What is the recommended pharmacist approach to unusual large narcotics quantities in unfamiliar patients?

• A. Pharmacists should be suspicious of large quantities in unfamiliar patients.
• B. The quantity should be filled as written regardless.
• C. The pharmacist should contact the prescriber for confirmation only if needed.
• D. The pharmacy should report to authorities immediately.

Answer: (A)

Being suspicious of unusually large narcotics quantities from unfamiliar patients is the prudent first step. These red flags can indicate doctor shopping, forgery, or diversion, and recognizing them helps protect patients from overdose and inappropriate use. The pharmacist should act by verifying the prescription before dispensing: confirm the patient’s identity, review their controlled-substance history in the prescription monitoring program, and, when necessary, contact the prescriber to verify details. Only after these checks—or following established policy for escalation—should dispensing proceed, and if the red flags persist, escalate through the proper channels.

Filling as written ignores safety checks and regulatory requirements. Waiting to contact the prescriber only if needed can miss early warning signs. Reporting immediately to authorities without a proper assessment can be inappropriate or premature; follow your pharmacy’s policy, which usually means verifying first and then escalating if warranted.