Community Pharmacy and Controlled Substances

The other day I had a patient come into our pharmacy with a prescription for a controlled substance (C  II) for pain control.  This was a new patient for us; however, the quantity of medication did not seem unreasonable and the prescriber was a local physician who I am very familiar with.  The patient stated they had been to a local chain pharmacy that they had been going to for the past couple years.  The pharmacy had told them that it is their new policy to phone the prescriber with all controlled substance (C II) prescriptions.  For one reason or another, the pharmacy was unable to get ahold of the physician and needed to leave a message for the physician to call them back.  The patient took the prescription and left.

The patient, bewildered and confused, then presented at our community pharmacy.  After a short discussion with the patient, I understood the reason they were taking their pain medication and had a reasonable history of their pain treatment.  I then logged on to the narcotic verification tracking website to check the history of narcotic usage of this patient.  As stated, the patient had been going to the same chain store pharmacy on a monthly basis for the last six months.  I then called the other pharmacy to see if there was some other issue I was missing.  The other pharmacy stated it was their policy to call the physician with each new narcotic (C II) prescription, and that was it. 

I, as a pharmacist, performed Due Diligence with regards to this prescription and this patient.  I determined that a legitimate need for the medication existed and that the prescription was legitimate.  The Drug Enforcement Agency has strict guidelines with regards to the verification process; however, unless warranted, the regulations do not dictate that the pharmacist must phone the doctor back with each and every prescription.

This issue stems from a legal case that ended in June of 2013.  One of the chain store pharmacies’s agreed to pay a fine of $80 million dollars for allowing millions of controlled substances to reach the black market.  The stores, located in Florida, had an unprecedented amount of record-keeping and dispensing violations.

The backlash to this legal case is that many chain pharmacies have now implemented egregious controlled substance verification campaigns that go far beyond the required verification process.  Systems that go as far to not fill a maintenance pain medication for a patient who has been coming to their pharmacy for months, for no other reason than the simple fact that the prescribing physician is not available for a phone call.

I am a community pharmacist, I have a code of ethics I follow, and I have state and federal  laws I need to heed.  Patients understand that if they come to our pharmacy, they will be treated as an individual.  They will receive appropriate medication counseling, and, at times, they may be asked as series of questions in order for us to gain an appropriate history.  At times, patients may be expected to wait for a short while if we need to contact their prescriber.  

If a patient shows up in our little community pharmacy with a prescription for a controlled substance from a physician who is located in another city, the patient better be prepared to wait.  I will need to go through every step of the process to assure all of the DEA requirements are met with regards to the prescription being legitimate, including having a discussion with the physician on the phone.  As mentioned earlier, this process is called Due Diligence.

Community Pharmacy is a practice, it is not a technical position where you get your orders filled.  Community Pharmacists work long and hard to assure that every prescription filled is appropriate for the situation it is being prescribed for. 
 
I have said this before, and I will continue saying it.  You have a choice which pharmacy you go to.  If you are unhappy with your current pharmacy, take an afternoon and visit four or five of the community pharmacies in your town.  Walk in to the store and see what it feels like.  Is a pharmacist available for questions?  Does the pharmacy department look like they have enough help to get the work done?  What is the general feel of the store? 

Stand in line and ask to speak to the pharmacist.  When the pharmacist comes over, let them know you are interviewing different pharmacies to see which store might work best for you.  You will know when you have found the right community pharmacy!
 
Thanks
Steve

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