine’s Homepage where the NIH reports that an estimated 20 percent of people in the United States have used prescription drugs for nonmedical reasons.1

With numerous studies highlighting the many aspects of prescription drug abuse, the topic is receiving more attention than ever.

Findings from the 2011 National Survey on Drug Use and Health estimate that 6.1 million persons aged twelve or older used prescription-type psychotherapeutic drugs — pain relievers, anti-anxiety medications, stimulants, and sedatives — non-medically in the previous month.2 Non-medical prescription drug use, particularly among young adults, is having a devastating effect on the United States.

The level of abuse has prompted the Centers for Disease Control and Prevention to categorize prescription drug abuse as a national epidemic.

Requirements and Guidelines

Pharmacies have a critical role to play in fighting the nation’s prescription drug abuse problem. As the “last line of defense” in preventing drug abuse and diversion, pharmacists must fulfill their professional obligations and exercise their “corresponding responsibility” when dispensing controlled substances.

Corresponding Responsibility

Pharmacists are required to exercise sound professional judgment when making a determination about the legitimacy of a controlled substance prescription.

The proper prescribing of controlled substances is the responsibility of the prescribing practitioner, however, pharmacists have a “corresponding responsibility.”3

In practice, this means ensuring that controlled substances are only dispensed pursuant to a valid prescription issued for a legitimate medical purpose by a practitioner acting in the usual course of his professional practice.

Tactical Implications for Pharmacists

Pharmacists must verify prescribing practitioner’s licenses (both state and federal), and ensure that prescriptions for controlled substances are facially valid and include all required elements.

These elements include:

  1. Date on which the prescription was issued
  2. Name and address of prescribing practitioner
  3. DEA registration number of the prescribing practitioner
  4. Signature of the prescribing practitioner
  5. Full patient name and address
  6. Drug name
  7. Strength and dosage form of the drug prescribed as well as quantity prescribed, and direction for use
  8. Number of refills (if any) authorized.

Remember, the law does not require a pharmacist to dispense a prescription of doubtful, questionable, or suspicious origin. To the contrary, the pharmacist who deliberately ignores a questionable prescription when there is reason to believe it was not issued for a legitimate medical purpose may be prosecuted along with the issuing practitioner, for knowingly and intentionally distributing controlled substances.4

Red Flags

There are numerous “red flags” indicating possible prescription drug misuse, abuse, and diversion. Some common “red flags” suggested by the DEA and certain State Boards of Pharmacy include:

  • Pattern Prescribing: Pharmacists need to be particularly alert for prescriptions for the same drugs, quantities or diagnosis codes coming from the same doctor. Further, the use of rubber stamps is another key red flag.
  • Antagonistic Drugs: Look for prescriptions written for antagonistic drugs (i.e., depressants and stimulants).
  • Drug Cocktails: Flag and scrutinize prescriptions for drug cocktails (i.e., opioids with benzodiazepines and/or carisoprodol).
  • Large Quantities: Look at the quantities. High doses and/or high quantities of drugs are often a key indicator of abuse.
  • Doctor Patterns: Be on the lookout for doctors that write significantly more prescriptions compared to other doctors in your area.
  • Beyond Specialty: Question prescriptions written by doctors for infirmaries not consistent with their area of specialty (e.g., Dentist writing ADHD prescriptions).
  • Geographic Flags: Notice geographic anomalies, such as prescriptions written by a local prescriber for out-of-state patients, or situations in which the pharmacy is not near the patient or the prescriber.
  • Unlikely Coincidences: Situations such as customers with shared addresses presenting prescriptions on the same day can also prove fraudulent.
  • False Caregivers: Further, you will want to scrutinize customers presenting prescriptions for other people.
  • Cash Payments: Customers paying cash should always be given additional scrutiny.
  • Early Refills: Customers requesting early refills of controlled substances should be questioned and may require additional scrutiny.
  • Suspicious Behavior: Look for signs of nervousness such as being overly talkative, agitated, emotionally volatile, evasive, etc.
  • Signs of Forgery: Fraudulent or forged prescriptions can often be identified by the following characteristics:
    • False contact information
    • Misspellings
    • Photocopies
    • Alterations to prescriptions
    • Different inks or handwriting
    • Quantity, directions, or dosages differ from usual medical usage
    • No abbreviations used or non-standard abbreviations

Best Practices

  • Know your state requirements for dispensing controlled substances.
  • Know the popular drugs of abuse for your area.
  • Know the local prescribing practices.
  • Know your local prescribers and his/her signatures.
  • Know your patients. Familiarity will help you to distinguish abuse.
  • Use your state prescription drug monitoring program. Pay attention to enforcement actions.
  • Require a government-issued photo identification prior to dispensing controlled substances.
  • Communicate with prescribers.
  • Educate patients about proper use, storage, and disposal of controlled substances during consultations.
  • Call the number listed in the pharmacy’s system rather that the phone number on the prescription.
  • Communicate with other pharmacies if you receive a prescription that was denied by them or if you deny a prescription.
  • Communicate with law enforcement and regulatory agencies (State Board of Pharmacy, State Medical Board, local DEA office, and local sheriff’s office or police department).

 Resources

Disclaimer: The information does not constitute legal advice. If you need legal advice, contact your attorney. Requirements relating to controlled substances vary by state and individual states may impose different or additional requirements from those discussed in this article. As the pharmacist, you are solely responsible for confirming and ensuring that your dispensing of controlled substances complies with all applicable laws and regulations. In addition, this article does not provide advice regarding how to practice pharmacy. Pharmacists are always required to use their own professional judgment.
1 Copied on July 15, 2013 from National Institute of Health US National Library of Medicine website
2 Substance Abuse and Mental Health Services Administration, Results from the 2011 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-44, HHS Publication No. (SMA) 12-4713. Rockville, MD
3 Code of Federal Regulations 21 CFR § 1306.04 (a)
4 Drug Enforcement Administration Office of Diversion Control website