In a development that has left the pharmacy profession both relieved and unsettled, state health officials announced Monday that they have located a prescriber who knows what "use as directed" actually means.
The search, which the Board of Pharmacy launched eleven months ago, involved 4,600 pharmacies, two prescription databases, and a dedicated tip line. It concluded last week in a rural county, when a pharmacist finally reached a prescriber's office that had an answer.
"We are pleased to confirm that at least one individual in this state holds the full context," said Dr. Alma Cresswell, a spokesperson for the board. "He is aware of which medication the instructions were intended for, how often it should be taken, and for how long. He has, so far, declined to share any of it."
The phrase "use as directed" appears on an estimated 2.1 million prescriptions written in the state each year. It is typically transmitted to the pharmacy without a dose, a frequency, or an indication, leaving the pharmacist to dispense the bottle and rely on the patient's recollection.
The prescriber, who was not named because the state has not obtained a signed release, met briefly with investigators on his porch and confirmed that "the directions were discussed with the patient." He referred all further questions to the board.
Frontline pharmacists greeted the news with cautious optimism. "I've been leaving voicemails at that office since Wednesday," said Renata Boyd, PharmD, a staff pharmacist at a suburban chain store. "The receptionist says she'll pass it along. I'm holding the bottle right now. I do not know how many times a day."
Others questioned whether the discovery had any practical application. "It changes nothing at the point of verification," said Desmond Achebe, a pharmacy technician who handles the store's DUR overrides. "Unless those directions come through on a fax I can actually read, it's trivia."
The board said it has formally requested the directions in writing, in a 12-point font, through the prescriber's office manager. The State Association of Pharmacists has asked that they be published, "so that the profession can stop guessing about this one, and return to guessing about everything else."
Officials described the find as unprecedented and said they intend to keep looking, in case there is a second one.
At press time, investigators confirmed they had received a fax from the prescriber's office. It was blank.
