RYAN DONNELLY HAD IT DOWN COLD. THREE years ago he was a 25-year-old Navy vet who had been booted from the service for a failed drug test, cycled through cocaine to alcohol, and finally landed on a 560-milligram-a-day oxycodone addiction. To maintain his habit, Donnelly stole prescription pads. When those ran out, he dipped legitimate scrips in nail polish remover to strip away the physicians’ scribblings. He then took his forgeries to more than 20 pharmacies in and around his hometown of Toms River, New Jersey.

Today when the clean and sober Donnelly looks back on those years, he knows there were obvious signs of his addiction that anyone, especially an experienced pharmacist, could have picked up on.

“When you’re withdrawing, your upper lip and your forehead sweat; you look like you have the flu,” says Donnelly, who now runs FreeFromHell.com, a social support website for recovering addicts. He says sometimes he’d even put on a suit in an effort to look normal. “You try to pull it together, but you end up looking like a hoodlum.”

If the red flags were there for all behind the counter to see, why didn’t anyone turn Donnelly away—or better yet, turn him in? Fortunately, a family intervention finally pushed the pillhead to rehab before he could hurt himself or anyone else.

Things ended more tragically in the case of David Laffer. In June 2011, Laffer walked into a Long Island pharmacy and shot the pharmacist, a 17-year-old employee, and two customers while stealing hydrocodone, a semisynthetic opioid derived from codeine. In the 12 days before the killings, he had filled six prescriptions from five different doctors for a total of more than 400 pills, according to one Long Island newspaper.

“We sometimes lose sight of the fact that pharmacists are trained to spot drug-seeking behavior,” says Luis Bauza, director of investigations at RxPatrol, an alliance formed between local law enforcement and the drug company Purdue Pharma, which makes OxyContin, to track pharmacy fraud and thefts across the country. “I see pharmacists as our last line of defense.”

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