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During my first week in my new store I had a patient asking for Phenergan liquid, which I'm sure you are aware, can be used for 'un-intended reasons'. The patient asking for the supply seemed knowledgeable about what she wanted, as well as why. The entire story seemed reasonable - she had found that it was the most effective OTC treatment for hay-fever and that the pharmacy she usually visits has no stock. Indeed, there was a full and colourful medical history that had led her to use Phenergan. Of course the doctor was already aware of her use of it.
Now I'm sure the more experienced of you will pick up on one of those comments as a warning sign, people who move around pharmacies for a particular item are sometimes in too much need of the product.
Luckily a pharmacist from another branch nearby had already contacted me and warned me of a person who had been in to them on three separate occasions and on one occasion sent in their son to buy Phenergan. This meant that I was prepared and as I didn't have any stock either I was unable to supply with a very good reason as to why I couldn't supply. I tried providing as much help as possible offering other products but as the conversation progressed I became more certain of the patient's desired off-license use.
My question is how do you truly know if someone is abusing medication either OTC or on prescription? If they are abusing it should you supply? If someone is addicted to a medicine, depriving them of it could potentially cause some harm and a determined addict will get it somewhere. Is it better to supply so that you know how much they are getting and how regularly?
Of course, you can never be certain someone is abusing. This delicate subject could cause great offence to someone. There are 'text book signs' which you do sometimes see, but often the signs are hidden or just confused with other things.
I wonder what methods other people use to deal with people they suspect of abuse. My current feeling is that if they are unlikely to cause immediate harm then I will sell/supply a small quantity and advise them a) to see a GP if they continue to need the medication and b) that I will not supply them the medication again until a suitable period has elapsed.
Still, a difficult conversation at the best of times.