The abuse of prescription drugs has been a growing problem in the United States over the past couple of decades (1). As a medical writer who has done a fair amount of work in the arena of treating chronic pain, I am well aware of this, and I am familiar with many of the actions that have been taken by the government and other entities to allay the problem (for example, placing restrictions on the prescribing of certain drugs and the development of tamper-resistant and abuse-deterrent drug formulations). Whereas some of these approaches have been effective, others have ostensibly done little but make it a greater pain in the butt for legitimate users of such drugs to obtain their medications. I do not claim to have all the answers to the problems of prescription drug misuse, but after my recent experience, I could not help but be perplexed by some idiocies of the current system.
I currently take a schedule 2 medication. Current regulations require that prescriptions for such drugs be written (except in case of emergency when oral orders may be acceptable) and cannot be refilled (2). In other words, prescriptions cannot be sent electronically or phoned in. I need a new written prescription from my doctor every month. However, it is acceptable for a doctor to write out 3 months worth of prescriptions for schedule 2 drugs, provided that an appropriate “fill after” date is written on each one. I have never understood the wisdom of allowing this but not allowing refills (which tend to have associated “fill after” dates), but I have gotten used to it. I have also never understood why the powers that be seem to assume that paper slips are somehow more secure than prescriptions sent electronically, but again, I’ve gotten used to it. I roll my eyes, shrug, and move on with life.
A few days ago, I left my doctor with my prescriptions for 3 months worth of my medication. Only after I had filled the first prescription did I notice that there had been an error. The pills looked different. I checked the label and checked the other prescriptions I had been given, and indeed, my doctor had mistakenly prescribed pills that were half the dose of the ones I had been taking for several months. I don’t know what happened, but my guess would be that he glanced at the wrong line in my record (I had been on the lower dose some time ago, so it’s on my chart) and wrote down the wrong number. Never mind the fact that this probably could have been avoided if he were sending the prescriptions electronically (that is, if he had just had to click a few times to send the prescription for the dose I have been on for months, the error probably would not have occurred), now I had a month supply of the wrong dose pills. Sure, I could take 2 per day, but I would run out in half the time, and prescription regulations would prohibit his prescribing more to make up the difference in the error. I also had two more prescriptions for the wrong dose of medication that could be filled one and two months down the line.
After speaking with my doctor, I drove over to his office to pick up 3 new prescriptions for the correct dose, in addition to a note (written on his prescription pad paper) explaining that the previous prescription had been an error. Although he had not asked me to, I had brought with me the remaining 2 erroneous prescriptions in case he needed them back to properly shred them, kill them with fire, or whatever needs to be done with such things. He simply wrote “void” on them and handed them back to me, suggesting that I keep them to show the pharmacist as further evidence that this was actually a mistake in the event that I encountered any trouble in trying to fill the new prescription.
I drove to the pharmacy, fully expecting that this was going to be a hassle and they were going to look at me sideways, take secret pictures of, and make notes about how I was probably up to no good. I was wrong on that, and the whole transaction went smoothly. Although it’s nice to know that the pharmacist was understanding that mistakes sometimes do happen, I was struck with what I had (or could have had) in my possession from this whole bungle:
- A one-month supply of my medication at half my current dose
- Two prescriptions, each for another one-months supply of my medication at half my current dose
- Three prescriptions, each for a a one-month supply of my medication at the correct dose
My medication happens to be an extended-release formulation that, as I am told, is not particularly “likeable” by abusers and is relatively tamper resistant. If that is true, one might reason that this particular formulation should not be on schedule 2. However, if it is not true and some creative addicts or entrepreneurial types have figured out ways to modify this drug to make it more abuseable, then I would like to point out that the current regulations (which prohibit refills and electronically sent prescriptions) have left me with (and with the ability to obtain, if not for my honesty and integrity) much more drug than I actually need.
So, yeah…paper and pen…much more secure than electronic transmission.
1. Prescription drug abuse, addiction and diversion: overview of state legislative and policy initiatives, a three part series. Part 1: Stat prescription drug monitoring programs (PMPS). Santa Fe, NM: National Alliance for Model State Drug Laws and the National Safety Council; 2013.
2. US Food and Drug Administration. Controlled Substances Act. http://www.fda.gov/regulatoryinformation/legislation/ucm148726.htm.