– Pharmacists’ Code of Ethics Joe had a full time job. He and his “team” had become quite proficient at their trade. Joe’s job had several parts and as the leader Joe had to be particularly good at each. Joe was a salesman and over the years he had developed a list of “loyal” customers – they were, however, only loyal as long as Joe and his team could supply “quality” products at a competitive price and have them available when they needed them. Joe sold drugs--actually pharmaceuticals--on the streets of Indianapolis. Joe didn’t sell generics, only brand names – names his customers recognized. Joe’s second skill was as a con man. The con was to walk into a pharmacy – usually in the more affluent suburbs around Indianapolis – and pass the prescriptions Joe had spent a considerable amount of time forging. Another member of the team would go into physician offices and steal prescription pads – she was good at this but she couldn’t forge nearly as well as Joe could. This last skill is what lead to Joe’s arrest.2 One fall afternoon Joe walked into a pharmacy in one of the affluent suburbs the team frequented, and presented the pharmacist, Ed, with a prescription for controlled substance favored by Joe’s customers. Joe easily conversed with the technician and the pharmacist, explaining that the prescription was for his cousin, which is why the (fake) ID Joe presented did not match the last name of the patient. He went into detail about his cousin’s accident and her intense pain.2 Joe was proud of his handiwork on the prescription – it was beautifully forged. That was his downfall. Later, during Joe’s trial Ed, the pharmacist, explained to the jury that he became suspicious. He called the doctor and then the police because “the prescription just looked too good.” There are a lot of Joes walking into pharmacies today. Some, like Joe, steal and forge the prescriptions. Others, willing to spend more on overhead, visit “pill mill docs” who -- for the right inducement -- will write prescriptions for whatever the dealer asks. Pharmacists unwittingly become their suppliers. In this country it is estimated we, as society, spend, an average of $484 billion each year on abuse and addition. In addition, drug addiction and abuse “can be linked to at least ½ of all major crimes committed.”3 It is also estimated that “half of those taken into custody for violent offenses, such as assault or homicide, were under the influence at the time of arrest.”3 It is said the most addictive drugs are medications obtained from a pharmacy.3 According to the CDC in 2014, ten% of all persons in the U.S. over age 12 were involved in illicit drug use.4 The CDC further noted that the number of “drug-poisoning deaths in 2013 was 43,982,” of which “deaths involving opioid analgesics was 16,235” -- almost twice the number of deaths involving heroin. Every pharmacist knows we have a problem in the prescription drug abuse in this country. While abuse may include medical and pharmacy problems of the overuse of these drugs by real patients who take more than prescribed, the larger problems are the non-medical, non-pharmacy problems. The more serious problem is the availability of pharmaceuticals not prescribed for a “legitimate medical purpose by a practitioner acting in the usual course of professional practice.”5 There are many sources where pharmacists can find red flags and signs of illegitimate prescriptions and what we can do when we see them. This article is only to remind us of our obligation to society as pharmacists. One further warning – we should never become so over-vigilant that we fail to treat a legitimate patient in real pain. References 1. APhA Code of Ethics. http://www.pharmacist.com/code-ethics.
2. The story of Joe is a true incident, told using only my memory. There is no confidential information as all the facts presented here are from a public trial.
3. Drug Abuse – 10 Interesting Facts, Blog, Above it All Treatment Center, the figure includes lost job wages, healthcare costs, crime, traffic accidents and costs of the criminal justice system, https://aboveitalltreatment.com/blog/drug-abuse-10-interesting-facts/
4. CDC FastStats Homepage, http://www.cdc.gov/nchs/fastats/drug-use-illegal.htm
5. DEA Pharmacist’s Manual, Section IX – Valid Prescription Requirements, http://www.deadiversion.usdoj.gov/pubs/manuals/pharm2/pharm_content.htm
These articles are not intended as legal advice and should not be used as such. When a legal question arises the pharmacist should consult with an attorney familiar with pharmacy law in his or her state. Ken Baker is a pharmacist and an attorney. He teaches ethics at Midwestern University, Glendale, Arizona, campus and risk management for the University of Florida. He consults in the areas of pharmacy error reduction, communication, and risk management. Mr. Baker consults with Pharmacists Mutual Insurance Company and is an attorney, of counsel, with the Arizona law firm of Renaud Cook Drury Mesaros, PA. Contact Ken Baker at [email protected].