Feb 9, 2009
Media contact: Patty Wellborn
604-795-2819
or 604-504-7441, local 2819
patty.wellborn.@ufv.ca
Pharmacists call for help to deal with fraudulent Rx slips
Its 8 p.m. on a rainy Thursday evening and a tired-looking woman passes a prescription for OxyContin across the counter to the pharmacist. He takes the paper, and does a double take. He recognizes the sweater the woman is wearing, only this time she is now wearing glasses and a baseball cap. He’s pretty certain he filled this same prescription, from a different medical clinic, less than 30 minutes ago. And while he has hunch, he doesn’t ask questions; he just quietly fills the prescription and pushes it silently back over the counter.
While the above scenario is a fictional one written specifically for this story, it is one example of prescription medication abuse — a growing trend in North America. While pharmacists are aware of the occurrence, many feel like their hands are tied when it comes to dealing with suspected misuse or abuse of prescriptions.
The B.C. Centre for Social Responsibility, which is housed in the School of Criminology and Criminal Justice at the University of the Fraser Valley, mailed 1,500 surveys to pharmacists across B.C. to determine how these professionals felt about suspected misuse of prescriptions.
“The role of the pharmacist in supervising and educating the public with respect to prescription drug misuse has been steadily increasing over the past several decades,” explains report co-author Amanda McCormick. “However, there appears to still be confusion regarding the roles and responsibilities of pharmacists in recognizing and intervening in prescription drug abuse.”
McCormick says the random survey of registered pharmacists was sent out to determine their awareness of prescription drug abuse and the extent to which they felt able and even obliged to intervene in cases of real or suspected misuse or abuse.
“The pharmacist may have a hunch the prescription is fraudulent, but how hard is the pharmacist going to question or push the issue?” asks McCormick. “The general feeling from the survey was that although most pharmacists agree that they have a responsibility to intervene, many were uncomfortable confronting the patient, or felt a call to the doctor to question the prescription was a waste of time as the doctor would often just tell them to fill it anyways.”
The B.C. Centre for Social Responsibility, in collaboration with provincial and community organizations, education partners, and the general public, develops training and educational opportunities, evaluates programs, services, and strategies, and conducts research in the area of social responsibility. With concern increasing about the fraudulent use of prescriptions across North America, the centre began the study to determine if it was an issue in B.C. The study was funded by the public safety branch of the federal government.
Pharmacists were asked how much abuse and how many fraudulent prescriptions they were aware of, common methods of abuse, how they detected abuse or fraudulent prescriptions, and what they might do if they encountered a situation of abuse or a fraudulent prescription. McCormick says the survey responses confirmed that it is indeed an issue here.
Dr. Irwin Cohen, the B.C. Centre for Social Responsibility research director and an instructor at UFV’s School of Criminology and Criminal Justice, says that the research suggests there is a lot of responsibility put on pharmacists without a lot of authoritative support if they do detect misuse, abuse, a fraudulent prescription, or even an error on the doctor’s part.
“Right now, we’re fundamentally relying on the experience of the particular pharmacist. It’s up to them to determine if the prescribed drug is not appropriate, see that the quantity is correct, and to check for quick refills,” Cohen says. “Much of this might be based on the pharmacist’s gut feeling and personal experience, but then this also might mean they may have to confront the patient, ask questions about why they are picking up this particular medication, or even question the doctor. Most of the time they’re acting on a hunch and they know they don’t have a lot of support.”
Cohen says the province is on the right track and says B.C. Pharmanet, a province-wide network linking all of British Columbia’s pharmacies to a central database, has made information-sharing between doctors and pharmacists much easier than in the past. Pharmanet provides some ability to detect abuse of prescriptions and allows the pharmacist to see the history of the patient’s prescriptions, check for early refills, and check for multi-doctor prescriptions for the same medications.
“B.C. Pharmanet is definitely a step in the right direction,” he adds, saying pharmacists are asking for additional training and support to deal with prescription misuse or fraudulent prescriptions. “Our pharmacists are saying that they’re on the front line, they’re there to serve the public and serve them safely, but that they don’t have the tools or the authority.”
One idea, he suggests, is getting rid of the paper prescription and having doctors electronically send prescriptions to a patient’s preferred pharmacy. While this and other ideas have been discussed, says Cohen, there has been no direct action by the province to solve the growing problem.
Pharmacists are the third largest group of health professionals in Canada with about 28,530 licensed pharmacists across the country and more than 4,000 licensed pharmacists in B.C. While most research on prescription abuse is based on statistics from the United States, Cohen says provincial leaders need to pay attention to the concerns from local pharmacists.
“It’s certainly not pandemic yet,” Cohen adds. “But pharmacists are telling us they are ill equipped to deal with the problem. We also can’t discount the fact that some people are using fraudulent prescriptions to obtain powerful and dangerous medications to sell for profit.”
In their report, Cohen and McCormick describe prescription abuse as ‘intentional use of a medication with intoxicating properties outside of a physician’s prescription for a bona fide medical condition.’ Prescription drug abuse can also be defined as the use of medication for non-medical purposes that may result in injury, harm, or dependence. The most frequently abused prescription drugs are analgesics or painkillers such as Morphine, Oxycodone, and Tylenol 3, followed by tranquilizers, stimulants, and sedatives.
The report came up with a number of recommendations including:
- improved communication and training in how to prevent and respond to prescription drug misuse and fraud
- improved methods to confirm the authenticity of prescriptions during late night hours
- the ability to report prescription drug misuse or fraud situations immediately to other pharmacies, rather than waiting until the British Columbia College of Pharmacists is open
- the ability to anonymously express concerns regarding a physician’s complicity or lack of intervention in the misuse of prescription drugs or in providing fraudulent prescriptions
- better communication and coordinated efforts between health professionals and between health professionals and law enforcement
Cohen says they hope the B.C. College of Pharmacists and the provincial government use some of the recommendations to develop and implement policies that will not only protect the pharmacists, but the public as well.
“Having an environment of shared responsibility where pharmacists, physicians, and law enforcement can all play a role in the prevention and response to fraudulent prescriptions and prescription drug misuse would remove some of the burden on pharmacists,” Cohen adds. “It will also increase the effectiveness of any individual or the B.C. College of Pharmacists to prevent and respond to prescription drug misuse, abuse, and fraud.”
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