Case study 6 Mrs. Carter brings in her 18-year-old son, Bobby, for evaluation of his SUD. He has been using unprescribed oxycodone and buying pills off the street. She asks for help getting assistance. What are some of the options available for treatment of Bobby’s OUD? Questions 1. What are some of the options available for treatment of Bobby’s OUD? _______________________________________________________________________________________________ 2. Are you authorized to prescribe medications for the treatment of OUD? _______________________________________________________________________________________________ 3. Mrs. Carter is concerned that medications for the treatment of OUD may just be as dangerous as the oxycodone that Bobby is using. What reassurance can you provide? _______________________________________________________________________________________________ PRESCRIBING PRACTICES FOR CONTROLLED SUBSTANCES
● Committed an act that would render the DEA registration inconsistent with the public interest. ● Been excluded from participation in the Medicaid or Medicare program. Clinicians who are agents or employees of a hospital or other institution (e.g., interns, residents, staff physicians, advanced practice providers) may, in the normal course of their duties, administer, dispense, or prescribe controlled substances under the registration of the hospital or other institution provided that the following apply: ● The dispensing, administering, or prescribing is in the ordinary course of practice. ● Practitioners are authorized by the state in which they practice. ● The hospital or institution has verified that the practitioner is permitted to dispense, administer, or prescribe controlled substances within the state. ● The practitioner acts within the scope of employment in the hospital or institution. ● The hospital or institution authorizes the practitioner to dispense or prescribe under its registration and assigns a specific internal code for each practitioner so authorized. In response to the opioid epidemic, many states have enacted policies to address the crisis yet still provide access to appropriate pain management. Procedures include guidelines for or limits on opioid prescriptions in Title 21 of the Code of Federal Regulations ( CFR ), Sections 1308.11 through 1308.15. 93 The DEA defines a prescription as an order for medication dispensed to or for an end user. Furthermore, to be effective, a prescription for a controlled substance must be issued for a legitimate medical purpose by an individual practitioner acting in the usual course of their professional practice. The responsibility for properly prescribing and dispensing controlled substances is upon the prescribing practitioner, but a corresponding responsibility rests with the pharmacist who fills the prescription. 94 Laws and regulations vary from state to state; thus, the prescribing clinician must ensure that the prescription follows all requirements. Prescriptions for
Multiple providers including physicians, dentists, podiatrists, veterinarians, or advanced practice providers (i.e., chiropractor, nurse practitioner, midwife, optometrist, pharmacist) may issue a prescription for a controlled substance. Others may issue a prescription under the following conditions: ● They are authorized to prescribe controlled substances by the jurisdiction of practice. ● They are registered with the DEA or exempted from registration (e.g., U.S. Public Health Service, Federal Bureau of Prisons, or military practitioners); to obtain a DEA registration, the clinician must complete DEA Form 224 (www.DEAdiversion. usdoj.gov). ● Effective May 11, 2022, DEA now requires all registration applications and renewal forms to be submitted electronically. ● They are an agent or employee of a hospital or other institution acting in the normal course of business or employment under the registration of the hospital or other institution that is registered instead of the individual practitioner being registered, provided additional requirements as outlined in the Code of Federal Regulations . 93 DEA registration grants federal authority to practitioners to handle controlled substances as part of their professional practice or research. A clinician may prescribe controlled substances only under the laws of the state where their practice is located. When federal and state laws differ, the practitioner should follow the more stringent aspects of both the federal and state requirements. This principle has led to much concern related to the state legalization of medical marijuana, despite the DEA maintaining its controlled substance Schedule I status. The DEA may deny, suspend, or revoke a clinician’s DEA registration upon finding the registrant has done any of the following: ● Materially falsified any application filed. ● Been convicted of a felony relating to a controlled substance of a Schedule I chemical. ● Had their state license or registration suspended, revoked, or denied.
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Book Code: TN24CME
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