Controlled Substance Medication Refill Policy: Fill & Download for Free

It depends on the drug and the pharmacy.(My answer is based on the United States. I don't know about other countries.)For most drugs if I were to report being sorted they would simply give me what I report missing. I've actually had this happen before so I know this for a fact.Of course, I've been going to the same pharmacy for most of my medications for years now. They know me. They know it isn't a habitual thing. Seriously, who complains about missing one hydrochlorothiazide (blood pressure medication) once over the course of ten years because they're lying to get more drugs?I've also had controlled substances. I have no doubt that I'd be out of luck if I were shorted any. So far that has never happened. The pharmacy I go to has a process where someone counts out the controlled substances and puts them into the bottle, writing the number they counted onto the label. (That way if they read the number wrong it will be obvious that that was the problem.) Then a second person counts them and, if it's accurate, circles the number. This is all done on camera so it isn't easy for someone to get away with stealing a few.There used to be a small pharmacy in my hometown of about 6,000 people. That was my pharmacy from the time I was a kid until the pharmacists retired shortly after I graduated from college. I sure do miss that pharmacy! They probably would have trusted me if I reported being shorted even a controlled substance. They knew me and my family and treated us like people rather than customers who have to follow a strict corporate policy.I say that because there was a time when I was going on vacation for a week and needed to refill a controlled substance a couple of days before it was due. I explained it to them and they filled it. The laws were more relaxed then but the bigger pharmacies still all had policies that prevented them from doing things like that, even for someone who has been a customer for years and just needs one exception for a perfectly valid reason. In fact, it was quite expensive and my insurance wouldn't let him bill it early so they just trusted me for it and billed it in a couple of days when it was due.From that experience I would say that if there's a small hometown pharmacy then you should go there. Even if it's a little out of the way, it's worth it if they treat you like a real person.

It depends on the patient, honestly. If it's someone I've been seeing for a long time and they've never lost a prescription before, I'd take them at their word and prescribe a replacement, advising them to keep their medication in a secure place in the future. If it's someone with a substance abuse history, I don't know them that well, or they have requested early refills more than once in a year period, I'd be inclined to refuse.I'd also closely monitor the controlled substance prescription database to make sure they don't respond to my refusal by going doctor shopping. I don't prescribe controlled substances to anyone with an active substance use disorder, regardless of the circumstances. They have to be sober for 3 months, verified by lab work, before I will consider it.I've lost patients due to these policies, and I know other docs are more lax about their prescribing habits.

When I was working in a retail pharmacy, the one we saw most often was people coming in asking for insulin needles and making a variety of excuses for why they didn't know the size and gauge needle they wanted. Often it would be something to the note of "its for my diabetic grandmother."The ones that had been using for a while would come in knowing exactly what they wanted and would refer to the needle as a "half-half thirty." Meaning half CC syringe with a half inch 30 gauge needle. I worked in Massachusetts and needles are legal to buy over the counter although it is up to the discretion of the pharmacist to deny the sale although the law may have changed in the past couple years since I practiced in MA. Most of the time, I or my co-workers would go through with the sale unless the person was extremely high or intoxicated (couldn't stand up straight, falling asleep, slurring, etc), being aggressive, asking people in the pharmacy for money to pay for the needles, things like that. There were a few pharmacists who would ask the person for ID and check if they were currently on suboxone and would refuse to sell needles if they had filled it within the past month or so. The reason being that patients on suboxone were supposed to sign an agreement that they will not use opioids (illicit or legal) while being treated for addiction. Additionally, many of these individuals were on Medicaid and were receiving treatment at taxpayer expense. Often times they would get their suboxone, sell it on the street (suboxone can and is still abused) and use the money they made to fund their heroin or other opioid use. I actually had one patient who was picking up his suboxone while talking on his phone negotiating a price to sell it.Another way would be how they referred to their medications. Clonazepam/klonopin were often referred to as "k-pins." Alprazolam/Xanax were referred to as "zani-bars." Gabapentin was called "gigs" or "johnnies."The most common way we could tell was from when they would come in for their refills. People who consistently come in and try to fill their controlled substance prescriptions several days early, or have claimed multiple times that their medications were lost or stolen raised a few red flags. Most stores I worked at had a policy that controlled substances would be filled no sooner than 2 days before they were due. Meaning a 30 day RX would be refilled on day 28. Might sound a bit arbitrary but if you're filling 5 days early every month for an entire year, you'll have an extra 60 days worth of medication over that time frame. So either that medication is being abused/misused or it is being sold and getting onto the street. For those who claimed it was stolen, we would ask for a police report to be filed and presented to the pharmacy. All this was done not only to prevent abuse, but also to protect us from malpractice should it be claimed that we weren't doing our due diligence in preventing drug diversion and abuse.In the hospital setting, it is a bit difficult. Pain is subjective and can be difficult to assess but there can be a few telltale signs the patient is trying to pull a fast one. One such example is what we facetiously call "positive cell phone signs." If a patient is texting/talking/playing on their phone when the nurse comes in to assess them, and they claim they are in 10/10 pain, they might just be lying. Especially if vital signs such as blood pressure and heart rate are relatively normal.Another sign is when a patient claims they know exactly what works for their pain and/or what doses they need. For example, they come in with a relatively minor complaint and are offered Tylenol or tramadol or morphine for their pain, they might say they have tried all those meds before and they "didn't do anything for my pain." The patient then goes on to say however that hydromorphone or fentanyl seems to work really well for them and ask if they could get and IV of that. That tends to set a few alarm bells off.I do need to note that there are patients who present in the hospital who have a complex medical history and truly need to be given massive doses of opioids to control their pain. Patients with sickle cell disease or a history of cancer may have been exposed to high doses of opioids in the past and will tolerate or ask for doses that seem excessive or abusive to some providers. Unfortunately, there are cases of such patients not receiving sufficient pain management and being treated unfairly due to preconceived notions or biases of the providers.