A suspicious dental diazepam prescription and a delayed controlled-drug register
A pharmacist in a licensed pharmacy in Phnom Penh receives a handwritten prescription from a private dental clinic for a 24-year-old man: 'Diazepam 10 mg tablets - 100 tablets - take 2 tablets at night - repeat ×3.' The prescription has the clinic stamp but no prescriber registration number, no patient address, and no date. The patient says he has 'tooth pain and cannot sleep' and asks to pay cash for all repeats today. The pharmacist knows the prescriber is a dentist who sometimes sends prescriptions by courier. The pharmacy's controlled-drug register is kept but has not been updated for two weeks. The patient becomes irritable when asked for identification. No emergency symptoms are present. A nearby clinic has reported forged dental prescriptions in the past month.
1. Identify the legal and professional problems with this prescription and decide whether to dispense it.
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Do not dispense. The prescription is incomplete: no date, no prescriber registration number, and no patient address or identifier. Diazepam is a controlled psychotropic medicine; 100 tablets with 2 tablets nightly and three repeats is a large quantity and prolonged supply for a dental complaint. Insomnia is not a typical dental indication, so the dentist's scope and rationale need verification. The request to pay cash for all repeats today raises diversion or forgery concern, especially with recent forged dental prescriptions. The controlled-drug register is two weeks behind, which is itself a compliance failure.
The pharmacist should politely refuse, offer no partial supply without a valid prescription, ask for identification, and contact the prescriber using an independently verified number. Document the refusal and the reason. If forgery is suspected, retain the prescription if safe, notify the manager, and report to the competent authority according to local procedure. Do not confront or accuse the patient.
2. If the prescriber confirms the prescription, what must be corrected before any supply, and how should the transaction be recorded?
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Even with confirmation, the prescription must be complete and legally valid: date, patient name and address or identifier, prescriber signature and registration number, dose, quantity, and directions. The indication should be documented and consistent with the prescriber's scope. The pharmacist should confirm the maximum legal quantity and whether repeats are permitted; if not, dispense only the allowed amount and do not give three repeats. Check for duplicate or recent benzodiazepine supplies.
Record in the controlled-drug register: date, patient, prescriber, drug, strength, quantity, batch, and running balance. Update the register at the time of supply. Label with clear directions and warnings. Counsel on sedation, driving, alcohol, dependence, and safe storage. If any requirement cannot be met, do not dispense.
3. What should the pharmacist do about the two-week backlog in the controlled-drug register?
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Do not backdate entries to hide the delay. Reconstruct entries from prescriptions, invoices, and dispensing records, mark late entries clearly, and reconcile physical stock with the register. Report any discrepancy or late recording according to pharmacy policy and regulatory requirements.
Assign one person to update the register at each transaction and have a second person check it monthly. Keep controlled drugs in the locked cabinet with restricted keys. Treat the backlog as a quality failure, not just paperwork. If stock cannot be reconciled, investigate before further controlled-drug supplies are made.