Benzo Police

I had a woman bring me a prescription today for Klonopin 1mg BID with 3 refills. The doctor forgot to include a quantity, so I had to call and speak the the nurse to clarify. While I had her on the phone, I asked about the benzodiazepine use in this patient, as she had received #90 generic Xanax only two weeks prior from the same doctor.

The nurse said there was no record in the chart of the Xanax script and it must have been a forgery. I pulled the original - it was written by the doctor for #90 Xanax with 3 refills. He just forgot to document it. So anyway, I asked the nurse if he wanted her to have both the Klonopin and the Xanax.

“Well, of course! The doctor wrote both,” she said.

I tried to politely explain that they were both benzodiazepines and that since the doctor didn’t chart the Xanax prescription he probably didn’t remember giving it to her. I was almost positive that the doctor didn’t want both. She said she would have to call me back.

Eventually, she talked to the actual prescriber and the patient. Apparently, the patient wanted the Klonopin, not Xanax. The office told her to come in with the “extra” Xanax that she had that “didn’t work” to be destroyed before they would authorize her to pick up the Klonopin.

That changed her tune. Of course she didn’t have 2 weeks worth of pills left. She wanted both.
She said she would wait until next month for the Klonopin prescription; the doctor cancelled all the refills on the Xanax.

It’s frustrating because if I hadn’t been persistent and/or if the doctor hadn’t left off the quantity forcing me to call I would have dispensed Klonopin AND Xanax to this patient for 3+ months. The doctor didn’t chart the Xanax prescription, the nurse thought that the doctor was God and could not be questioned, and the patient was trying to abuse the system. All of these things contributed to this benzodiazepine miscommunication. But I straightened it out because I pay attention.

This is just one example of me “playing police” as a pharmacist.

It’s my job. It’s never fun to be the bad guy, but it’s what I’m for.

And really, I’m not being a “bad guy.” I’m looking out for the best interests of my patients. I’m decreasing driving while under the influence (do you want people on the road on two benzodiazepines?). I’m reducing drug diversion.

But the patients sure think that I’m a meanie.