Magazine article Drug Topics

Stepwise Approach Can Help Weed out Suspicious Rxs

Magazine article Drug Topics

Stepwise Approach Can Help Weed out Suspicious Rxs

Article excerpt

Every pharmacist has encountered the dreaded controlled-substance prescription that Calls into the twilight zone, somewhere between obviously legitimate and clearly phony. The problem professionally and legally has always been what to do with such a suspicious script? Fill it and perhaps abet a criminal? Refuse to fill it and deny a patient relief?

One answer to the fill-or-refuse dilemma is to take a stepwise approach to suspicious Rxs, said David Brushwood, R.Ph., J.D., professor of pharmacy health-- care administration, University of Florida. He doesn't claim it's foolproof but he offers it as a way to help pharmacists do their jobs better.

"I'm trying to describe a process for evaluating a suspicious prescription," said Brushwood. "I'm not suggesting any of this process applies when a prescription is obviously valid. For heaven's sake, go ahead and fill it and don't worry about any of this. I'm also suggesting that when it's obviously invalid, for heaven's sake, refuse it and don't worry about it. Sometimes it's not so obvious. Sometimes there are suspicions. I'm trying to guide pharmacists through those suspicions to a particular action."

Step 1 is to throw out some old notions about drug-seeking behavior. For example, it's impossible to spot a drug abuser merely by the way he or she looks. In addition, offlabel use of a drug has no bearing on whether a script is legitimate. Likewise, a patient aggressively demanding that the script be filled right away may just be in a lot of pain. And the ratcheting up of drug dosage or frequency may mean that the physician has decided to adjust the patient's therapy.

"None of those factors has any correlation with prescription forgery," Brushwood said. "Sometimes pharmacists confuse drug-seeking behavior with relief-seeking behavior That's an unfortunate thing to confuse."

Setting aside the irrelevant factors, pharmacists should assess the conditions that make a script suspect. …

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