The Ultimate Guide to Prescription Drug Abuse

The Ultimate Guide to Prescription Drug Abuse: The Problems and Solutions

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Stories like this just scream for tighter controls when filling prescriptions

 In the LA Times on January 27th, there was an article about a pharmacy in Burbank that dispensed painkillers and other narcotics to five young patients who later died of overdoses.

The pharmacy catered to the patients of two physicians whom were later convicted of crimes in connection with their prescribing.

The pharmacy also had its license revoked  after the state pharmacy board found that its employees failed to properly scrutinize prescriptions that contributed to patient deaths.

The interesting thing is that the patients of the pharmacy had all of the warning signs of nefarious intent.  According to the article, the patients were all in their 20′s, all looking for Schedule II narcotics, the ones that are most commonly abused. They traveled more than 40 miles from their homes to go to this particular pharmacy. And they typically paid cash for their prescriptions. 

These young men all had an obvious prescribing pattern and patient profile that should have drawn the attention of both the pharmacists and the physicians.  But in the interest of money, they were will to turn a blind eye in prescribing the narcotics. 

Because of that, the young men are now dead. 

What could have prevented this situation?

Clearly, on the most fundamental level, the young men are responsible for their own behavior. They allowed themselves to get into a pattern where they used prescription drugs, became addicted, and then needed to get more to feed that addiction.  It can certainly be argued that these men would have obtained the drugs somehow, be it from this pharmacy or through other mean.s  Their own destructive behavior led to this outcome.  That is true. 

On the other hand, they would have never even received these drugs if the decision making power had been taken away from the pharmacists to begin with.  Had their been a mechanism in place in which the pharmacists had easy access to their records, a system that prevented the pharmacist from even filling the prescription to begin with, then perhaps a lot more people would be unable to obtain drugs for nefarious purposes. 

Had their been a state monitoring system in place that was able to work, the pharmacy would have had better oversight and checks and balances on their pharmacists.  Instead, they continued the pattern of filling prescriptions for the wrong people. As a result, the pharmacy has been shut down, and there are thousands of individuals who are affected because of this, unable to fill their needed prescriptions at this location.   

 

Article credit by Scott Glover and Lisa Girion - http://www.latimes.com/local/la-me-rx-pharmacy-20140128,0,4310212.story#axzz2s1O973Xx 

 

 

 

20 Risk Conditions for Controlled Substance Prescriptions

Attached is a brief list of 20 potential risk conditions that should generate a risk warning at the physician or pharmacy level when prescribing controlled medications:

  1. Controlled prescriptions from more than 1 provider within the last 30 days.

  2. More than two controlled medications filled at more than two separate pharmacies in the past 30 days.

  3. Pill count on any single controlled prescription over 200 in the past 30 days.

  4. Simultaneous prescriptions for controlled medications from more than 1 class (i.e. Vicodin + Ambien + Soma).

  5. Controlled prescriptions from more than three providers within the last 90 days.

  6. Prescriptions from outside state of residence (except mail-order or recently moved),

  7. Prescriptions written or filled greater than 20 miles from residence (except in low-population-density areas).

  8. Conviction related to controlled substances or street drugs in any state.

  9. History of prescriptions from any prescriber with a revoked, suspended, or expired State Medical license or DEA Prescription License.

  10. New prescriptions for same drug from same prescriber within 15 days of the same drugs fill date . All poor excuses are taken into account (“my pills fell down the toilet”, “My Rx flew out the window,” etc.)

  11. Inconsistency of medical diagnosis across more than two prescribers for controlled medications of the same class in the past 90 days (ie diagnosis of abdominal pain + Vicodin from prescriber 1 and diagnosis of headaches  + Norco from prescriber 2).

  12. Prescriber with unexpectedly high volume of controlled substance prescriptions (greater than 50% except for specific specialties).

  13. Controlled prescriptions paid in cash while non-controlled prescriptions paid for by insurance in the past 30 days.

  14. Controlled prescriptions paid for in cash repeatedly in the past 90 days.

  15. Controlled prescriptions received from urgent care or emergency room more than twice in the past 90 days.

  16. Diagnosis of attempted suicide, substance abuse, or Hx of suboxone-subutex prescriptions within 1 year.

  17. Doctor prescribing controlled prescriptions from more than three office locations

  18. Doctor prescribing any single controlled substance for more than 50% of his patients (ie Oxycodone 15mg for more than 50% of his patients),

  19. Doctors that are not registered for or do not regularly use a PDMP. This is not feasible at this stage of the development of PDMPs. In CA, it’s very hard to subscribe, for example. 

  20. Doctors that do not use regular Urine Drug Screens.  

If you believe that some risk conditions are missing from this list, please feel free to provide your opinions in the comment section. 

The Challenge for Physicians and Public Policymakers

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The Risk of the Pharmacist

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Prescription drug abuse: the human epidemic

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More Pharmacist / Physician Collaboration

 The US faces a major public health epidemic with prescription drug abuse, particularly opioid abuse. The DEA and other government entities have placed an increased burden on pharmacists to validate prescription orders received and medications dispensed in pharmacies. This is largely due to concerns with substance abuse and growing public pressure to address the associated […]

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