Drug Topics - June 30, 2008 - (Page 3) 3 Of Interest to Pharmacists Hadi Ale-Ali and Kevin Weissman, Pharm.D. Is your patient getting his Oxycontin filled elsewhere? ne of the most uncomfortable aspects of practicing pharmacy is being confronted by patients in need of frequent and/or large amounts of controlled substances. Controlled substances, although medically necessary for many patients, have an inherent potential for abuse and conflict with pharmacists’ mantra of “do no harm.” Pharmacists would never consciously deny a patient with legitimate medical need, but on the other hand they don’t want to perpetuate a patient’s illegitimate use of narcotics. Due to controlled substances' high potential for abuse, many states have implemented prescription drug monitoring programs (PDMPs) to track the use of such medications. The first of such programs was started by California in the 1940s using a multi-copied, state-issued, and serialized prescription to help monitor and regulate the use of Schedule II controlled substances. By the turn of the new millennium virtually all states have implemented an electronic method of monitoring controlled substance use. These electronic monitoring programs have drastically improved investigations into drug diversion, prescription forgery, “doctor shopping,” and have assisted healthcare professionals in seeking appropriate treatments on their patients’ behalf. Pharmacists play a pivotal role in identifying patients with an abuse problem. Often times, pharmacists are the only ones in a position to recognize that a problem is occurring. Understanding a patient’s unique individual pain needs and being comfortable with the patient’s pain program are all factors that can aid the pharmacist’s screening process. With the establishment of PDMPs, authorized personnel can gain access to a pool of uniform information to help differentiate and weed out legitimate versus illegitimate drug use. Some states, such as California, have established special request forms [called Patient Activity Request form (PAR)], which O allow pharmacists, as well as physicians, to gain access to the government-run database. The database contains patient-specific histories of all controlled medications for the past 60-90 days, regardless of where the medications were dispensed. After a request is made, the Department of Justice provides a letter via mail that includes the patient’s name, date of birth, drug name, drug form, strength, quantity, date the drug was filled, pharmacy name where the controlled substances were picked up, pharmacy license number, and the prescribing physician information. The requester remains annonymous, and all physicians and pharmacies who are on that list also receive a copy of the form listing the patient’s activity. See example below. Since the program’s inception in California, we have had cases where we discovered patients utilizing multiple pharmacies to fill the same prescription, patients forging their own prescriptions, and justifiable cases where patients were thought to be abusers but were not. However, the most significant impact has been with aiding pharmacists in making a case to a prescriber that a patient may have a problem. A pharmacist’s quick conversation with a prescriber or his office’s ancillary
Table of Contents Feed for the Digital Edition of Drug Topics - June 30, 2008 Drug Topics - June 30, 2008 Contents Is Your Patient Getting His Oxycontin Filled Elsewhere? Top 200 Drugs Used in Hospitals in 2007 Latest News Roundup Drug Topics - June 30, 2008 Drug Topics - June 30, 2008 - Contents (Page 1) Drug Topics - June 30, 2008 - Contents (Page 2) Drug Topics - June 30, 2008 - Is Your Patient Getting His Oxycontin Filled Elsewhere? (Page 3) Drug Topics - June 30, 2008 - Is Your Patient Getting His Oxycontin Filled Elsewhere? (Page 4) Drug Topics - June 30, 2008 - Top 200 Drugs Used in Hospitals in 2007 (Page 5) Drug Topics - June 30, 2008 - Latest News Roundup (Page 6)
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