September 7, 2019

Today was somewhat unpleasant. I had to deal strongly with 2 opioid users.

The first had never filled with my company, so we had no history to immediately check. We processed a hydrocodone RX, and the insurance rejected the claim stating the patient was on interacting medications. I accessed the PDMP and fortunately found information on what the interactions entailed (other controlled substances, including duplicate opioid therapy). For my due diligence, I contacted the hydrocodone prescriber to ensure the prescriber was aware of the interactions and was still ok with us dispensing the hydrocodone. The prescriber was very irritated that the patient did NOT state all of the medications, so the prescriber instructed me to cancel the hydrocodone prescription. As a courtesy, I contacted the patient to inform of the situation. No surprise, I received a lot of pushback. The patient argued and argued. I told the patient that this is between them and the prescriber. There was nothing further I could do. 20 minutes later, I received a call from the prescriber asking for more information from the PDMP. I read exactly what the PDMP said to the prescriber. The prescriber then asked if I could dispense only 3 tablets. As I had not yet cancelled the RX in our computer system, I was able to document the conversation and prepare the RX for 3 tablets. The patient came to get the RX and was furious that only 3 tablets were authorized. I told the patient that this is between them and the prescriber. I have done my due diligence and must follow the prescriber’s direction. The patient then stormed off. At this point, I was worried that the patient was intending to force me to dispense more (gunpoint, for example). Fortunately, the patient returned about 30 minutes later, in the drive-thru, so there was zero chance of harm. The patient took the 3 tablets and left, hopefully for good.

The second patient came to the pharmacy requesting I do a pill identification. I checked the identifier and determined the pill was ibuprofen 200mg (OTC). The patient then claimed that this was dispensed in place of tramadol as listed on the bottle. I then checked the patient’s history to see which staff was involved in the fill and check process, discovering that I was the one who did the final product check. I then informed the patient of my method of checking filled RX’s and how even today I discovered an RX that was missing just 1 pill. I do this frequently. I can spot even 1 pill of a wrong MFR that looks very similar to the correct product. I have done it many times before, and I will continue to ensure proper dispensing going forward. I assured the patient that it was impossible that we dispensed the ibuprofen in place of tramadol. The patient tried to argue, but I wouldn’t have it and recommended the patient check with others in the household that could have access. The patient then gave up and left. A little while later, I received a call from this patient asking if the ibuprofen was prescription only. I responded that it was OTC only and that we do not carry OTC ibuprofen in the pharmacy. The patient sighed then hung up. I honestly think the patient put the ibuprofen in the bottle themselves and was trying to get more tramadol. Sad.

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