Drug Diversion and Abuse: Identifying Legitimate Patients Revisited

FEBRUARY 01, 2009
Cmdr John Burke

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 , via the Web site www.rxdiversion.com, or by phone at 513-336-0070.

In my December 2008 column (www.PharmacyTimes.com/LegitimatePatients), I discussed the idea of patients providing positive photo identification when picking up controlled substance prescriptions at the retail pharmacy. In that article, I asked for input from you—the reader—on the pros and cons of making this mandatory in any one state or on a national level. I probably received more responses from that article than any other article I have written over the past few years.

One reader indicated that the pharmacy technician in his store wrote the patient's driver's license or state identification number directly on the prescription for CII drugs only. This took very little time, but the reader felt that it was a very effective way to curb drug diversion.

One North Carolina pharmacist had an interesting thought: to handle picking up controlled substances in a similar fashion as the pick-up process at many daycare centers in America. She indicated that her and her husband's names were on a list of individuals who were allowed to pick up their child at the center. Her thought was—why couldn't the pharmacy have a list of individuals authorized to pick up the patient's prescription? When proper identification was shown by that person, no entry would need to be made in the database. This would save database entries, and she thought that the process would be fairly easy in most cases.

A drug diversion investigator in Little Rock, Arkansas, said that no law existed in his state to require pharmacists to positively identify patients receiving controlled substances but that they had encouraged identification requirement and obtained excellent compliance by the pharmacy staffs. He said that virtually all of the pharmacies in his area were happy to cooperate and obtain photo identification from these patients, making law enforcement's job much easier.

Another pharmacist said, however, that he did not feel that it was his job to do police work. He was trained to properly and safely dispense medication, and his completion of any additional work was difficult due to time issues and, in his opinion, improper conduct by the pharmacist. He felt that if a pharmacist's role was more clearly defined, they would not be completing law enforcement tasks. I understand this point of view, but I reminded him about the "corresponding responsibility" that is part of any pharmacist's regulations to abide by.

A Michigan pharmacist said that, in her pharmacy, the staff requires photo identification for all patients that come into the store for scheduled drugs. They also write the identification information on the prescription and, in some cases, even go into the parking lot to jot down license plates of those under suspicion. She did admit, however, that she was in a small independent pharmacy that filled about 300 prescriptions per week, and that made this task more feasible than in larger stores.

One industry representative felt that, if identification was required for controlled substance prescriptions only, it would make those individuals more susceptible to being targeted for robberies as they left the store or break-ins if followed to their home. This would require the perpetrator to be very near the pharmacy counter to observe this as part of the transaction. The proposal was to make all prescriptions subject to photo identification, instead of only controlled substances.

Unfortunately, this would seem to be highly impractical and would increase the volume of prescriptions in the database almost 10-fold. In addition, this solution would inhibit the passage of any legislation or administrative rules to deal with the problem of drug diversion.

Thanks to all of you who responded to me on this issue, plans are under way to assemble a symposium on this issue in the spring. I will be reporting back to you what we learned and the feasibility of requiring photo identification when picking up controlled substance prescriptions.