Drug Diversion and Abuse: Identifying Legitimate Patients Revisited

John Burke, commander of the Warren County, Ohio, drug task force and retired commander of the Cincinnati Police Pharmaceutical Diversion Squad, is a 40-year veteran of law enforcement. Cmdr Burke also is the current president of the National Association of Drug Diversion Investigators. For information, he can be reached by e-mail at linkEmail('burke','choice.net');, via the Web site www.rxdiversion.com, or by phone at 513-336-0070.

In my December 2008 column(www.PharmacyTimes.com/LegitimatePatients), I discussedthe idea of patients providing positivephoto identification when picking upcontrolled substance prescriptions atthe retail pharmacy. In that article, Iasked for input from you—the reader—on the pros and cons of makingthis mandatory in any one state or ona national level. I probably receivedmore responses from that article thanany other article I have written over thepast few years.

One reader indicated that the pharmacytechnician in his store wrotethe patient's driver's license or stateidentification number directly on theprescription for CII drugs only. Thistook very little time, but the reader feltthat it was a very effective way to curbdrug diversion.

One North Carolina pharmacist hadan interesting thought: to handle pickingup controlled substances in a similarfashion as the pick-up process at manydaycare centers in America. She indicatedthat her and her husband's nameswere on a list of individuals who wereallowed to pick up their child at thecenter. Her thought was—why couldn'tthe pharmacy have a list of individualsauthorized to pick up the patient's prescription?When proper identificationwas shown by that person, no entrywould need to be made in the database.This would save database entries, andshe thought that the process would befairly easy in most cases.

A drug diversion investigator in LittleRock, Arkansas, said that no law existedin his state to require pharmaciststo positively identify patients receivingcontrolled substances but that theyhad encouraged identification requirementand obtained excellent complianceby the pharmacy staffs. He saidthat virtually all of the pharmacies inhis area were happy to cooperate andobtain photo identification from thesepatients, making law enforcement's jobmuch easier.

Another pharmacist said, however,that he did not feel that it was his jobto do police work. He was trained toproperly and safely dispense medication,and his completion of any additionalwork was difficult due to timeissues and, in his opinion, improperconduct by the pharmacist. He felt thatif a pharmacist's role was more clearlydefined, they would not be completinglaw enforcement tasks. I understandthis point of view, but I reminded himabout the "corresponding responsibility"that is part of any pharmacist'sregulations to abide by.

A Michigan pharmacist said that, inher pharmacy, the staff requires photoidentification for all patients that comeinto the store for scheduled drugs. Theyalso write the identification informationon the prescription and, in somecases, even go into the parking lot tojot down license plates of those undersuspicion. She did admit, however, thatshe was in a small independent pharmacythat filled about 300 prescriptionsper week, and that made this taskmore feasible than in larger stores.

One industry representative felt that,if identification was required for controlledsubstance prescriptions only,it would make those individuals moresusceptible to being targeted for robberiesas they left the store or break-insif followed to their home. This wouldrequire the perpetrator to be very nearthe pharmacy counter to observe thisas part of the transaction. The proposalwas to make all prescriptions subjectto photo identification, instead of onlycontrolled substances.

Unfortunately, this would seem to behighly impractical and would increasethe volume of prescriptions in the databasealmost 10-fold. In addition, thissolution would inhibit the passage ofany legislation or administrative rulesto deal with the problem of drug diversion.

Thanks to all of you who respondedto me on this issue, plans are underway to assemble a symposium on thisissue in the spring. I will be reportingback to you what we learned and thefeasibility of requiring photo identificationwhen picking up controlledsubstance prescriptions.