As electronic prescribing of controlled substances becomes more widespread, the need to fax or call
in a Schedule II controlled substance (or any other controlled substance) will decrease.
Schedules III–V controlled substance prescribing considerations A prescription for controlled substances in Schedules III, IV, and V may be communicated verbally, written, or by facsimile to the pharmacist. It may be refilled if authorized on the prescription or by call-in. The CSA provides that a pharmacy may dispense Schedules III and IV controlled substances according to a “written or oral prescription.” DEA regulations further specify that a pharmacist may dispense a Schedule III, IV,
Schedules III and IV controlled substances may be refilled if authorized on the prescription. However, the prescription may only be refilled up to five times within 6 months of the date it was issued. After five refills or 6 months, whichever occurs first, a new prescription is required. Prescriptions for Schedules III through V controlled substances may be transmitted by facsimile from the practitioner, or an employee or agent of the individual practitioner, to the dispensing pharmacy. The facsimile is equivalent to the original prescription. 112 In addition, a pharmacist may dispense a controlled substance listed in Schedules III, IV, or V according to an oral prescription made by an individual practitioner. The pharmacist must promptly reduce to writing the oral prescription containing all information required for a valid prescription, except for the practitioner’s signature.
or V controlled substance according to “either a paper prescription signed by a practitioner [or] a facsimile of a signed paper prescription transmitted by the practitioner or the practitioner’s agent to the pharmacy.” Accordingly, an authorized agent may transmit such a practitioner-signed paper prescription via facsimile to the pharmacy on behalf of the practitioner. 93
SUBSTANCE USE AND DRUG DIVERSION
Drug misuse typically refers to prescription drugs and is defined as the use of drugs for a purpose other than that for which they were prescribed. Examples include taking higher doses than prescribed, taking for a longer duration than prescribed, using drugs for purposes other than prescribed, using drugs in conjunction with other medications that affect CNS or alcohol, and skipping doses/hoarding drugs. Drug diversion is defined as “any criminal act or deviation that removes a prescription drug from its intended path from the manufacturer to the patient,” including everything from outright theft of the drug to doctor shopping, prescription forging, manufacture or sales of counterfeit drugs, and international smuggling. 132 Diversion can occur at any point—from the manufacturer’s distribution to the wholesalers
to pharmacies and, in turn, to the patient. However, some drugs are more targeted than others: (1) antianxiety medications and sedatives, including benzodiazepines; (2) prescription pain medications, including opioids; (3) stimulants, including those used to treat attention deficit disorder and narcolepsy; (4) sleep aids; and (5) anesthetics, such as propofol. Healthcare providers can divert medications through false documentation, scavenging wasted medications, and theft by tampering. 132 Behavioral changes include subtle changes in appearance, increasing isolation from colleagues, inappropriate verbal/emotional responses, and diminished alertness, confusion, or memory lapses. Many healthcare workers with substance use disorders are unidentified, unreported, and untreated.
THE IMPAIRED PHYSICIAN
The prevalence of SUDs in physicians is thought to mimic the prevalence in the general public and has been estimated at 8 to 13 percent in the United States population. 135 In the past, physicians with SUDs were described as “impaired physicians,” a term that was also applied to physicians with psychiatric, cognitive, behavioral, or general medical problems with potential to adversely affect their ability to perform specific duties. More recently, the terminology has evolved to “physicians with potentially impairing conditions” to more accurately reflect the reality that not all physicians with a diagnosable SUD demonstrate workplace impairment. 136 The American Medical Association’s (AMA) Code of Medical Ethics outlines the reporting responsibilities of physicians who suspect that a colleague might be impaired: Conclusion Providers who prescribe controlled substances are responsible for ensuring these potentially dangerous medications are used as safely and as effectively as
Physicians’ responsibilities to colleagues who are impaired by a condition that interferes with their ability to engage safely in professional activities include timely intervention to ensure that these colleagues cease practicing and receive appropriate assistance from a physician health program (PHP)…. Ethically and legally, it may be necessary to report an impaired physician who continues to practice despite reasonable offers of assistance and referral to a hospital or state physician health program. The duty to report...may entail...reporting to the licensing authority. This decision to report can be difficult and physicians are encouraged to seek guidance from others, including experts in physician health and substance abuse, that can assist with the justification for action. 137
possible. Providers can use many tools to assist in prescribing controlled substances, including thorough history taking, professional documentation, patient–
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Book Code: TN24CME
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