Prescription drug abuse affects millions of people in America, and as an independent community pharmacist, you play an important role in curbing this dangerous and expensive epidemic.
Over the past few decades, prescription drug abuse has grown significantly. Today, it’s the second-most popular category of illicit drug abuse, according to the Substance Abuse and Mental Health Services Association’s annual report, the National Survey on Drug Use and Health.
And, prescription drugs account for 45 percent of drug overdose deaths, which is more than cocaine, heroin and methamphetamine combined, according to the Centers for Disease Control and Prevention (CDC).
The abuse of prescription drugs is costing the U.S. government—and the health care system—billions. It’s estimated that fraudulent prescriptions and prescription drug abuse costs the health care system $42 billion and the criminal justice system $8.2 billion each year.
With mounting abuse and increasing attempts to obtain prescription drugs illegally, pharmacists need to understand how they can keep their businesses and their patients safe from drug diversion.
Know what to look for
Pharmacists play an important role in battling prescription drug abuse because of their proximity to fraudulent scripts.
“They’re on the front lines because they’re the ones seeing the prescription first—long before law enforcement,” said Karin Caito, a spokesperson for the Drug Enforcement Administration (DEA).
She suggests that pharmacists learn their prescribers’ and patients’ typical patterns.
Pay attention to how the physicians in your area typically prescribe. Learn the common medications they prescribe, their refill patterns, and even their handwriting, to clue you in when any of these are out of the ordinary.
If you notice a physician suddenly prescribing a commonly abused drug that he doesn’t normally prescribe, such as hydrocodone, oxycodone, or benzodiazepines, you know to be suspicious.
You should also be on alert for patients who bring in prescriptions from physicians or hospitals that aren’t in your area, or if they try to fill scripts that are out of the ordinary for them.
If you see any of these troublesome signs, or if you’re uncomfortable filling a prescription, the DEA recommends these courses of action.
First, call the physician or the hospital that prescribed the medication to confirm the script and ask the patient for identification.
If you think the script is forged or that the medication will be abused, refuse to fill the script and call the local police department. If you think you’ve recognized a pattern of prescription abuse, you should also contact your state board of pharmacy or the local DEA field office.
Abuse trends
Be sure to pay attention to drug abuse trends today. One trend, Caito noted, is using older Americans to obtain illegal drugs. Abusers will either steal prescription medication or offer to buy it from older patients who have a legal prescription.
Caito said that often, these older patients don’t realize they’re not getting all of their medication or that they even had a prescription for those drugs.
Also, sophisticated computer systems today enable drug abusers to scan and replicate scripts and physicians’ signatures. This high-quality reproduction results in realistic-looking forged scripts, and the ability to produce more scripts.
Some patients are also crossing state lines to fill fraudulent prescriptions or to fill prescriptions for abuse. Be sure to pay extra attention to out-of-state scripts.
“We suspect that abusers think there isn’t a monitoring program that links between states,” Caito said. Every state, except Missouri, has its own monitoring program that links doctors’ offices and pharmacies. The states’ systems are also connected.
If you follow common sense, sound professional practice, and proper dispensing procedures, you’re on your way to putting proper safeguards in place to prevent drug abuse in your community.
Ways to Recognize Non-Legitimate Scripts
- The prescriber writes significantly more prescriptions (or in larger quantities) compared to other practitioners in the area.
- The patient appears to be returning too frequently. (For example, a prescription that should last a month in legitimate use is being refilled on a biweekly, weekly or even a daily basis.)
- The prescriber writes prescriptions for antagonistic drugs, such as depressants and stimulants, at the same time. (Drug abusers often request prescriptions for “uppers and downers” at the same time.)
- The patient presents prescriptions written in the names of other people.
- A number of people appear simultaneously, or within a short time, all bearing similar prescriptions from the same physician.
- People who aren’t regular patrons or residents of the community show up with prescriptions from the same physician.
Source: Pharmacist’s Guide to Prescription Fraud, Drug Enforcement Administration
5 Ways to Identify Forgeries
- Prescriptions that feature handwriting that looks too good (for example, the physician’s handwriting is too legible)
- Quantities, directions, or dosages that differ from usual medical usage
- Prescriptions or directions that don’t comply with standard abbreviations or appear to be copied from textbooks
- Prescriptions that appear to be photocopied
- Prescriptions written with different colors of ink or written in different handwriting
Source: Pharmacist’s Guide to Prescription Fraud, Drug Enforcement Administration
Drug abuse, in numbers
52 – Million people have used prescription drugs for nonmedical reasons at least once
20 – Percent of abused prescription drugs obtained through a script are filled at a pharmacy
1 – Controlled prescription drugs are increasingly the choice of first-time users
Sources: The Centers for Disease Control and Prevention; National Institute on Drug Abuse; National Survey on Drug Use and Health
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