CommunityPharmacist1837
New Member
- Joined
- Oct 28, 2019
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Hello,
I am currently a retail (community) pharmacist and wanted to share a story that will hopefully change the views of many physicians out there for the better.
Let me start by saying that I respect very much what physicians do. The vast majority of individuals in healthcare work very hard to do a good job. However, there is a substantial population of physicians who often prescribe controlled medications when they most definitely should not. I understand there are systematic issues with our healthcare system and I will discuss these at length. First, allow me to tell the story objectively and then follow up with a discussion.
I received a prescription a few weeks ago for a 90 day supply of high dose benzodiazepines from an ER doc (patient brought in a hardcopy). Our system showed that the patient had picked up a script for a different benzo 5 days prior to showing up again. Patient claimed he lost the prescription he got 5 days ago. I checked our state's prescription drug monitoring program and found that this guy has been to over 15 different prescribers for controlled medications in the past few months alone (mostly benzos). Different doc almost every time. Patient said he takes benzos for anxiety (no evidence of withdrawals). I called the doc at the hospital and the doctor informs me that he is unaware of who is managing the patient's controlled medications, that he wasn't sure if he believed the patient had actually lost his medication or not, and that I must fill any prescription the doctor writes. I informed the patient that he must see a single provider for his controlled medications and that all physicians must be aware of which controlled medications he is already taking and I denied the rx and gave it back to the patient. The patient became belligerent and threatened me and our staff. It was evident he had practice intimidating pharmacists into filling controlled medications when they obviously shouldn't. We had to call the police and the patient is no longer welcome at our pharmacy. He made us and our customers feel very unsafe and uncomfortable. Unfortunately, in my state we are required to have our addresses publicly available online with our board/license. Retail pharmacy is not always easy.
Most physicians recognize that patients with this many red flags should be told "no" and that they need to see a single physician to take care of their controlled meds in the future. And I'm guessing most physicians taking the time to read this online go above and beyond what they're asked to do in their profession. However, issues like these are very common. It is illegal federally and in most states to obtain a prescription through deception and that includes Dr. shopping (seeing multiple physicians and not notifying them you're getting the med already somewhere else). Some states require prescribers to check state registries before prescribing controls for this reason. By law, a physician may only prescribe a controlled medication "for a legitimate medical purpose acting in the usual course of his or her professional practice." Giving drug addicts benzos when there are plenty of red flags to suggest the patient is Dr. shopping and being deceitful is not a legitimate medical purpose. The DEA and board of pharmacy instruct us to deny filling prescriptions for controlled medications when we are unable to resolve "red flags" after speaking with the prescriber and patient. I reported this physician to our board of medicine and I honestly wish more pharmacists would do the same. This doctor caused a few serious problems: he gave dangerous, addictive controlled medications to someone who is likely selling them or abusing them and putting himself or others in serious danger, he shifted the problem to the pharmacy and endangered the pharmacy staff, he wasted the time of the police and the pharmacy. Unfortunately, physicians do not always see the downstream effects of their decisions. Simply saying no and telling the patient to establish a relationship with a PCP would have resolved this. If enough people say no he will stop asking. Unfortunately, there are enough physicians out there who practice like this that he has continued to get away with this for almost a year. From what I could tell no one had ever bothered to tell him to try an SSRI for anxiety before trying high dose benzos long term (no evidence it's effective, tolerance, addiction, escalating doses, dangerous drug interactions, fatal overdose, etc).
I understand physicians are overworked and drowning in paperwork. I understand that our healthcare system, unfortunately, incentivizes stakeholders to increase profit over maximizing patient outcomes. I understand that the same patient is probably pressuring the doctor to write the script and is very practiced at saying just the right things. But ethically this is important and physicians need to unanimously resist these types of patients. Just say no. You will save lives and potentially your license. Thoughts?
I am currently a retail (community) pharmacist and wanted to share a story that will hopefully change the views of many physicians out there for the better.
Let me start by saying that I respect very much what physicians do. The vast majority of individuals in healthcare work very hard to do a good job. However, there is a substantial population of physicians who often prescribe controlled medications when they most definitely should not. I understand there are systematic issues with our healthcare system and I will discuss these at length. First, allow me to tell the story objectively and then follow up with a discussion.
I received a prescription a few weeks ago for a 90 day supply of high dose benzodiazepines from an ER doc (patient brought in a hardcopy). Our system showed that the patient had picked up a script for a different benzo 5 days prior to showing up again. Patient claimed he lost the prescription he got 5 days ago. I checked our state's prescription drug monitoring program and found that this guy has been to over 15 different prescribers for controlled medications in the past few months alone (mostly benzos). Different doc almost every time. Patient said he takes benzos for anxiety (no evidence of withdrawals). I called the doc at the hospital and the doctor informs me that he is unaware of who is managing the patient's controlled medications, that he wasn't sure if he believed the patient had actually lost his medication or not, and that I must fill any prescription the doctor writes. I informed the patient that he must see a single provider for his controlled medications and that all physicians must be aware of which controlled medications he is already taking and I denied the rx and gave it back to the patient. The patient became belligerent and threatened me and our staff. It was evident he had practice intimidating pharmacists into filling controlled medications when they obviously shouldn't. We had to call the police and the patient is no longer welcome at our pharmacy. He made us and our customers feel very unsafe and uncomfortable. Unfortunately, in my state we are required to have our addresses publicly available online with our board/license. Retail pharmacy is not always easy.
Most physicians recognize that patients with this many red flags should be told "no" and that they need to see a single physician to take care of their controlled meds in the future. And I'm guessing most physicians taking the time to read this online go above and beyond what they're asked to do in their profession. However, issues like these are very common. It is illegal federally and in most states to obtain a prescription through deception and that includes Dr. shopping (seeing multiple physicians and not notifying them you're getting the med already somewhere else). Some states require prescribers to check state registries before prescribing controls for this reason. By law, a physician may only prescribe a controlled medication "for a legitimate medical purpose acting in the usual course of his or her professional practice." Giving drug addicts benzos when there are plenty of red flags to suggest the patient is Dr. shopping and being deceitful is not a legitimate medical purpose. The DEA and board of pharmacy instruct us to deny filling prescriptions for controlled medications when we are unable to resolve "red flags" after speaking with the prescriber and patient. I reported this physician to our board of medicine and I honestly wish more pharmacists would do the same. This doctor caused a few serious problems: he gave dangerous, addictive controlled medications to someone who is likely selling them or abusing them and putting himself or others in serious danger, he shifted the problem to the pharmacy and endangered the pharmacy staff, he wasted the time of the police and the pharmacy. Unfortunately, physicians do not always see the downstream effects of their decisions. Simply saying no and telling the patient to establish a relationship with a PCP would have resolved this. If enough people say no he will stop asking. Unfortunately, there are enough physicians out there who practice like this that he has continued to get away with this for almost a year. From what I could tell no one had ever bothered to tell him to try an SSRI for anxiety before trying high dose benzos long term (no evidence it's effective, tolerance, addiction, escalating doses, dangerous drug interactions, fatal overdose, etc).
I understand physicians are overworked and drowning in paperwork. I understand that our healthcare system, unfortunately, incentivizes stakeholders to increase profit over maximizing patient outcomes. I understand that the same patient is probably pressuring the doctor to write the script and is very practiced at saying just the right things. But ethically this is important and physicians need to unanimously resist these types of patients. Just say no. You will save lives and potentially your license. Thoughts?
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