• Gary Reisfield, Gabriel Paulian, Lisa Merlo, Roger Bertholf, and George Wilson.
• Department of Community Health & Family Medicine, Division of Pain and Palliative Medicine, University of Florida College of Medicine, 655 West Eighth Street, Jacksonville, FL 32209, USA. gary.reisfield@jax.ufl.edu
• Pain Med. 2010 Apr 1; 11 (4): 586-90.

IntroductionPrescription opioid abuse is a major public health problem in the United States. Physicians who prescribe opioid analgesics are sometimes confronted with patients who request early refills, claiming that they have been "shorted" by their pharmacy. While a substantial differential diagnosis exists for apparent opioid overuse, the underfilling of opioid prescriptions at the level of retail pharmacies has not yet been systematically investigated.ObjectiveThe goals of the present study were to: 1) determine the incidence and magnitude of opioid prescription underfilling among retail pharmacies in Northeast Florida and 2) to compare the rates of under- and overfilling with noncontrolled substance prescription controls.DesignPatients receiving opioid prescriptions were recruited for this study during routine primary care office visits. These patients, blinded to the study goals, filled their prescriptions, and returned to the clinic with unopened medication bag(s) for dosage unit counts.ResultsOne hundred and twenty-one patients filled 134 opioid prescriptions from 103 unique pharmacies. Dosage unit counts revealed three slight opioid prescription underfills (1-3 dosage units) and three slight opioid prescription overfills (1-3 dosage units). We found no statistically significant differences between opioids and noncontrolled substance controls with regard to prescription underfills.ConclusionsThere was no evidence supporting patients' claims of significant opioid analgesic underfilling by retail pharmacies. Patients who repeatedly report medication shortages should be evaluated for opioid use disorders.

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