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What is the pharmacists role in dealing with addictive drugs or drugs that might be abused or misprescribed?

I'm writing a paper and I need to know how pharmacists would treat a situation where a patient may be addicted to drugs. Moreover, I'd like to know the protocol. What would happen in a situation where the doctor prescribed the wrong medication to a patient? How would the pharmacist deal with it? What are the safety protocols? How do they make sure patients with psychological disorders take their medicine? Please be elaborate. If any pharmacists choose to respond, some personal situations would help.

Public Comments

1. they count out pills
2. Two things - 1. This would depend on what part of the world you are referring to; 2. Why would you ask this in an anti-pharmaceuticals forum? You'll be lucky to find any pharmacists in here. Try in the General Health Care Section.
3. Well, this obviously depends on the situation, and wether the person is a Pharm Tech, or Pharmacist. Generally the responsibilities of a pharmacist are much more substantial than a mere tech. The ability of a pharmacist to second guess a doctor is quite limited, though it's been legally established that under certain circumstances they have the ability to refuse to fill a prescription, and even contact law enforcement. The latter occurs particularly when it's clear a customer is attempting to fill a forged or altered prescription. Prescriptions generally have anti-tampering methods, and if it's clear a prescription has been altered (eg, bleached and rewritten), it tends to be fairly obvious. Certain shorthand notations are common and a prescription that has been altered generally won't follow these. If a prescription is for an extremely atypical medication in turns of dosage, or amount (say a very large number of opiate painkillers, or multiple high potency ones), under most jurisdictions a pharmacist has a legal obligation to contact the doctor and confirm this before they can fill the prescription. As for incorrect medications, there's a limit to a pharmacist's ability to identify these though it's generally greater than a doctor's (say if a patient is seeing several doctors, such as specialists). If a patient comes in with two conflicting prescriptions this is fairly easy to recognize - or if they have prior prescriptions in the pharmacy's database that conflict. In this case, it's the obligation to discuss this with the patient, and contact the doctors in question. Most pharmacy software systems used in hospitals and a good portion of those used in retail automatically recognize some of the more common medications. Hospital systems also tend to recognize medication allergies - though this can be a problem as sometimes patients confuse poor tolerance (eg, Vicodin made my stomach upset) vs a true allergy. Safety protocols vary from pharmacy to pharmacy. CPhT and Pharmacist continuing education generally requires the person to take some units in legal aspects and recognizing medication diversion and illicit prescriptions. I've only worked as a CPhT when I was an undergraduate, and it was generally our responsibility only to report suspicious materials to the on-staff pharmacist and let him deal with it. Medication adherence is a messy issue, in general, but especially so with psychological disorders. One common thing we ran into all the time was patients with more severe asthma being prescribed steroids. These are of course, corticosteroids, used to control the run-away immune response in asthma. Patients would hear the term steroid and then not take their medicine, assuming it to be the same sort of steroids railed against in the newsmedia and abused in professional sports with catastrophic effects. In medicine, steroids are a huge variety of molecules, and doctors frequently don't recognize that when they say steroid inhaler, a patient here's insane sportsplayer muscle building horror drug. Psych things are tricky. They can talk with the pharmacist of course - most know more about the details of medications, the messy biology than doctors and can give a lot of reassurance. There's also been some effort for devising a sort of protocol for a medication consult system, where a pharmacist meets with a patient, discusses any problems they have taking their medication (eg, I forget) and works with them to use some techniques to address these problems. I don't know if these have been implemented in the CE curriculum or in practice, they were still being developed when I was in the field. Hope that's somewhat useful. A relic of a part time undergraduate job. I work primarily in the lab these days and don't see a lot of this, but if you want something specific, feel free to mail me and I'll offer what I can.
4. It is actually a very unfortunate situation for pharmacy's in The US (where I assume you are). There is some liability on the pharmacy but more falls on the doctor. If a pharmacist has concerns about the legitimacy of a Rx or to clarify they would call the prescriber. And, as Az R said, in a case of tampering or forgery law enforcement may become involved. A pharmacist is unlikely to do a lot unless a patient is filling 90 tablets of Xanax, 60 tablets of OxyContin, and 30 Adderall every couple of days. Pharmacists basically just follow orders and in some cases any question you ask will be answered with "talk to your doctor." Aside from a major drug interactions little is done. I have on several occasions been socked about what pharmacists (mostly in The US) allow. I have a legitamite pain problem and at one point I was tossed around to three specialists and all prescribed opioids (different ones each time) in a single weeks. In my case it is not an issue but that certainly sounds like doctor shopping. There is no way, except a court order, to make a person take medication, psychiatric or otherwise. Here are a couple of stories I can give about a pharmacy. I once went to a pharmacy to pick up an unfortunate number of prescriptions, including one I was no longer taking- M-Eslon a brand name of morphine. There were so any bottles of medication I did not notice it. The next day my doctor called and requested I bring the medication to the pharmacy because THEY were in violation of the law. They failed to notice the "discontinue" printed on the computer generated Rx. The pharmacy was a bit frantic but I lived a block away and I knew the pharmacist well so they did not appear to completely lose their heads. There was one occasion when a pharmacist pulled me aside to ask about the number of refills I was getting. He did look concerned but once I told him I would be on a long trip he felt comfortable. And he did almost call my doctor. In The UK, where I once lived, pharmacists are completely different from Canada or The US. In London I was prescribed propranolol, a beta-blocker for migraines. I also felt sick so I asked for some cough medication. The assistant refused to give the the cough medication because it could raise blood pressure and propranolol is mostly used to lower bp. It took a while but I explained it and the pharmacist was able to tell the assistant that I could take both. Pharmacists go through a lot of schooling and I would think it might be better to use them as more than pill counters. In the end that is what they mostly do, count pills.