Red Flags & Getting Back to Basics: Talking with Commander John Burke

Recently, I read the very unsettling story of a teacher’s assistant, Gary Dimick, who was arrested for selling more than 25,000 30 mg oxycodone tablets over 7 years, some on the elementary school grounds where he worked. He is a 33-year-old male, very clean-cut looking, the type you would never suspect to be engaging in such activities. This story has bothered me for a few days, as I have children in elementary school, and this could have happened anywhere.

The opioid crisis is at an all-time high. A chart on the US Department of Health and Human Services website shares many sobering statistics. For example, in 2016, more than 42,000 people died as a result of opioid overdose, and 2.1 million had an opioid use disorder.²

The situation had me thinking: what can we, as pharmacists, do to help? I spoke with Commander John Burke, President and Owner of Pharmaceutical Diversion Education, Inc, with more than 47 years of law enforcement experience, for answers.

He said he feels that we need to go back to basics, in recognizing fraudulent prescriptions. We talked about how, in a busy pharmacy, it is difficult to cross every 'T' and dot every 'I', but we need to make sure we address potentially fraudulent activity related to opioids. As he explained, we have all been taught many of these basic concepts, but it may be all too easy to bypass them in a rushed environment.

Commander Burke stresses the importance of trusting your gut feeling. Do you ever just have the feeling that 'something' is not right? Most times, your gut feeling is correct. Even if everything looks right, and we have a doubt, it is our corresponding responsibility to look into it.

Here are some other red flags we need to look for, and things we need to do:

• Always check the PMP on controlled substances. If it is a regular patient, this can be done periodically as time allows, because many times it is the patient you would least expect that is engaging in illegal activities. Check PMP on all new patients with a prescription for a controlled substance. If you see multiple prescriptions from different doctors, this could potentially be a problem.
• Call the doctor with any questions; do not worry about bothering them or feeling silly; this is your license on the line!
• Look out for multiple patients with the same exact prescription from the same doctor, often coming to the pharmacy together. Commander Burke explained that not all criminals are smart!
• View written prescriptions carefully for any alterations; for example, changing the quantity from ten to sixty. Sometimes, the phone number is altered, which is another reminder that when you call the doctor to verify the prescription, do not go by the phone number on the prescription. Look up the number in your computer system’s prescriber record.
• Cash-paying patients are always a possible red flag. Many times, patients are legitimately paying cash, but many times, they are not.
• Does the overall scenario make sense? If your pharmacy is in Pittsburgh, PA, and the prescription comes from a doctor’s office 1 hour away, and the patient lives 1 hour in the other direction, evaluate whether this makes sense. Is the doctor a specialist and does the patient work in the area of your pharmacy? Or does it not make sense to have all these factors, and other red flags exist? Why did the patient pass so many other pharmacies to come to your pharmacy?
• Commander Burke stressed that looks can be deceiving and there is no typical profile anymore. The opioid abuser can be a young man, a little old lady, or anything in between.
• When a patient comes in right before closing or on weekends, they could be legitimate, or they could be hoping you will rush and fill the prescription so you will get out on time and/or so you don’t page the doctor.
• Be wary of patients who talk too much—they may be trying to make you feel comfortable in the hopes that you won’t check on the prescription. Too much chatting can also be a sign on nervousness on their part.
• Handwriting on the Rx—this could potentially be a red flag. Many doctors scribble the name and date. If the entire prescription is neatly filled out, with address and date of birth, this could potentially be a red flag. A fully written out prescription with no abbreviations may potentially be suspicious (example—take 1 tablet every 6 hours, as opposed to i po q6h prn)
• Patients who present with several prescriptions and only want the control, could be a red flag. Always evaluate the situation. I have personally seen this several times with an antibiotic and promethazine with codeine.
• If your pharmacy/chain allows, require ID for controlled substances. Checking the PMP is important, but if patients are using different names, the PMP can fail to detect abuse.
• Does the prescription make sense for the doctor/scope of practice? If a patient comes in with a prescription for #10 Percocet 5/325 from a surgeon, this makes sense. If a patient comes in with a prescription for #120 Percocet 10/325 from a dentist, this does not make sense.
• Commander Burke and I also discussed how, often, the pharmacist may not come face to face with the patient, and that it is important to train the technicians to also be alert for these red flags.

He also explained that many pharmacists may be wary of reporting a suspicious prescription, but it is better to be safe and let law enforcement make that determination.

While taking into account all of the above, remember to always trust your gut feeling—many pharmacists can just tell when something isn't right.

What other red flags have you seen in your pharmacy? Email me at karenmichelleberger@gmail.com

References

• Teachers assistant pleads guilty to selling thousands of oxy pills. NY Post https://nypost.com/2018/03/14/teachers-assistant-pleads-guilty-to-selling-thousands-of-oxy-pills/. Accessed March 16, 2018
• US Department of Health and Human Services https://www.hhs.gov/opioids/about-the-epidemic/index.html. Accessed March 16, 2018