How to not be treated like a criminal at a pharmacy

January 17, 2008 8:04 PM

My pharmacy screwed up on my Xanax prescription, and I'm afraid they're going to hassle me for what might appear to be drug seeking behavior.

I'm on some heavy meds for my ADHD, Adderall XR plus Xanax and Ambien for its side effects. Please don't give me grief about the medication, I'm very aware of the risks and work closely with my doctor to make sure that I'm not headed for trouble.

This month my regular pharmacy was out of the Adderall, so I took my prescriptions to another (different chain) that I've only been to once before. The problem is that when I got home I counted the pills and the Xanax bottle contained 40 instead of 45. I called the pharmacy and they told me to bring in the bottle tomorrow to get things straightened out.

Now, I know that the new prescriptions and scheduled drugs involved are going to raise some red flags. But I also know that I use the meds completely legitimately and they should straighten out their mistake. Am I likely to be hassled/disbelieved/black marked in their database?

If it's at all pertinent, our state has no central DB for them to look up my history, and I've had a long term relationship with my doc who knows I'm not out to get high.

Thanks a bunch!

posted by anonymous to health & fitness (22 comments total)

I'm no expert, but I used to work as a pharmacy tech, and this kind of thing happened on a semi-regular basis. I didn't see the pharmacists get nervous about it unless it was a prescription for something like OxyContin - because those got triple checked, and they were pretty sure the person was probably lying.

Anyway...they do have the ability to put notes on your account, but it's not likely they'd do it for a single instance like this. They shouldn't hassle/disbelieve you, either - they know that mistakes happen.
posted by Liosliath at 8:14 PM on January 17, 2008

I don't think your claim of an error of -5 pills is going to set off their alarm bells. If you tried to tell them that they erred to the tune of -20 or something, THEN they'd get suspicious.
posted by amyms at 8:18 PM on January 17, 2008

First off, don't try to solve problems you don't have (yet). Your first approach should be to just take them at their word and go in to solve the problem, assuming that they will happily fix their mistake. They should be able to count and confirm that they have five more pills left over than they should.

If you do come away without the pills I'd call the doctor for help. A call to the pharmacy from him/her may be helpful. I might also go back to your regular pharmacist and ask for advice on how to deal with the situation -- s/he might be able to vouch for you, or tell you what the procedure is for resolving disputes with pharmacists.
posted by winston at 8:21 PM on January 17, 2008

Go in wearing business casual attire. Explain honestly what happened and that you expect them to fix their error. You're not lying (right?) so you needn't be nervous.

There's really no reason for a one-time error like this to lead to blacklisting. That's what they reserve for when a doctor disavows a refill or other behavior like suspicious signatures or alterations to the scrip.
posted by dhartung at 8:25 PM on January 17, 2008

i'm thinking that they could just call your doctor, to confirm what you were supposed to get.
or maybe not, due to HIPAA, or whatever. I did notice that for a prescription for some Oxy's I got, that the script was on one of those pressure-sensitive carbon pads, presumably for record-keeping purposes.
posted by ArgentCorvid at 8:42 PM on January 17, 2008

I once picked up a prescription for 30 count of celebrex only to realize when i got home that they had given me 90 count of hydocodone. I probably wouldn't have realized the mistake except for the difference in the number of pills. It could've been bad if I had taken the hydocodone thinking they were celebrex. Mistakes do happen. And yes, I took them back. The fact that you called right away will help.
posted by tamitang at 8:43 PM on January 17, 2008

I worked as a pharmacy tech and I would have found this very suspicious. I could be mistaken but I have never heard of people going straight home to count their pills. (Do people really do this?) The people who came back with this claim were always well-known to the pharmacists. I would just ask the doctor to call in more for you if you need them. YMMV etc.
posted by loiseau at 9:09 PM on January 17, 2008

tamitang: I once picked up a prescription for 30 count of celebrex only to realize when i got home that they had given me 90 count of hydocodone. I probably wouldn't have realized the mistake except for the difference in the number of pills. It could've been bad if I had taken the hydocodone thinking they were celebrex. Mistakes do happen. And yes, I took them back. The fact that you called right away will help.

This really is *quite* a different situation than the original poster's.
posted by loiseau at 9:10 PM on January 17, 2008

loiseau: I thought the same thing: I always assumed I was the only one obsessive-compulsive enough to count out my pills.

However, I think a few things are working in the OP's interest:

- It's a difference of 5 pills. It's not like you're walking in claiming that you got 2 pills when you should have 45. I don't think junkies would be smart enough to get the idea of claiming to only be a few pills off, and, frankly, it's probably not worth their time.

- You're in the right. They can stare at you over their glasses and scrutinize the prescription under a microscope, all the while glaring at you suspiciously, but, at the end of the day, it's their mistake.

- Your doctor can vouch for you, and, depending on your relationship with the pharmacist at your regular place, s/he may be able to, too.

- There are valid reasons to count pills, including (but not limited to): being obsessive-compulsive like me, having been shorted in the past, not trusting the new pharmacy, having been told by your doctor that you should always count pills with a controlled substance, etc.

My advice: take dhartung's advice, but, when explaining your problem, casually slip in why you counted the pills, to try to short-circuit any potential suspicion. And then take winston's advice.
posted by fogster at 9:29 PM on January 17, 2008 [1 favorite has favorites]

Just to chime in, according to the Washing Post at lest "1.5 million Americans are sickened, injured or killed each year by errors in prescribing, dispensing and taking medications"

This breaks down to about 1 every 4 minutes. Considering it takes 30 seconds of my time to do this every month, I think it's worth it. Obviously being a few pills short of a non-life threatening is a different story than the stat quoted above, but I just don't see why it's considered so suspicious.
posted by TungstenChef at 9:51 PM on January 17, 2008

I have heard of patients receiving more pills than they required - often rounding up to the nearest 5 or 10 - but NEVER fewer.

Return to your pharmacy and ask to speak to the pharmacist. Someone in the pharmacy is probably "diverting," which is a fancy word for stealing - the meds. This is extremely common.

Worst case: you may have to explain what happened to your doctor and ask him to write a scrip for the extra 5 pills. I can't think of any situation in which I'd refuse to prescribe 5 more Xanax to someone who I just prescribed 45, unless it got to be a pattern of behavior.
posted by ikkyu2 at 10:38 PM on January 17, 2008 [1 favorite has favorites]

(I sometimes work as a pharmacy tech. Also, I'm assuming you're in the U.S.)

I don't think five Xanax is anything that anyone is going to worry about. It's a scheduled medication, which means it has some potential for abuse, but it's pretty low down there (schedule IV - same as Ambien).

Best pharmacy practices is that any scheduled prescription should be double-counted by the tech, but I know that in practice this doesn't always happen. Pharmacies are very careful about the schedule II drugs, but only because they're required to account for every single pill by the DEA. Schedules III-V aren't treated as carefully.

It's possible, but IMO pretty unlikely, that your profile at the pharmacy may be flagged by the pharmacist. Even if it does, this is unlikely to actually affect you, since it isn't your regular pharmacy. Just go in and let the pharmacist give you the five extra pills, and be done with it.
posted by neckro23 at 10:52 PM on January 17, 2008

The pharmacy near my parents shop routinely shorted them, usually 3-5 pills...figure 3-5 pills per perscription per day an they are making a ton of extra bucks. They *knew* they were shorting people...fixing the ones they get caught on is easy.

Seems there are three flavors of PharmTech posting here, the one saying its an honest accident that happens in a high volume place, the one that says its nothing to worry about and the one that says OMG someone's going to catch us, tell him to go away or we'll arrest him!

Pay attention to the two that are saying its nothing to worry about, ignore the one that's worried about the State pulling their license.
posted by legotech at 12:53 AM on January 18, 2008 [1 favorite has favorites]

i'm thinking that they could just call your doctor, to confirm what you were supposed to get.
or maybe not, due to HIPAA...

Its not unusual for me to get calls from a pharmacists to either confirm a prescription or clarify something; HIPAA is not an issue since the pharmacist is involved in the patient's care.
posted by TedW at 5:31 AM on January 18, 2008

I take two Zoloft a day, so my monthly prescription is for 60 pills. Recently, I realized that Bartell Drugs had only given me 30 Zoloft. I freaked for a few minutes, then called the pharmacist on duty. No problem. I stopped off after work and picked up the other 30. Mistakes happen.
posted by Carol Anne at 5:35 AM on January 18, 2008

You really should have no problem with this, especially if your doctor is on board, because you can refer the pharmacist to him (or her) if they get snippy with you. They should absolutely make right on this, and five pills is no big deal.

Also, as far as insurance carriers go, they will usually renew a prescription for controlled drugs, according to my pharmacy, after at least 3/4 of the prescription is meant to have been used (I didn't state that well, but anyway), so if you had a prescription for a month, taken one a day, you could come in at 3/4 of 30 days, or ~24 days later, for next month's Rx.

What I am getting at is, worst case scenario, if they won't give you the five pills you are missing, you can fill your next prescription a little early and the insurance will let it slip through.
posted by misha at 8:09 AM on January 18, 2008

I worked at a high volume pharmacy. This is not a big deal unless the drugs were very expensive or there was a clear history of drug seeking behavior. Xanax, while addictive and abused, is nothing compared to the major offenders that we tried to catch. There were people literally coming in with multiple opiate prescriptions from different doctors and engaging in all sorts of obvious fraud. We also had a bunch of profiling techniques we used, and they usually worked. There are far too many people who aren't clever about it, and this is with Oxycontin and heavy opiates, that no one cared about anything really except opiates. That and one thing you learn in a pharmacy is that people have weird prescriptions, so someone with the cocktail you have does not bat an eyelid.

Pharmacists are always going to give you what you need, and give you the benefit of the doubt, unless you have a history or you look like you might be abusing. Dress professionally, make sure you shower and clean up, and you won't have any problems. We didn't have time to catch abusers who were smart enough to not look like junkies.
posted by geoff. at 9:52 AM on January 18, 2008

Oh and if this is a recurring script it should be in the system, so it isn't like this is a one time script and you want to trip on Xanax for just a few more days. Xanax is simply not addictive enough for abusers to seek out 5 pills on a recurring script.
posted by geoff. at 9:54 AM on January 18, 2008

go back to the pharmacy with complete self-confidence, explain their error and request that they make it up. at the slightest suggestion that you're a drug abuser, cue nuclear dudgeon.
posted by bruce at 10:32 AM on January 18, 2008

There are valid reasons to count pills, including (but not limited to): being obsessive-compulsive like me, having been shorted in the past, not trusting the new pharmacy, having been told by your doctor that you should always count pills with a controlled substance, etc.

I count my prescriptions, as I have been shorted in the past, to the point that one prescription was cut in half. Now, luckily none of them were schedule II drugs, although I do count those out as well, when I receive them.

Medications are expensive and pharmacists are human beings, mistakes happen, why not double check?
posted by SuzySmith at 12:54 PM on January 18, 2008

Yes, just be very nice, dress well and do not get angry. There's a strong possibility someone at the drugstore stole the drugs to feed *his or her* own habit or selling. They won't want to get caught, so it will probably be easily resolved.

As long as you don't go in nodding and filthy and furious, with a drug like that and a one-time incident, it is unlikely to be problematic.
posted by Maias at 12:56 PM on January 18, 2008

Another pharmacy tech answer:

If you come in for your first fill ever and you hand me a pile of controls, I might wonder if you are pharmacy hopping. If the other pharmacy called ahead of time and asked if we had it in stock because they didn't, and you came over there shortly after, I wouldn't think anything of it. That isn't uncommon at all.

Now, if no pharmacist called looking for a control because they were out of stock, and you came in saying your pharmacy was out and could you fill my pile of controls and by the way I'm paying in cash and I'm going to sit right in front of the window and wait and then count them as soon as I get them, then, yeah, you are acting like a drug seeker.

So my guess is that you were written for 45 alprazolam because you take 1 1/2 a day. The majority of scripts that come in are some multiple of 10, so it's kind of easy to go on autopilot and count things out. Unless the pharmacist does a recount or they use a pill counter, the only things that are verified before selling are NDC number and patient.

our state has no central DB for them to look up my history

There sort of is. It's your insurance company. That's why junkie pillheads try to pay cash for early refills or 5 different Vicodin scripts they got in a week from 5 different ERs. The insurance company will reject the claim for excessive dosage, to soon a refill, or excessive duration.
posted by pieoverdone at 12:58 PM on January 18, 2008