North Carolina Board of Pharmacy

Drug Diversion Pocket Card Drug Diversion Pharmacy staff: What is drug diversion?  Conduct background checks (criminal Drug diversion is the transfer of a prescription checks, credit checks, reference checks) on drug from a lawful to an unlawful channel of all staff. distribution or use. Federal law prohibits a patient » Note: Federal law prohibits a from giving, selling, or otherwise transferring a DEA registrant from employing controlled substance to another person. any person who has been convicted of, or pleaded guilty or What is diverted? no contest to, a felony involving The most commonly diverted/abused controlled substances. pharmaceutical drugs are:  Drug screen new hires.  Narcotics: hydrocodone (Vicodin, Lorcet,  Consider random drug screens for current Norco, etc.), oxycodone (OxyContin, staff. Percocet, etc.), fentanyl (Duragesic, Actiq,  Watch for changes in pharmacy staff etc.), hydromorphone (Dilaudid), etc behavior:  Stimulants: amphetamine mixtures ○ Personality changes (Adderall, Vyvanse), methylphenidate ○ Changes in work habits (Ritalin, Concerta). ○ Taking frequent breaks  Depressants: Benzodiazepines: ○ Frequent phone calls and visits alprazolam (Xanax), diazepam (Valium), from family and friends clonazepam (Klonopin), etc. Barbiturates: ○ Financial problems pentobarbital, phenobarbital, etc. ○ Unusual interest in a drug not  Muscle relaxants: carisoprodol (Soma), normally handled metaxalone (Skelaxin). ○ Taking down drug bottles when  Pseudoephedrine (Sudafed). not needed ○ Filling own and family/friend’s Who can divert? prescriptions Anyone! Drug diversion can occur at any point in  Lock up expired/recalled controlled the drug supply chain. If you suspect diversion, substances. start from the beginning.  Pharmacists should check in controlled substance orders themselves, or closely Courier Service: monitor technicians who perform this  Couriers are aware that they are trans- task. porting drugs.  Observe technicians and other  As soon as an order is delivered to the pharmacists’ counting of medications. pharmacy it should be immediately checked  Double count on prescriptions (two in and inventoried to determine if the order different people), especially schedule II is correct. drugs.  Double check invoices and immediately  Check refills on staff prescriptions, notify wholesaler if order is not correct. especially for friends and family of staff  Be aware of packages that disappear, members. packages that are not sealed completely (or appear altered), and changes in delivery schedules. Hospital/Institution Staff: Potential signs a prescription may not have  Drugs can be diverted anywhere in their been issued for a legitimate medical purpose: path of distribution in the hospital, even  Practitioner writes prescriptions that are when delivered to units by technicians. notably in excess of those written by other  Addicted nurses are one of the most widely practitioners. reported causes of diversion.  Prescriptions for antagonistic medications (i.e. depressants and stimulants) are » Frequent sign-outs » Frequent wasting presented simultaneously. » Patient refusals » Substitution  The patient appears to be returning too » Accidental breakage » Dilution quickly (a prescription which should have » Documentation issues » Verbal orders lasted for a month in legitimate use is being refilled on a biweekly, weekly, or even daily basis).  Patient presents prescriptions written in the Patients/Prescribers: names of other people. Potential signs a prescription may have been  A number of people present within a short forged: time bearing prescriptions from the same  Standard abbreviations are not used. physician.  Quantities, directions, or dosages differ from usual medical usage.  Prescription appears to have been photo- Prescription forgery prevention techniques: copied.  Encourage physicians to write out the  More than one ink color or handwriting is quantity (i.e. “ten”) on the prescription, used on the prescription. making it more difficult to alter.  Eraser marks are visible.  Verify telephone numbers on prescriptions  The paper appears to have been wet (acetone with a phone book or electronic physician may be used to erase a valid prescription). records on file.  Quantity appears to have been changed (a  Maintain a reference file of physician’s valid prescription for 10 pills could easily be signatures. changed to 40, 70 or 100 pills).  When there is any question about any  Prescription pads may have been printed aspect of the prescription order, telephone independently using a valid physician’s name, the prescriber for verification or address and DEA number, but with a clarification. different phone number where the forger’s  Check the date on the prescription. Has accomplice will answer the phone and the prescription been presented to you in a confirm the information. reasonable length of time since the  Patients could call in their own prescriptions prescriber wrote it? and give their own telephone number as a callback number. How to handle a potentially forged Reporting Diversion: prescription:  Contact the prescribing physician to verify  Any theft or significant loss of a the information on the prescription. controlled substance must be reported in Should the physician instruct you not to fill writing to the field division office of the the prescription, make a notation to that DEA within one business day of the effect on the face of the prescription. discovery of such loss or theft.  Ask the patient for identification. Completion of a DEA 106 form  When you have a confirmed forged regarding the loss or theft is also required. prescription, contact local law enforcement. (DEA 106 form/information: http:// Make a copy of the forgery to keep in your www.deadiversion.usdoj.gov/21cfr_repor records. ts/theft/index.html).  If the patient demands the prescription be  Any theft or significant loss must be returned, give it back. Do not jeopardize reported to the NCBOP within 10 days the safety of your customers, your staff or of the drug loss/theft via the Drug yourself. If you have to return a Disaster and Loss Report prescription you believe is forged, jot down (https://portal.ncbop.org) and click on what you can remember about the forger the Facility Management tab. Log in with and the prescription if you did not have the pharmacy's permit number, scroll time to make a copy. down to Reports, and select "Drug Loss Report". Remember:  If you believe that you have a forged,  It is impossible to spot a drug abuser solely  altered, or counterfeited prescription, by the way he or she looks. contact local police. Be objective and  Several signs of forged prescriptions are factual when talking to the police. subjective and are not necessarily indicative of wrong doing. Other information may be obtained General diversion prevention measures: from the following:  Limit access to pharmacy for staff (i.e. limited access for cashiers/front-of-store Drug Enforcement Agency employees) and close monitoring of non- Greensboro, North Carolina staff (i.e. repair workers, drug reps). 336.547.4219  Install security cameras. Controlled Substance Information  Training and education for all staff http://www.deadiversion.usdoj.gov/ members to be aware of the potential for DEA Office of Diversion Control diversion. Drug abuse prevention should be an ongoing staff activity. North Carolina Board of Pharmacy Chapel Hill, North Carolina 919.246.1050 http://www.ncbop.org

Nov 2017