Sensible Rules for Narcotic Prescription

Oddly, at the present time, any physician with a medical license who registers for a DEA number can prescribe the most addictive and dangerous narcotics, e.g., morphine, Oxycontin, Fentanyl, Percocets, and Vicodins, but cannot prescribe the best treatment for narcotic dependence, Suboxone.  However, in order to prescribe the best treatment for narcotic dependence and the less dangerous partial opiate Suboxone, the physician must pay for and take a special course and be issued a special Suboxone unique provider number.  Also, physicians may give any number of patients the most dangerous narcotics, but is limited under penalty of law to treating only 30 Suboxone patients.

This bizarre arrangement desparately needs to be changed.  Obviously, a much longer special course should be required to prescribed the dangerous and relatively ineffective full narcotics than is currently required for Suboxone.  In view of the disastrous impact of narcotics on society, any use past single dose treatments should require at least a month long course and be restricted to only select physicians.

Any physician wishing to prescribe narcotics on a patients should: 1) have exhausted every reasonable non-narcotic alternative including at a minimum NSAIDs, acetaminophen, glucosamine/chondroitin, nortriptyline, gabapentin, psychotherapy, physical therapy, TENS and similar treatments.  Any person with GI bleeding from NSAIDS should have been tried on proton-pump inhibitors, misoprostol, melatonin, taurine, and other treatments to prevent bleeding before NSAIDs are eliminated as an option; 2) obtain a second option before starting treatment; 3) have patients sign an informed consent acknowledging that narcotics are highly addictive, will cause tolerance, may cause rebound pain, and, even in short-term treatment, are no better than acetaminophen; 4) be restricted to no more than 30 patients on narcotics per physician; 5) screen every patient with random urine tests; 5) be able to communicate with a national databank to assure that the patient is not a known addict and is not using more than one physician and pharmacy for the narcotics; and 6) not give narcotics to anyone who has ever had a problem with alcohol abuse, or any type of illicit drug abuse until long-term research demonstrates that such a practice is safe.  7) There should be extra restrictions placed on even single dose treatments during pregnancy or delivery or during childhood, such that even single dose treatments are avoided.  8) Narcotics should never be allow in any type of dental procedure until research clearly demonstrates some superiority for narcotics for a specific procedure.  9) Patients, or their parents should always be required to be given an alternative to narcotics and no pressure should be applied to patients to favor the narcotic.  10) Also, all patients on Suboxone must have random urine drug screens.  

Current Regulations on Prescriptions for Stimulants

Prior to the fall of 2004, writing post-dated prescriptions was specifically authorized by the DEA. This allowed doctors to write for two or three months worth of prescriptions on a single day for the same patient.  On its website, the DEA posted the following (now deleted) message:

“Question: What date should be placed on a written prescription when multiple prescriptions are written for the same drug for the same patient at one time?

Answer: The date that should be placed on a written prescription is the date that the prescribing practitioner actually writes and signs the prescription. A practitioner can write multiple prescriptions for a controlled substance on the same day if permitted by state law. These prescriptions must be signed and dated on the day they are written. The prescriber should then indicate on each prescription the directions for dispensing (i.e., “do not dispense before mm/dd/yy).”

In late August, 2004, the DEA published on its website a document called “Prescription Pain Medication: Frequently Asked Questions and Answers for Health Care Professionals and Law Enforcement Personnel.” This document stated, among many other things:

“Schedule II prescriptions may not be refilled; however, a physician may prepare multiple prescriptions on the same day with instructions to fill on different days.”

On October 6, 2004, the DEA decided to rescind the entire document.

The Federal Register reported the “Interim Policy Statement” on November 16, 2004.  The DEA pulled the Pain Management FAQ document becaused of what it called the “misstatement” authorizing multiple same-day C-II prescriptions. It has now decided that preparing “multiple prescriptions on the same day with instructions to fill on different dates is tantamount to writing a prescription authorizing refills of a schedule II.”

The DEA has solicited comments on the withdrawal of the Pain Management FAQ document, including the multiple same-day C-II prescriptions misstatement.  The letter you receive in response to a comment says that the solicitation of comments “does not represent any change in the agency’s investigative emphasis or approach.” This means that whether or not the language authorizing multiple same-day C-II prescriptions is ultimately determined to be a “misstatement,” for now the agency will not change its investigation of doctors and pharmacists to reflect the interim policy statement.

http://www.dea.gov/concern/concern.htm

http://www.deadiversion.usdoj.gov/

Dispensing of Controlled Substances for the Treatment of Pain

August 2004 Interim Policy Statement: (Now Modified)

Rules 2004 from the DEA: http://www.deadiversion.usdoj.gov/fed_regs/rules/2004/fr1116.htm :

"As one federal appeals court has correctly stated, one can glean from the reported cases in which physicians have been convicted of dispensing controlled substances for other than a legitimate medical purpose "certain recurring concomitance of condemned behavior,'' such as the following:

(1) An inordinately large quantity of controlled substances was prescribed.
(2) Large numbers of prescriptions were issued.
(3) No physical examination was given.
(4) The physician warned the patient to fill prescriptions at different drug stores.
(5) The physician issued prescriptions to a patient known to be delivering the drugs to others.
(6) The physician prescribed controlled drugs at intervals inconsistent with legitimate medical treatment.
(7) The physician involved used street slang rather than medical terminology for the drugs prescribed.
(8) There was no logical relationship between the drugs prescribed and treatment of the condition allegedly existing.
(9) The physician wrote more than one prescription on occasions in order to spread them out.

United States v. Rosen, 582 F.2d 1032, 1035-1036 (5th Cir. 1978)"

For a physician to prepare multiple prescriptions on the same day with instructions to fill on different dates is tantamount to writing a prescription authorizing refills of a schedule II controlled substance. To do so conflicts with one of the fundamental purposes of
section 829(a). Indeed, as the factors quoted above from the Rosen case indicate, writing multiple prescriptions on the same day with instructions to fill on different dates is a recurring tactic among physicians who seek to avoid detection when dispensing controlled substances for unlawful (nonmedical) purposes. It is worth noting here that the DEA regulations setting forth the requirements for the issuance of a controlled substance prescription are set forth in 21 CFR 1306.01-1306.27.

If a physician is aware that a patient is a drug addict and/or has resold prescription narcotics, it is not merely "recommended'' that the physician engage in additional monitoring of the patient's use of narcotics. Rather, as a DEA registrant, the physician has a responsibility to exercise a much greater degree of oversight to prevent diversion in the case of a known or suspected addict than in the case of a patient for whom there are no indicators of drug abuse. Under no circumstances may a physician dispense controlled substances with the knowledge that they will be used for a nonmedical purpose or that they will be resold by the patient.

a family member or friend might be aware of information that the physician does not possess regarding a patient's drug abuse. Given the addictive and sometimes deadly nature of prescription narcotic abuse, the tremendous volume of such drug
abuse in the United States, and the propensity of many drug addicts to attempt to deceive physicians in order to obtain controlled substances for the purpose of abuse, a physician should seriously consider any sincerely expressed concerns about drug abuse conveyed by family members and friends.

DEA clarifies rules on multiple prescriptions for some pain meds
Agency to allow refill orders for Schedule II controlled substances without a physician visit, mailing of prescriptions.

On August 26, 2005, the DEA issued a clarification of its earlier Interim Policy Statement regarding the prescribing and dispensing of Schedule II controlled substances (C-II) for pain management. In the document, the agency emphasizes that patients who have been successfully treated with C-II analgesics for some time do not need to see their physician every month to obtain their monthly prescriptions and that physicians can mail refill orders directly to such patients pharmacy.

http://209.85.165.104/search?q=cache:mQhJvhOdCsIJ:www.medsch.wisc.edu/painpolicy/DEA/FR8.26.05.pdf+dea+interim+policy+2005&hl=en&ct=clnk&cd=4&gl=us