Connor asked
I have been taking generic Ritalin for about a year now. I see a nurse practitioner every two months. Six months ago she took a job as a professor at the local university. The first time I had the ritalin filled, it was hard to believe I was 35 years old and was feeling like a normal person. I have been diagnosed with moderate depression, general anxiety disorder and ADD. I've been taking anti-depressants and benzodiazepines for about 10 years. The depression and anxiety subsided when I started taking Ritalin. The second time I had the prescription filled I was given a different generic. It made me very jittery and it felt as if my heart was going to explode. I hadn't changed anything else and wasn't taking any other medications than the previous month. I told my APRN and she said all the key ingredients were the same, but had similar cases in the past with the generic I was given the second time.
The first prescription was a generic made by Watson, I know they've changed their name or been bought out. She then started writing Watson brand only on my prescriptions. I live in a small town, but am 15 minutes away from a town of 300,000. The pharmacy a mile down the street that I drove by everyday didn't carry the Watson brand, only the Mallinckrodt generic, which is what I received the second time. It's a cvs and the pharmacist tried to even order watson, but they apparently can only ask for it, not guarantee it. I started having just the ritalin filed at a walgreens that's 15 minutes away. I had no issues Getting the prescription filled. My APRN would write me two prescriptions at every visit. One to fill then and another to fill in 30 days. That way I would always have my mess between visits. The normal time of fill was always around the 26-28 of every month.
In June I went on vacation and we left the 21st and returned the 1st of July. I went to the pharmacy and explained I would be out of the state when my prescription would need a refill. Missing several doses would make me a zombie and I would get very lethargic and fatigued. They filed the prescription and I went on my way. When I started taking ritalin,I was taking 10mg, 3x a day. My body started to adjust and I became depressed, moody and extremely fatigued. She gradually raised the dose to 20mg, 3x per day up until Wednesday. I had begun experiencing the normal symptoms associated with my body adjusting to the drug. She said I likely have an extremely high metabolism and I'm 6'9", 255 lbs, so she told me to take an extra half a pill per day. This was while I was on vacation. I called her office and she called me back and said it would be alright. She gave me my scripts Wednesday that will last until September at our next appointment. She told me to fill the new ritalin script even though I had just received 90 pills 8 days earlier. I told her I had plenty and didn't need them, yet. She told me to fill it, because she wanted the prescription schedules to all coincide with another. I took 3 of my more 4 scripts to the pharmacy I live close to the next day.
I was near the walgreens two days after my appointment and went in to explain to the pharmacist why I was already there to get another refill. It was a new prescription- 105 pills vs 90 so my APRN said they would fill it. I spent 5 minutes explaining everything in detail to the pharmacist and told him my APRN said they might have to call her to verify why I was getting a more meds so soon. She said the pharmacy had to keep records in case the DEA came knocking. The pharmacist went to his computer and said he wouldn't fill it until the end of August. I asked why, and he said he couldn't do it until then. He was very rude and looked at me as if I was a drug seeker. It was embarrassing to explain all of that to the pharmacist at walgreens just to be turned away like I was an addict. I don't want to go pharmacy to pharmacy and go through all the reasons why I'm getting it filled. Any help would be greatly received.
Answer
In regards to your situation, I have seen many cases much like your own over years of practicing pharmacy. It's unfortunate that the people that DO abuse drugs and go doctor shopping ruin things a little for patients with legitimate medical needs. All pharmacists are extremely wary of prescription abuse, especially on controlled substances such as Ritalin. Many times this hesitation and feeling of suspicion is driven by how harsh and strict the pharmacy laws are in many states. It's the job responsibility of the pharmacist to make sure they dispense prescriptions for legitimate medical needs. Their licenses are on the line if they make errors in dispensing or medical judgment. This unfortunately leaves many pharmacists jaded when patients come in with situations like yours and they tend to assume the worst. The best thing you can do is to visit the same pharmacy and build a relationship with the pharmacists on staff. Nothing will bring on more suspicion on the pharmacists part if you are a new patient somewhere and only fill controls.
Just take a look at what the DEA says about controlled substance dispensing. It's honestly frightening in the eyes of a pharmacist:
"A pharmacist is required to exercise sound professional judgment when making a determination about the legitimacy of a controlled substance prescription. Such a determination is made before the prescription is dispensed. The law does not require a pharmacist to dispense a prescription of doubtful, questionable, or suspicious origin. To the contrary, the pharmacist who deliberately ignores a questionable prescription when there is reason to believe it was not issued for a legitimate medical purpose may be prosecuted along with the issuing practitioner, for knowingly and intentionally distributing controlled substances. Such action is a felony offense, which may result in the loss of one’s business or professional license."
Having said all this, there are things you can do to help. The more information your prescriber writes on the prescription the better. In your last statement about your situation, you mentioned the prescriber increased the dose of the drug. This is absolutely a legitimate reason to get a new prescription so the prescription bottle will accurately reflect the dose you are taking. It would certainly help for your doctor to write something along the lines of "dose increase to 20 mg three times daily". It always helps to have the prescriber indicate dose increases or reasons for the increase. While opinions differ, I am of the opinion ANYTIME there is a dose change, you get a new prescription and a new fill to accurately reflect how you are taking the medication, even if you have some left of an older prescription. Others will say you have enough pills remaining and therefore won't fill the prescription as the pharmacist did in your case. It depends on the state you live in, but in most cases a dose change warrants a new prescription.
Having your doctor (not a nurse or receptionist) call the pharmacy before you drop off the prescription to explain the situation helps immensely as well. When the pharmacy calls the office, the pharmacist rarely talks to the actual prescriber and instead communicates with the other staff, be it nurses or receptionists. This can often create miscommunication and assumptions that are wrong. If I had to guess, this happened in your most recent case.
You are in a situation many people have been in. The key is communication with all parties involved (Pharmacist, Doctor, Patients) and a good relationship with you and the pharmacy. Please let me know if I can be of any further assistance. I am more than happy to help.
Could you possibly provide more information in regards to you being flagged? As far as I am aware, there is no specific "red flag" system for any patient in the United States that is permanent mark on your medical history. Most pharmacies currently have the ability to look at ALL of your controlled substance prescriptions in a specific time period, but there is by no means a central flagging system with law enforcement. Many states have controlled substance monitoring programs including Arizona, New York and Tennessee. This programs simply allow access for all health care professionals to monitor patient specific controlled substance history. It's use is not intended to deny legitimate prescriptions that are appropriately prescribed.Most likely, you might just have a specific note on your patient profile at a pharmacy regarding your controlled substance history. Pharmacists are legally responsible for the medications they dispense, and if they ignore what the DEA calls "red flags", then the pharmacist can be held liable. Anyone with a past history of problems may just be scrutinized to a greater extent than other patients. All pharmacists are keenly aware of suspicious behavior or "red flags" so to say. Certain "red flags" identified by the DEA are:
- Patients receiving multiple controlled substance prescriptions from multiple doctors.
- Patients seeking early refills on controlled substance medications
- Patients with out of state address or presenting prescriptions from out of state doctors
- Patients paying high dollar cash amounts for controlled substances.
Can you describe how you were made aware you were "flagged" and if you have been denied legitimate and appropriate prescriptions?
If you have a legitimate medical need, and have not recently received controlled substance prescriptions from multiple providers, I see no reason you cannot get a future pain medication filled. Worst case, the dispensing pharmacy may just call your prescribing doctor to clarify any prescription.
Please feel free to email us any follow-up questions! We are always more than happy to help and wish you luck in the future!
