A Case of Stolen Identity at the Pharmacy

I recently received an anxious phone call from one of my outpatients. He said that his prescription for the benzodiazepine I had prescribed needed to be rewritten. Of course, I asked why. The story he told me surprised me as it was the first time in my 25-year career that I had heard it. He said his pharmacy told him that someone else had claimed to be him and picked up the prescription. After I asked for more information, he said he suspected that a certain family member with a history of substance use picked it up. The pharmacy told him to call me to see whether I would prescribe the medication again.

To verify the story, I called the pharmacy. The pharmacist confirmed that someone claiming to be the patient came through the pharmacy drive-through and picked up the refill. I was still surprised that such a thing could happen so easily. The pharmacist said there was no policy for checking a photo ID for benzodiazepines; only the patient’s full name and date of birth were requested. The pharmacy did check IDs for opiates and the like.

The pharmacy had camera surveillance, but it would take time to review the video. Also, because of the lighting and the difficulty of seeing people’s full face as they use the drive-through, the pharmacist could not give a useful description of the person who had picked up the medication.

I pondered the situation and contemplated what next steps would be medically and ethically appropriate. I considered the patient’s clinical history, diagnosis, medication list, and the pattern of benzodiazepine use. I thought of giving the patient only written prescriptions, but my clinic had completely transitioned to electronic prescriptions. Consequently, I could not ultimately guarantee that the medication would get to the right person, and the pharmacy could not guarantee that either.

After more thought, I decided to replace the benzodiazepine with an alternative as-needed medication and further encourage alternative methods of controlling anxiety. During a difficult conversation with the patient, I explained that I could not continue to prescribe a potentially abusable and habit-forming prescription medication when it was so easily and intentionally being interdicted. I apologized to the patient for this decision and vowed to assist him in transitioning to an alternative treatment approach.

I have always strongly considered safety and clinical appropriateness regarding such prescriptions. I am aware that any patient could choose to give or sell his or her medication to someone else. I try to maintain an awareness of abuse potential and street values of various prescription medications. Being a naturally trusting person, I have thought less about other ill intentions and the possibility of an associate of the patient interdicting prescriptions from the pharmacy without the patient’s consent. This particular experience caused me to further lower my bar for discontinuing medications of higher risk (be they FDA scheduled or not) and to rethink other scenarios by which prescription medications can end up in the wrong hands.

No matter how convenient (or “safe”), a drive-through may not be a wise way to dispense prescription medications, even during the COVID-19 pandemic. ■

DIERICH M. KAISER, M.D.

Gainesville, VA.