Someone please disrupt controlled substance storage technologies

Management of controlled substances(1) inside acute care pharmacies is a mess. It’s difficult for me to stress how utterly disappointed I am by this area of pharmacy technology.

  • The technology has been around for a long time. The controlled substance area of the pharmacy was one of the first areas to start using technology as part of routine medication distribution.
  • More pharmacies use technology to manage controlled substances than any other area of the pharmacy. It’s probably considered “best practice” to use technology in this area of the pharmacy.
  • There’s a fair amount of technology being used to deal with controlled substances: inventory management software, barcode scanning, biometrics, analytics and reports, remote access refrigeration and “vaults”.
  • It’s the worst technology in the pharmacy, hands down.

I haven’t been in a pharmacy in years that wasn’t using technology to manage these drugs. This is likely due to the amount of fear and regulation swirling around controlled substances. These drugs have the highest level of control and are more regulated than any other drug class; at least until USP <800> goes live. The paranoia around these medications is crazy. The man hours dedicated to their management is obscene.

Based on my observations, the technology is outdated, difficult to use, and has failed to improve the process in any appreciable way. It remains unclear to me what advantage these systems offer. I don’t think it would be difficult for someone to argue in favor of ditching the technology in lieu of replacing it with two people locked inside a room using pen and paper. Crud, it might even be more efficient.

Consider that in a majority of instances the inventory management system used to manage controlled substances is separate from the system used for other inventory, and almost never tied directly to the EHR. Yes, it means you have to maintain a separate database for one area within the pharmacy.

Also consider that at least one of the major players in this area cannot handle partial doses, i.e. half-tablets or increments of mL’s. That’s right, software designed to keep detailed records for controlled medications chokes on something as simple as 7.5 mL.

This is an area of the pharmacy that needs an enema. Someone out there must have a better way. If you have any ideas, please give them up.

And for the companies playing in this space, you really need to do a better job. Go sit in a pharmacy for a day or two and observe how utterly terrible these systems are to use.


  1. The term ”controlled substance” means a drug or other substance, or immediate precursor, included in schedule I, II, III, IV, or V of part B of the Controlled Substances Act . This includes medications like morphine, fentanyl, hydromorphone, etc.

4 thoughts on “Someone please disrupt controlled substance storage technologies”

  1. Ok, I’ll bite. What makes the RxVault 1800 System disruptive? I’ve been to the sight. Looks like nothing more than a different take on controlled substance storage. I’m particularly interested in knowing how it “automatically and accurately track[s] scheduled drugs down to the pill or package, while providing a complete “closed-loop” chain of custody”. I assume it’s using the same bar code scanning technology as everyone else.
    How does it identify one oxycodone tablet from another?
    How does it track lot number and expiration for tablets that have been dispensed and are no longer in the machine?
    Can it track partial tablets and/or partial mL’s?
    Does it offer a bi-directional interface with EHR’s and ADC’s?

  2. I agree with you about the monolithic challenge of controlling CS’s. I help manage the C2 safe and Pyxis ES systems where I work.

    The one challenge I have seen is the ability to pinpoint actual patterns of diversion. One may be lucky and catch a one-off theft via discrepancies, but we know that diversion can happen over time.

    We are using Medassist to look for patterns in Pyxis dispenses. It is ok and does work. But, a perceptive analyst I work with can also see behavior that is not picked up by Medassist.

    I guess my dream would be the incorporation of predictive analytics into ADS systems so we can be more proactive. That would be huge!

    My director just gave a draft on ASHP’s take on CD. I am curious to see how it addresses CS security.

    Thanks for your post!

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