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Fraudulent Arrest - Valid Prescription
By David B. Brushwood, R.Ph., J.D.
University of Florida
January 24, 2003

On January 24, 2003, the Associated Press reported that a lawsuit has been filed against a Tacoma, Washington pharmacist, alleging that the pharmacist had a cancer patient arrested when the patient presented her legitimate opioid analgesic prescription for filling. The 35-year-old patient has alleged that she used the drive-up window at her local pharmacy, and she was still waiting in her car when the police arrived to arrest her. The police allegedly refused to call the patient's doctor or nurse to verify the prescription. She posted bail that night, but was arraigned the next day. Her lawyer eventually succeeded in getting the felony charge dropped, after her physician confirmed to the prosecutor's office the validity of the prescription.
The facts within the news report are scant, thus it is hard to know why the pharmacist suspected the prescription to be fraudulent. The story reports that the pharmacist called the University of Washington Medical Center neurosurgery department to verify the prescription. Apparently the prescriber was not available, so the prescription could not be verified immediately.
Perhaps as additional facts come to light this pharmacist's conduct will become better understood. Pharmacists try hard not to confuse legitimate patients with drug diverters, and the failure to make this important distinction is a clear error. While the conduct of this pharmacist is difficult to excuse, it is not difficult to explain.
Pharmacists are responsible for screening to differentiate between valid prescriptions and those orders merely purporting to be prescriptions. Purported prescriptions are all too frequently presented by criminals intent on diverting opioid analgesics and other medications to abuse and the support of addiction. This is a burdensome responsibility undertaken within a context of regulatory suspicion and distrust.
One example of this unfortunate regulatory context is the case of a Redding, California physician and pharmacist charged with five counts of murder in the deaths of patients allegedly resulting from the use of prescribed and dispensed opioid analgesics. The AP reported on July 16, 1999 that these five charges had been reduced to involuntary manslaughter; on January 8, 2003, AP reported a reduction to a single manslaughter count; and on January 15, 2003, AP reported that all charges were dismissed when prosecutors arrived for trial lacking key evidence.
The implicit message for pharmacists is that they should be suspicious of high dose opioid prescribing. Otherwise they risk years of stress and tens of thousands of dollars expended in the defense of trumped-up charges filed by well-meaning law enforcement authorities who fail to understand that some patients need high dose opioids to relieve their chronic pain. It is difficult for pharmacists to see their patient care responsibilities clearly when regulatory challenges are so daunting.
The pharmacist's responsibility to verify a suspicious prescription can be met by contacting the prescriber, but this is far easier said than done. Physicians are busy, they are difficult to locate, and they often do not regard pharmacist verifications as a high priority task. The Tacoma pharmacist who reported the cancer patient to police had to verify the prescription by placing a telephone call to a specific individual within a huge medical center in a different city. It is easy to imagine how miscommunication could have occurred during this process.
Drug addicts and drug diverters come in all shapes and sizes. A pharmacist can't tell from “looks” alone whether a person is a legitimate patient or a drug addict. Yet, experienced pharmacists may develop subjective feelings that something about a patient just does not seem quite right. Alternatively, a history of close interaction with a patient over a period of months or years can confirm that all is well despite initial concerns. The Tacoma pharmacist was separated from the patient by a bullet-proof drive-up window that was probably not conducive to relationship building.
One take-away message from the distressing story of the Tacoma pharmacist and the cancer patient should be that pharmacists can use some help in meeting their prescription screening responsibilities. Regulators can help by assuring they have sufficient evidence before charging pharmacists with crimes for dispensing high does opioids, and they can also help by filing appropriate charges when a misstep by a pharmacist has occurred. Physicians can help by instructing their support personnel on the importance of prescription verification by a pharmacist, and by setting up a process to assure that verification is provided when it is requested. When unusual, and potentially suspicious, high opioid doses are prescribed for a patient, physicians can help by contacting the patient's pharmacist with a “heads up” on what is happening and why. Patients can help by developing a relationship with a pharmacist and relying primarily on that pharmacist to supply high dose opioids.
The primary responsibility for accuracy in prescription screening rests with the pharmacist, but systems can set pharmacists up to fail in this role. A system in which regulators are suspicious and distrustful, where physicians de-emphasize the importance of pharmacist verification, and where patients do not value relationships with pharmacists, will inevitably lead to false positives in the pharmacist screening role. This is not an excuse, but it is an explanation.

David Brushwood is Professor of Pharmacy Health Care Administration at the University of Florida in Gainesville. He is a Mayday Scholar with the American Society of Law, Medicine and Ethics (ASLME). For information about ASLME pain policy projects, go to ASLME.