What's Involved in Filling Narcotic Prescriptions?

Pharmacy students often graduate without ever filling a narcotic prescription. That’s because, depending on state and store policies, only a licensed pharmacist can do some of the functions and routine checking involved in the process.

I vaguely remember the first time I filled a prescription “from the safe.” It felt so awkward and unfamiliar. I kept mentally rehearsing the things I was supposed to do, because if there was any mistake, it was all on me. Thankfully, that first fill when through without issue, and then things became a bit more comfortable.

What I’m about to explain are some of the common steps involved in filling a narcotic prescription. My focus is on the things unique to a narcotic (Schedule II) prescription—not the routine steps that happen every time a prescription is filled.

Nothing in this article is intended to suggest pharmacists shouldn’t fill controlled substances or treat patients who present such prescriptions as criminals. However, we have a responsibility to make sure we comply with the many rules and regulations related to narcotic dispensing. We have legal responsibilities to our state, professional responsibilities to our employers and patients, and moral responsibilities to our communities.

The following steps aren’t necessarily listed in the order you’ll do them, and all steps may not apply to all situations. Your particular state may have additional requirements not mentioned here.

1. Is the Prescription Both Legal and Legitimate?

Narcotic prescriptions have a higher likelihood of being forged or faked than the average prescription for amoxicillin. Not only that, but both federal and state law have additional stipulations concerning what constitutes a legal prescription for a Schedule II controlled substance. You’ll have to know your state’s laws, but you should think about things like days’ supply, date written, prescriber name, and the state of origin.

Is there any evidence showing the prescription was tampered with? Has a date been altered or a quantity changed? Does the prescription paper look like the type of paper a prescription should be written on? Is the prescription written for a patient who doesn’t live near the pharmacy or by a prescriber you’re unfamiliar with? If anything appears to have been tampered with, you should call the prescriber to verify prior to filling and dispensing.

Is the prescriber properly licensed to prescribe controlled substances? If so, is his or her DEA number recorded on the prescription, or at least in your computer software?

All of these questions must be going through your mind when assessing whether the controlled substance prescription being presented is legal and legitimate.

2. Has the Patient Presenting the Prescription Shown Proper Identification?

Most states require some form of identification from the patients bringing a controlled substance prescription to the pharmacy. Have you complied with these state laws, as well as any additional store policies pertaining to the identification of the patient presenting the prescription?

3. Have You Checked Your State’s Prescription Monitoring Program (PMP)?

This step may vary by situation, but nearly every state now allows pharmacists to access the controlled substance prescription filling history of a patient to help deter drug abuse and diversion. Certain circumstances may require or at least encourage the pharmacist to check the PMP to make sure a prescription isn’t part of an attempt to use multiple pharmacies and physicians.

Most patients aren’t abusing their medication, but checking is prudent, especially in certain circumstances. An example of such a circumstance might be a prescription from an emergency room for a patient you’ve never seen before.

4. Have You Properly Maintained the Perpetual Inventory?

Your pharmacy will likely have some sort of paper log where the exact amount of the controlled substance dispensed is documented, along with the amount remaining in stock. Most pharmacies will then “back count” the stock to make sure an accurate record of the exact amount on hand is maintained.

5. Does Dispensing the Drug Require Any Further Documentation or Communication with the Patient?

I’m not talking about the counseling we always provide. Some states have additional material that must accompany a narcotic prescription. Massachusetts, for example, requires a pamphlet to be handed to every patient receiving a Schedule II or III controlled substance that warns about the dangers of addiction and even provides a list of resources for helping those addicted get treatment.

6. Have You Returned the Stock Bottle Properly to the Safe (If Applicable) and Locked It?

This process may vary by state and location, but as a rule, you don’t want to leave stock bottles of narcotics out on the counter, where they could get mixed in with the rest of your prescription inventory.

7. Has Appropriate Identification Been Properly Documented for Transmission to Your State’s PMP?

Sometimes, picking up a controlled substance will require an additional signature step.

Those are the basic steps a pharmacist goes through, both mentally and operationally, when filling a narcotic prescription. This process becomes routine over time, but each step is important, and our compliance with all related laws is a good step toward doing our part to help controlled substances be used safely and appropriately.