When an error is a good thing.
Brent Ferris from the Smiths Falls Shoppers Drug Mart pharmacy spoke at the municipal drug strategy networking day at the Brunton Community Hall, Blacks Corners, Beckwith Township, on Friday, March 1.
Desmond Devoy
SMITHS FALLS - Brent Ferris is actually pleased when he get an error message on his work computer.
As a pharmacist at the Shoppers Drug Mart in Smiths Falls, it means that the new computer program to monitor who is buying prescription drugs with addictive properties, is working.
The error message pops up when someone tries to fill the same prescription on the same day at two different pharmacies, as part of a larger series of laws first brought in in November of 2011, with a second phase initiated last May.
“It’s better (but) by no means perfect,” said Ferris during a presentation entitled “Enforcement of Drug Legislation in Community Pharmacies” at the Municipal drug strategy networking session on Friday, March 1, at the Brunton Community Hall, Blacks Corners, Beckwith Township. “Wading through more error messages is worth it to catch the cheaters.”
Part of the problem with monitoring drugs in this country is that, well, pills are popping up everywhere.
“We use a lot of drugs,” Ferris said. “Canada is the only place you can buy codeine with no prescription.”
Canada also ranks fourth in the world in terms of narcotics use, and 15th for use of amphetamines, and that 11 per cent of substance abuse comes from abusing prescription drugs.
Even though he handles drugs every day, at the methadone clinic run at his pharmacy, he was surprised to learn that it was not just recovering heroin addicts using the service, but former OxyContin or Fentanyl users too.
Another surprising fact that Ferris found was actually a good one – a problem he doesn’t face, which is that forged prescriptions are not a big problem for him, though “we have had a few prescriptions that we though were forged.” But people who do have legitimate prescriptions are sometimes deluding themselves that the doctor’s note gives them free reign with how they use their drugs.
“They are getting them from a doctor, which is kind of giving them license to do it (they feel),” said Ferris. “Our role as a pharmacist is to identify people who may be abusing.”
He admitted that he graduated in the “wild west,” days before these new laws were brought in, but just as a doctor needs to work on his bedside manner in real world settings, so too do pharmacists have to develop a bit of an inner amateur psychologist – and common sense – to see when someone may be pulling a fast one.
For example, a woman came into his pharmacy seeking to fill a prescription for Percocet.
“Please don’t run it through my drug plan,” she said, asking to pay only in cash. “She said it enough times that we tried to run it through her drug plan. She had (already) filled the prescription at another pharmacy…The drug plan helped us stop it.”
Even at a moment like this, Ferris stressed that, with other people standing around the pharmacy, it is not a good idea to make a big show of the situation.
“We’re not drug dealers whom you can threaten,” either, he added.
But computer programs are not the only way to keep an eye on potential abuse of the system – the small town grapevine helps too. With five pharmacies in Smiths Falls, and at least three in Perth, “it is easy to find if people are getting them elsewhere.”
With the changes in rules, area pharmacists are having to contend with irate customers who have never had to, say, show identification before when picking up medication for themselves or a family member, or who get offended when a pharmacist has to phone a doctor to double check a prescription.
“We’re not police,” said Ferris. “We’re not going to do anything with them. We just need to see it (the ID)…(The changes) led to a lot of feisty people who didn’t know the law, even though there were signs in the pharmacies.”
Ferris admitted that the narcotics monitoring system “is not a perfect system. (But) it allows us to keep track. It is a net. Some things are slipping through. It (also) catches things that should not be caught.”
One aspect of the computer system that Ferris finds quirky is that the “double-doctoring” application only flags more than two doctors, if a patient is seeing more than one doctor, to obtain multiple prescriptions, though he pointed out that it had to allow for medication prescribed by, say, a family doctor and then, a short time later, an emergency room doctor.
“We never want to deny people,” Ferris said. “Many prescriptions flagged are not suspicious. You try to solve it before you ever talk to a doctor because they are busy. Most prescribers are upset when alerted to a patient’s inappropriate behaviour.”
While pharmacists typically have less information about a patient’s background than, say, a doctor, they must look for clues that could well prove valid for, say, multiple prescriptions, or someone running out on a prescription early. Ferris found out that one patient is a drywaller, and so is often covered in dust, necessitating multiple applications – and prescription renewals – of a medicinal patch.
Even then, “there are situations where you are like, ‘What is going on?’ We use our brain. I feel professionally responsible, even if I am not legally responsible. It’s hard for us as people who want to do good.”
He has even seen some doctors cancel a prescription when abuse has been brought to light, with a promise to talk to the patient about their abuse at their next appointment.
While some drugs are certainly known to the public as having the potential to be addictive, some more “benign” drugs are also open to abuse.
“People never think of Tylenol as being bad,” said Ferris. He admitted that “it is fairly benign,” but that overuse can be “very hard on your liver…you are at serious risk of doing serious damage to your liver,” by abusing it.
One way in which doctors and pharmacists are working together to stop the abuse is by getting patients to sign narcotics contracts, in which the patient promises not to abuse the system, use multiple doctors, get the prescription filled at more than one pharmacy, and so on.
“Many prescribers are requiring this of patients before writing (prescriptions) for controlled substances,” said Ferris. “Ultimately, it is still the doctor who is at the top of the food chain.”
This can be a problem for him when he comes up against some doctors, one in particular who was “pretty free-wheeling with what he prescribed.”
Another partnership that area pharmacists have is with the police. The police will sometimes approach him to identify prescription medication they have seized or discovered in order to identify it. At other times, “we would not hesitate to call the police,” if it was necessary.
Ferris revealed that one of the most popular drugs at his pharmacy is Fentanyl, and “the amounts are terrifying.” Requiring patients to bring their used packets back to the pharmacy in order to repeat their prescription is a good first step, he feels.