Sleuthing may not be part of a pharmacist's official job description, but most druggists call on their detective skills when they suspect a customer is abusing a prescription drug.

Knowing the possible signs of addiction and how to respond to them will give pharmacists the best chance of helping customers who may be in trouble.

Telltale Signs

Although it's wise to give customers the benefit of the doubt, pharmacists should be alert to warning signals that someone is abusing a drug.

"All healthcare professionals have to be careful about labeling someone as an addict," says Rod Shafer, RPh, CEO of the Washington State Pharmacy Association. "They may be taking a large amount of narcotics but have a legitimate reason to do so. But that doesn't negate the fact that one of our roles is to make sure drugs are taken appropriately."

Customers abusing drugs may try to get refills earlier than prescribed, fill a prescription for the same medication using different physicians or demand a prescription be filled the same day it's brought in.
It can be harder to detect customers who visit multiple pharmacies to obtain the same medication. However, as a relief worker at several pharmacies when she first moved to Pierre, South Dakota, Julie Meintsma, RPh, recognized customers who had been in other drugstores where she was also filling in.

"I had seen someone at one pharmacy one day, and then I saw them at another pharmacy," she says. "We did some checking and then alerted the department of health."

To collect more clues, a pharmacist can call other pharmacies to ask if a customer has been filling prescriptions there also. If the evidence suggests drug abuse, the first step is usually to call the customer's doctor.

"We tell the doctor that we think there may be a problem," says Mary Jane Fry, PharmD, a pharmacist at Medic Pharmacy. "We don't usually try to confront the patient, because that is something the doctor will do. As a pharmacist, you don't always know the circumstances, so you can't be privy to a disease the patient has or some extra stress that warrants them taking more than usual."

The most commonly abused prescription drugs include pain medications like hydrocodone or oxycodone, anti-anxiety medications such as benzodiazepine and muscle relaxants such as carisoprodol, Fry says.

High Tech Tools

Some states have made sleuthing easier for pharmacists. For example, 17 states have controlled-substance prescription monitoring programs, according to the National Association of Boards of Pharmacy (NABP). In Kentucky, when a pharmacist fills a prescription for a controlled substance, the information is transmitted from the pharmacy to a state database. Pharmacists can request a report on a customer if they need information from multiple pharmacies.

Also, 25 states are cracking down on the sale of over-the-counter drugs that contain ingredients such as pseudoephedrine, used in the illegal production of methamphetamine, the NABP says. In Oklahoma, for example, customers cannot buy more than 9 grams of pseudoephedrine over the counter in a 30-day period. Pharmacists keep track by having customers sign a ledger.

Intervention Often Welcome

Although such laws can add to pharmacists' workloads, the reward comes in knowing drugs are being used properly. Most customers who abuse prescription drugs didn't plan on becoming an addict and often welcome intervention, says Fry.

Shafer once had a female customer with an asthmatic condition who came to his pharmacy for Hycodan, a cough medicine. He noticed that over time, her prescription rose from 4 ounces to 16 ounces. One day she came in with a prescription from a different doctor, claiming her own doctor was unavailable. After making some calls, Shafer discovered this wasn't true.

Shafer told the woman that she seemed to be taking a lot of medication and that he had notified her doctor. She broke down and admitted she had a problem. "She was really glad someone had stopped her," he says. "Most people who are in that situation are not happy about being there. That's the positive side of confronting them."