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Controlled Substances Dispensing Gets Pharmacy in Trouble – AGAIN!

Yet another pharmacy owner was just convicted of unlawfully dispensing over 1.5 million doses of controlled substances, primarily oxycodone and hydrocodone. 

By: Karen Davila

In my last couple of articles, I’ve focused on the controls necessary to safely operate a pharmacy and dispense appropriate prescribed medications, including controlled substances.  And those of you who heed that kind of advice are likely to avoid the unwanted attention of law enforcement.  However, for those who continue to think they can operate with impunity, heads’ up:  the war against opioids in the U.S. is ongoing and enforcement activities are not slowing down.  Below is an article about this recent case out of Texas and some lessons we can all take away from what was reported.

In this most recent case, a federal jury in Texas convicted a Texas pharmacy owner (Carr) on March 7 of one count of conspiracy to unlawfully distribute and dispense controlled substances, four counts of unlawfully distributing and dispensing controlled substances, one count of conspiracy to launder money, and two counts of engaging in transactions in property obtained from the illicit activity.  Carr now faces up to 140 years in prison, among other consequences.

Prosecutors were able to prove that Carr and five other co-conspirators engaged in a scheme to unlawfully distribute over 1.5 million doses of controlled substances, including 1.1 million oxycodone and hydrocodone dosage units, in just 18 months.  Care co-owned and operated CC Pharmacy in Houston and two others in the Austin area.  During that 18-month period, CC Pharmacy unlawfully dispensed the 1.1 million of oxycodone and hydrocodone on forged or stolen prescriptions for cash to individuals who claimed to be staff of long-term care facilities picking up prescriptions for their residents and patients.  The cash payments were then structured to avoid reporting requirements.

In my last article, I strongly recommended evaluating and reinforcing inventory controls, dispensing policies, and destruction/reverse distribution protocols.  For individuals who are hell bent on criminal acts, those controls might not help much.  But a diligent pharmacist, exercising his/her corresponding responsibility and independent professional judgment can make a difference.  A pharmacist should evaluate each prescription, focus on regulatory compliance, and only dispense a prescription written for a legitimate medical purpose and pursuant to a valid prescriber-patient relationship.

As previously discussed, a pharmacy’s dispensing policies should address the pharmacist’s corresponding responsibility and the expectations for the pharmacist to verify the validity of each controlled substance prescription before dispensing.  Completing each of these steps can provide meaningful information to assist the pharmacist in exercising his/her professional judgment as to whether to fill a prescription.  Dispensing policies and procedures also should include requirements for verifying the patient’s identity, calling the prescriber, using the state’s PDMP, and restricting delivery of controlled substance prescriptions to patient only, except in well documented circumstances.  When criminal activity, including fraudulent prescriptions are identified, the pharmacist should assure reporting to appropriate authorities.  If a pharmacist refuses to fill a fraudulent prescription, the pharmacist should either attempt to keep the original prescription (if there is a hard copy) or maintain a record of the prescription with details related to the concerns that caused the pharmacist to decline to fill the prescription.

Pharmacists can also play a role in identifying ordering and dispensing trends that raise suspicions.  Data analytics are used by law enforcement agencies to evaluate pharmacies and spotlight outliers.  Proactively reviewing the pharmacies data before the DEA and FBI are knocking at the door is a sure-fire way for pharmacists to avoid becoming the target of the investigation.

Lessons Learned

What can a pharmacist learn from this case?

  1. Crime doesn’t pay. In this case, Carr and his co-conspirators made over $5.5 million (between 5 of them).  However, Carr now faces up to 140 years in prison.  The press release on this conviction does not reference the likely fact that all of the ill-gotten gains were seized by feds and or will be returned through financial restitution, leaving Carr and the other criminals involved in this scheme with less than they had before they engaged in the criminal conduct.
  2. Focus on the basics. Each pharmacist should always exercise his/her corresponding responsibility.  Is the prescription for a legitimate medical purpose and written pursuant to a valid prescriber-patient relationship?  Is the patient known to the pharmacy?  Is the patient on other controlled substances or a doctor-shopper?  These and many other factors should be considered in each case.  Identifying and resolving “red flags” may prevent the pharmacist from filling a fraudulent prescription.
  3. Be observant. Pay attention to the individuals filling prescriptions at your pharmacy. Observe when they come, how they arrive, etc.  Patterns such as these are well known to law enforcement and should be on the radar for the pharmacist.
  4. Don’t ignore the data. Pharmacy operating systems usually can support analytics to help the pharmacist know if there are any overarching concerns with the controlled substance dispensing in the pharmacy.  Familiarity with that data can reduce the risk that a criminal enterprise is using the pharmacy to obtain controlled substances illegally.

In sum, pharmacists play a key role in assuring controlled substances are not distributed in a manner that continues to contribute to the opioid crisis.