It may not be at the top of the list of things people consider when they think about what a pharmacist does all day, but one important, and over-looked aspect of the profession is a form of law enforcement. Specifically, pharmacists are constantly on the look-out for drug seekers and forged controlled substance prescriptions. Criminals are becoming more and more sophisticated in their attempts to secure controlled substances without a valid prescription, and today’s blog is going to describe some of the challenges pharmacists need to be ready to embrace.
Drug Seekers
One of the more common problems encountered is the drug seeker. Most of the time, these present as a patient with an otherwise valid prescription for a controlled substance. The problem is that the person is using many different doctors and many different pharmacies. Spotting a drug seeker is generally not very difficult as long as the pharmacy has proper training and policies in place. These often present as new patients to a pharmacy who request a cash price for the controlled substance.
When presented with a potential seeker, pharmacists and pharmacies should check the state registry for a controlled substance dispensing history (sometimes called a PMP for Prescription Monitoring Program). These lists, while often a week or so behind, quickly reveal multiple pharmacies, physicians and insurance / cash histories.
Once a problem is identified, however, pharmacists are confronted with an even more difficult task: what do you do? The answer is far from trivial, because there is likely a real medical issue being treated alongside physical dependence to the controlled substance(s). A pharmacy may elect to refuse to fill a prescription in this cases, but that does not address the underlying problem. It just moves the patient to a different pharmacy or pharmacist. A better approach is to speak with the patient about their issue and then send a short clinical note to each of the recent prescribers alerting them to issue, directing them to the PMP for details. The goal is to get all of the prescribers on the same page and have one prescriber and pharmacy manage the patient. Addressing the root of the problem takes effort and fortitude.
Criminals
Less common, and far more difficult, are forged prescriptions. Criminals are becoming amazingly sophisticated with their tactics, making the job of the pharmacist recognizing an invalid controlled substance prescription increasingly difficult every day. The criminals plan carefully, usually targeting a pharmacy at a busy time or just before closing, trying to catch the staff in a hurry. Spotting a forged prescription is an art. The pharmacist relies on many different pieces of information to spot a fake, but don’t look for me to publish a list. The last thing we want to do is make it easier for criminals to fool the pharmacist. Instead, I will detail several common tactics:
- A out of town or out of state doctor.
- Trying to fill the prescription after the physician’s office is closed, making contacting the prescriber inconvenient or impossible
- Coupled prescriptions: presenting one controlled and one non-controlled prescription together to make them both appear more legitimate.
- Someone other than the patient on the prescription presents the prescription and wants to pick it up.
If a prescription is not passing the sniff test, the pharmacist has to make a choice of what to do next. My first advice is to trust your gut. When it doubt, consider the prescription suspect and do not fill it.
The law does not necessarily cover what a pharmacist can, and cannot do in these circumstances: we are generally left to figure this out on our own. The advice of the thriving pharmacist is this:
- Request the identification (photo ID) of the person requesting the prescription to be filled. Make a photocopy of this information in case the prescription is determined to be fake.
- Stall. Tell the person the pharmacist needs to verify the prescription and it will not be released until that has been complete. This may not be possible until the next business day when the prescriber’s office opens.
- Do not risk your safety. Starting with the items below, the situation could become risky. It is in your best interest to call the police now and alert them to a possible situation. It cannot hurt to have the local law enforcement nearby or even at the store.
- Do not relinquish the suspect prescription to the patient until it is verified as valid by the prescriber. If the patient demands the prescription back before this, suggest the local law enforcement stop by to discuss the problem. (They may even be outside by this time if you followed step 3)
- If the person actually waits for the police to arrive and discuss, the prescription may actually be real, and you should follow the advice of the officer(s), returning the prescription if directed to do so.
- Provide all information to the police, including information obtained from a verification check and any video surveillance if available.
- Report the incident to your local PMP or state board. Many states maintain a mailing list alerting pharmacies to current threats.
The Rubber and the Road
Neither of the above scenarios are easy to handle, and either can become dangerous. Physical dependence and criminal intent can be a tricky combination. Each issue presents its own set of challenges, and successfully foiling a scam may mean the pharmacist has to testify in court. This is an important part of the profession: a part that does not involve any reimbursement–but should.
In the words of Sergeant Esterhaus (Hill Street Blues): Let’s Be Careful Out There. Make every encounter count.