OK now and again you will get a methadone/controlled drug addict who will become abusive due not being able to collect his medication due to legalities.
For example take this scenario:
Addict comes in and says he wants to collect his 400ml methadone. But he was meant to collect it yesterday. Now he says forget yesterdays but you have to give him atleast three days supply.
You say no its against the law and will not supply it. As the prescription says dispense on Friday but he has turned up on saturday.
He then gets abusive and no matter what you say he will not leave.
What would you do?
How would you personally deal with this and what would consider to be the main legal, ethical and moral points to consider?
Last edited by rafhelp; 11th, July 2010 at 04:53 PM.
In practice just deduct the one day. I know you should not, but in court a pharmacist who did so was excused by the judge who thought it was common sense. I did consider getting a rubber stamp with the correct wording on.
johnep
You don't need a rubber stamp. In practice I would have ascertained the CDT's intention were this to happen, before taking the script on, and ensured the addict knew what would happen if the CDT were against it. If necessary I would write the wording on myself.
You just know that at some point its going to happen, and this should be a discussion already had between the shop and the local CDT.
Clinics suffer from the following (or rather we do)
1) New Drs from overseas who do not know Good Friday, Easter Sunday, Christmas, and New year are holidays.
2) Drs who do not realise that a script written and dated for first supply from a specified pharmacy will not be dispensed if script written at 5.30pm and the pharmacy is closed by time addict able to get there from far side of town. (Pharmacy closed at 5.30pm but general store/supermarket open late)
3) Drs who have no idea what the correct date is and who cannot do the basic arithmetic to calculate total dose.
4) Drs who have an illegible signature and do not print their name. (we were reduced to putting 'dr at adact etc).
5) Drs who say that MST means morphine sulphate tablets and therefore no need to put dosage form.
6) Drs who think that Concerta tablets are capsules because of the shape.
7) Drs who think the computer puts on a date and therefore no need to add one.
All above apply to handwritten scripts, often computer has crashed and new Drs may not have written a script before.
Naturally, these scripts are presented on Saturdays, Bank Holidays etc.
johnep
Last edited by johnep; 12th, July 2010 at 07:51 AM.
"Drs who think that Concerta tablets are capsules because of the shape"
Testify to this as experienced it in pre-reg.
A consultant was prescribing concerta XL capsules. I'm the one who ended up calling him, and with hindsight my explanation/discussion to him was quite good on my part, but apparently he'd been writing capsules for years and looked like no one else had bothered to call him about this, so didn't see why we were bothering him, did explain to him cellulose/gelatin bit, he wasn't having any of it. asked him to look in BNF still nothing, ended up sending the patient away.
Another case of Doctor (in this case a consultant) says it's ok so why can't you pick it off the shelf and give it to me.
Trouble with Concerta is that usually prescribed by Child Psychiatrist who only visits local centre, perhaps once a month. In my case script had 'been on CD clip' for a week. Pts carer came in on a Saturday of course. In the end I amended the script and signed my name. No come back.
johnep
yeah i seen some prescriptions where its all in doctors handwriting (or should i say scribble) and I could not make out a single word or number even. For all i know the patient could have scribbled it themselves and said it was a private prescition.
One methadone regular came in for his supervised and sneezed some of it over me. I looked like I had the Venusian flu.
Then he came back later in the day for his supply, so his social gaffe obviously made a big impression on him.
Another came in asking for a plaster, and I offered to sell him some (where do I get these wild ideas from) whereupon he told me off for not looking after the public's health, as he had hepatitis C.
I met a third outside a local shop, got a cheery wave, then turned a corner to hear the security guard warning all-comers that one of their major scourges had just entered the precinct: yes, her.
They are all OK with me, though, I couldn't have called any of them abusive.
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