Smithers asked
I was in hospital for surgery. When I left, the doctor gave me a prescription for Vicodin and a steroid. One day later, I had to be taken back to the hospital and when I left, the doctor gave me another prescription for Vicodin (a second one) and a muscle relaxer. Different doctors, same hospital. They told me to go to my primary care doctor for follow up. When I went to my primary care doctor, they gave me yet another prescription for Vicodin as well. I turned in one prescription that was given to me but forgot the other one, which was for 15 pills. My Husband went to buy food and saw one of the Vicodin prescriptions with my release papers and thought that I needed that one as well. He went to the pharmacy by the store he was shopping at, instead of our normal one and left the script to be filled. When he came back from the store, the pharmacist said the Vicodin prescription had been cancelled because I had gotten some already (from my other prescription) the day before so my husband said ok and left without the Vicodin. When I went to my doctor again, she was really mad and said I had been red flagged. I didn't know what that was and she told me . I tried to tell her what happened but I could tell she thought I wasn't telling the truth. How can I get this removed and how long does the state of Missouri leave this on my file?
Answer
Unfortunately, this is a story we hear from our readers all too often. A simple mix up in prescriptions from different doctors that leads to one being perceived as a 'controlled substance shopper' or a 'drug abuser' when in reality, there was an innocent error and you are simply trying to appropriately start/continue on a therapy your doctor has prescribed.
It would be an understatement to say that the tracking of patient opioid use (and all controlled substances for that matter) has been in the spotlight recently. We are currently in an opioid abuse/overuse epidemic with countless people getting hooked on or abusing these types of drugs which can have serious health consequences in addition to the financial impact on the health care system.
To help combat this epidemic, the abuse and diversion of all controlled substances as well as the overprescribing of them, most states have created and utilized what is known as a Prescription Monitoring Program (PMP) or Prescription Drug Monitoring Program (PDMP). There is no federal prescription monitoring program as they are all run by the states themselves. Federal agencies (e.g. the DEA) can legally gain access to records but again, do not have a specific patient drug dispensing history tracking program in place. In New York, where I practice, our law for a PMP is called the Internet System for Over-Prescribing Act (ISTOP).
Prescription monitoring programs basically provide practitioners and pharmacists with secure access to view a patients history of dispensed controlled substance prescriptions. The systems show the dispensed prescription record of a patient, regardless of where the prescription was filled. In fact, in New York, before prescribing a controlled substance, the provider is legally required to check this registry to ensure appropriate prescribing.
The drugs that are to be legally reported typically vary by state and in general, the use of these systems is restricted to prescribers, pharmacists, and other parties such as law enforcement (which may need a subpoena before access). Patients typically do not directly have access the data. Some systems pull data from pharmacies daily while other systems pull data slightly less frequently.
In your question, you mention you reside in Missouri. Missouri was actually the last state to approve the use of a prescription monitoring program. The bill passed in April of 2017 but the program is still in the process of being set up and implemented.
In terms of being 'red flagged', there simply is no federal or state program for that matter that assigns a patient a 'red flag' for trying to fill too many controlled substance prescriptions. The prescription monitoring programs simply provide a detailed history of dispensed medications so practitioners/pharmacists may use their judgement when prescribing or evaluating their patients history. There are 'red flags' (i.e. situations that look suspicious and warrant further questioning/evalutation) to look for, but again, no one is physically marked with a 'red flag'. The 'red flag' your doctor refers to could be some sort of internal system the institution they work at uses or a personal way of recording things but again, there is no state or federal program that makes such marks.
Having said all that, as we have moved forward with electronic medical records and record keeping in general, one key in preventing medication errors and improper use/prescribing practices is having quick and direct access to a patients record as well as having open and transparent communication between medical providers (e.g. between providers at different locations and with pharmacies). While you may not have a physical 'red flag' on your file, there certainly could be some sort of patient note that has been written by your doctor which could be communicated to others.
Be assured that you are not now exempt, or excluded, from getting the proper care you need, even when if that includes the use controlled substance medications. You may just be checked more thoroughly by a provider if your past history has been communicated or someone sees multiple controlled substance fills in a PMP in a short amount of time, fair or not unfortunately. The best thing you can do as a patient is to have clear, consistent and accurate communication with your medical providers and pharmacists to build strong and trusting relationships.
