The primary provider should be dispensing and tracking the medication, but quite often he/she will simply state _this is not my field (referring to a class of drugs) and allow someone else to prescribe.
The secondary provider(s) then may cross boundaries and refer a second or third narcotic, second or third antidepressant, anti-inflammatory, etc.
There are obvious and there are subtle concerns:
a. Obvious: This unmonitored avalanche of medications can be a source of harm and/or abuse for the patient
b. Subtle: The patient can spend much of his/her day just keeping track of medications
The solution lies in being certain that someone evaluates the patient, not the medication:
1. Does the patient know his/her medications and why they are prescribed?
2. Does the patient take the medication as directed?
3. Does the patient recognize adverse side effects?
4. Is the patient able to recognize when redundant medications are being prescribed?
5. Is the patient able to communicate his/her concerns and physical responses to those who are prescribing?
Part of this evaluation must also be a determination whether all of those prescribing are willing to re-examine and alter their prescribing behaviors.
Unfortunately, the feelings, thoughts and behaviors of the patient are not often independently and formally examined.