● Use of street slang for medical drugs ● No logical relationship between prescribed drugs and alleged medical condition The DEA further clarifies that the existence of any of the foregoing factors does not automatically mean a prescriber has acted improperly. For example, some patients require doses that would be considered large for other patients, and the DEA asserts that each case is individually considered. 24 Information on Prescriptions CS prescriptions must be dated and signed on the day when issued and include the patient’s full name and address as well as the registrant’s full name, address, and registration number. 22 In addition, the prescription ● Drug strength ● Dosage form ● Quantity prescribed ● Directions for use ● Number of refills (may be 0) CS prescriptions must be written in indelible ink or pencil or else be typewritten. 22 must include: 22 ● Drug name term care facilities, hospice patients, or compounded IV opioids. 22 Prescriptions for Schedule III-IV drugs may be written or phoned in and may be refilled up to 5 times within 6 months of issue. 19 Schedule V drugs have no refill limits but are restricted in that the patient must be at least 18 years old and must offer some form of identification to fill a prescription. 19
for instances where “conduct is not merely of questionable legality, but instead is a glaring example of illegal activity,” and that cases “typically involve facts that demonstrate blatant criminal conduct;” however, the agency does not set a clear standard or signify a basis for prosecution. 24 The DEA does provide some examples of prescribing in violation of the CSA (i.e., for other than a legitimate medical purpose or outside the usual course of professional practice). 24 While there are no set criteria, some recurring patterns cited by the DEA that might indicate inappropriate prescribing include: 22 ● An inordinately large quantity of CS or numbers of prescriptions in comparison to other area HCPs (while also recognizing that some practitioners, for example, those who treat cancer, may prescribe more than others) ● Lack of physical exam ● Warnings to the patient to fill prescriptions at different pharmacies ● Prescriptions issued that are known to be delivered to others ● Prescriptions issued in exchange for sex or money ● Prescribing intervals inconsistent with legitimate medical treatment Federal Restrictions Regarding Refills Schedule II prescription orders must be written and signed by the HCP and may not be phoned into the pharmacy except in an emergency. If phoned in under emergency circumstances, the HCP must present the written and signed prescription to the pharmacy within 7 days. 19,22 One further exception is that a fax may serve as the written prescription for residents of long-
COMMONLY PRESCRIBED CONTROLLED SUBSTANCES
The 5 drug classes regulated by the CSA are opioids (called “narcotics” by the DEA), sedative-hypnotics, stimulants, hallucinogens, and anabolic steroids. Each class produces its own effects in the body, but all share the commonality that they have the potential for being misused by patients and non-patients. They are also among the most highly sought-after drugs for diversion. 25 Many CS drugs are commonly prescribed for indicated medical conditions. Others, such as cocaine, have very limited medical indications. Non- Opioids As Schedule II medications, opioid prescriptions are not limited by quantity or treatment by the CSA; however, many states and insurance carriers do set limits on quantity, frequency, and duration of prescriptions as well as other facets of treatment and monitoring. Remember that the more restrictive law trumps the less restrictive in regard to prescribing CS. Prescribing for pain has dropped off in recent years after peaking in 2011. 17 However, the danger from the opioid crisis is ongoing, and HCPs are called on to prescribe judiciously, reserving opioids for pain that does not respond to other treatments.
opioid medications can minimize opioid exposure, and different medications can complement one another; however, each has unique risks and benefits as well as mechanisms of action, 5 and their effects can be synergistic when used in combination. 5 A risk-benefit analysis is always recommended based on the individual patient’s medical, clinical, and biopsychosocial circumstances. 5 Specific categories and medications will be described as required by the State of Tennessee. Despite some recent progress on several fronts, the situation in Tennessee remains dire as illustrated by the following statistics: ● In 2019, 1,543 Tennesseans died from an opioid- related overdose, an average of more than 4 deaths every day, a 49% increase compared to 1,034 deaths in 2015. 26 ● Tennessee had the nation’s third-highest rate of opioid prescriptions (68.5 for every 100 persons) in 2020, which was almost one-and-a-half times higher than the national average of 45.9 prescriptions per 100 persons. 27
Book Code: TN24CME
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