Monday, May 09, 2005

Prescribing controlled substances

When I was in private practice, I would not write for refills on controlled substances. If my patients needed ongoing supplies, I would rewrite the meds each month. I didn't require the patient to see me, but just to take a piece of paper to the pharmacy. This way, if anyone presented a pharmacy with a prescription for a controlled substance, purported to be from me, with refills (as most forgers do) the pharmacist would know it was a forgery. My policy was known by all of the pharmacies in town, and resulted in several forgery discoveries.

The DEA forbids refills on C-II prescriptions. Read this article in The Prescriber's Letter (link requires subscription, but the whole article is reprinted here. BTW, you should subscribe to this valuable newletter.):
There’s HUGE confusion over the legality of writing multiple C-II Rxs on the same day, for the same patient, for the same drug.
Prescribers often write multiple Schedule II Rxs on the same day...and write instructions to not fill until a certain date.
This allows stable patients to get chronic therapy for pain, ADHD, etc...without having to see the doctor every month.
The DEA used to say this was okay. In fact, up to the fall of 2004, the DEA website specifically described how to do this.
But recently the DEA changed its tune.
DEA now says that writing multiple C-II scripts on the same day is illegal because it’s like refilling a C-II.
This is causing a huge uproar.
Many legal experts and state boards say it STILL is legal.
Experts point out that the law has not changed...just current DEA interpretation has changed.
Keep in mind that the DEA’s emphasis is to use the law’s power to nab the bad guys and stop drug diversion. DEA is not out to interfere with legitimate medical or pharmacy practice.
Responsibly writing multiple, same-day C-IIs for a medically necessary use...in a stable patient...is extremely unlikely to cause a DEA problem.
Be sure to always date any Rx on the day you write and sign it. Do NOT future-date any Rx.
You can also write a future FILL date on ONE C-II Rx...for now. There is dissension inside the DEA, but so far the higher-ups have not come out against this.
You can mail an Rx when the time is due. Make sure you’re comfortable that this meets other standards of practice.
Consider having a medication agreement with patients that outlines how to use their medications and get new Rxs.
What do you folks do/think about this?