Fed Laws on prescribing controlled substance?

[Masta]

Does anyone know the law on prescribing controlled substances?

13yr difficult child is on adderall.. we usually go to the doctors once every 3mths.. difficult child sees doctor he writes a script, the following 2mths i call up when month supply has ran out, doctor writes a new script for 30 day suppply, i pick it up.

some doctors do it here, some dont.
i hate paying copays for medication management.. difficult child isnt sick he just needs his medications. so why go every month, to sit for hours in a doctors office for a script.

i know you cannot ask the doctor to post date scripts... i call up each month in between our 3 mth check up to get a script.

is it legal for doctors to write scripts in between doctors visits?

the reason why i am asking is i plan on changing doctors. if i knew the law.. i could show them if they ask difficult child to come in every month for a prescription.

Thanks,

Masta

 

[DammitJanet]

Im not sure what class adderal is in. I know that when I was on narcotics I had to pick up my pain medication prescriptions at the doctor office each month...however after awhile he would allow me to just come in and pick up the script from the nurse if I wasnt having a problem that I felt I needed to see him for. That happened rarely though because I wanted my symptoms documented.

 

[busywend]

It could be different requirements by state.

I just went through it this week, but I called the office and asked if they could send it direct to pharmacy. They had to put me on hold and it took awhile for them to check it out, but they are doing it.

 

[Sara PA]

Adderall and all the stims -- Ritalin, Concertal, Metadate, Focalin, all of them -- are Schedule II Controlled Substances.

 

[Janna]

Yeah, it's the stims. easy child is on Adderall, have to get a new script once a month. FYI - if you get a script for, say, Concerta on the 1st of the month, realize it's not working, want to try another stimulant, you have to wait the 30 days to get another stimulant. At least, that is what is going on with us.

I know the atypical antipsychotics (Abilify, Risperdal, Seroquel) can all be refilled. We have 3 refills at a time on the Abilify. Ditto on the Lithium.

It's a PITA. Luckily, our psychiatrist just writes me multiple scripts (gives me one for Jan, one for Feb, one for Mar, we go back in March).

I don't even know if he can call those in. Grr!

Janna

 

[Sara PA]

It's a PITA. Luckily, our psychiatrist just writes me multiple scripts (gives me one for Jan, one for Feb, one for Mar, we go back in March).

I wouldn't talk about that too much. It's illegal.

 

[BusynMember]

Doctors HAVE to be careful with amphetamines. They have no choice; these are hot drugs on the streets. When my now 22 year old abused drugs, the main drug of choice for her and her friends was Adderrall (other ADHD drugs were used, but they liked Adderrall the most). She says it went for $10/pill. The teens would crush it in pillcrushers and snort it, either alone or with other drugs. She became quite addicted to it. I know it's a pain to have to refill these scripts in such a careful way, but this is the reason why. Heck, my friend works as a disabilities social worker--many PARENTS take their kid's Ritalin and use it to get high, never giving it to the kids. Antipsychotics have no street value--there is no "high" attached to them and they are not abused, so they don't worry about them as much. I know this doesn't help, but maybe you can understand the rules a little better. They even have some OTC drugs that you have to sign for these days. Kids abuse some of them too. Ephedrine (could be spelled wrong) comes to mind.

 

[Stella Johnson]

When my difficult child was on Adderall I just had to pick up the rx every month to take to the pharmacy. We didn't go in for an actual dr appointment each time. That is a waste of $$$ if it is the only reason you are there.

I do know some docs charge a $15 fee to write a triplicate rx. Really pointless.It didn't cost them any more ink to write that one than any other one.

steph

 

[Sara PA]

is it legal for doctors to write scripts in between doctors visits?

Yes, provided he continues to have an ongoing relationship with the patient. However, doctors don't have to write prescriptions in between visits if they don't want to. The can require that they see the patient before writing any script, even on like this.

 

[witzend]

According to my insurance company who is now mailing me three months worth of medications at a time, a federally controlled substance narcotics scrip can be issued for a six month period. when I got them from the pharmacy, I would get a month's worth at a time. Now I get them in the mail and they send 3 months worth twice. (Much cheaper this way, but you have to watch the mailbox like a hawk!)

Of course, each doctor has their own prescribing regimen that they adhere to for their own comfort. How long has this doctor been writing this Rx? If it has been working successfully for say 6 months or more, you should be able to talk to him about relaxing the visits to at least bi-monthly or even as needed every six months. If you do decide to change doctors, please be sure that you have someone new lined up who will write the rx without making things harder on you than they already are. I didn't read all of the replies and etc, but have you voiced your concerns about this and if so what does he say? If you tick him off, he could raise "medication seeking" concerns about you with any new doctor you choose and you could be worse off than you are now. If it's working, you don't want to change the medication.

What does difficult children pediatrician say about this? You could ask him to write the scrip with the therapist being seen as needed to confirm that things are under control. There's no way a pediatrician would expect to see you once a month. I think that might be a good place to start.

 

[Sara PA]

That's odd, witzend. Back in September there was a proposed amendment to the law to allow multiple prescriptions. Comments had to be sent to the Department of Justice by November 6th. I haven't seen anything that indicates the proposal went through but I can't imagine that your mail-in pharmacy would be violating the law.

ETA: Maybe the Dept of Justice is allowing some programs to violate the law to see how it works out. Maybe. It could happen...

This is the issue:

Following the publication of the clarification document, DEA received further comments from the public indicating that many physicians, patients, and pharmacists believe it would still be beneficial to allow physicians to provide individual patients with multiple prescriptions for the same schedule II controlled substance at a single office visit. Those who have commented in favor of allowing this practice suggest that under this approach, the physician would write instructions on each prescription indicating the earliest date on which it could be filled. In this manner, these commenters suggested, a physician should be allowed to authorize up to a 90-day supply of schedule II controlled substances at a single office visit. Other physicians who commented indicated that they do typically see their patients at least once every 30 days for the treatment of pain but that they too believe they should be permitted to issue multiple prescriptions over a shorter time frame (for example, three prescriptions each for a 10-day supply). Physicians who sought to issue multiple prescriptions in this latter manner suggested that doing so would facilitate greater physician oversight and minimize the likelihood of diversion and abuse.

 

[judi]

I have a controlled substance license and writing schedule II drugs is a huge responsibility. As a provider, I know it is illegal to post-date scripts. In IL (where I practice), the medicaid folks watch these scripts and the prescribers who write them because of the abuse potential.

 

[Masta]

Thanks for the input.

My question is: can i call in the following 2 months woth of prescriptions month after month after seeing the doctor for a one months supply, i dont want to pay
co pays to visit the doctor every month just for a prescription refill.

the url that Sara PA suggested: http://www.deadiversion.usdoj.gov/fed_regs/rules/2005/fr0826.htm

said i didnt have to take difficult child every month to see the doctor.

No matter what my state law is federal law overrides state law in this situation.

i know writing post dated prescriptions is illegal.. im not asking for posted dated im asking... once my difficult child's one month supply has ran out i want to be able to call the doctors.. tell them difficult child needs his prescription then just go pick it up. i want to do this twice ater out initial visit so we only have to see the doctor every 3 months.

 

[Sara PA]

No matter what my state law is federal law overrides state law in this situation.

State laws may be stricter than federal laws but states may not pass laws the lower the standards set by federal laws.

i know writing post dated prescriptions is illegal.. im not asking for posted dated im asking... once my difficult child's one month supply has ran out i want to be able to call the doctors.. tell them difficult child needs his prescription then just go pick it up. i want to do this twice ater out initial visit so we only have to see the doctor every 3 months.

As I said, that's the doctor's prerogative, not a legal directive.

 

[DDD]

Our MD does the same with multiple Rxs but he didn't do so until we had a relationship established. Frankly, I would
directly ask the Physician if it is necessary for him to see
difficult child in person more often than every three months. DDD