What Every Practitioner Needs to Know About Controlled Substance Prescribing
Use of controlled substances
Controlled substances can be effective in the treatment of illness, pain, and disease and must, therefore, be accessible to persons who medically need them. These same drugs, however, have the capacity to cause addiction, injury, impairment, and death when abused, misused or diverted to illegal use.
Prescribing controlled substances
Practitioners in good faith and in the course of their professional practice are encouraged to prescribe controlled substances for legitimate medical purposes, including pain management, when appropriate. Practitioners are expected to regulate the dosage and prescribe a quantity of such drugs that ordinarily are recognized by members of their profession as sufficient for the proper treatment or medical purpose.
Record keeping
Practitioners must maintain a written record of the prescribing of all controlled substances. The patient record must contain sufficient information to justify the diagnosis, which warrants controlled substance treatment. The record should include the drug name, amount, strength, and directions for use of the controlled substance.
Practitioner notification of "doctor shopping"
Under the Official Prescription Program, the Department of Health will notify a practitioner when prescription data analysis indicates that a patient under his or her treatment with a controlled substance is also obtaining controlled substances from other practitioners, which is unlawful unless the patient informs each practitioner. The Department's notification will include a detailed drug utilization review and information on rehabilitation treatment if the practitioner deems it necessary for the patient.
Common misperceptions regarding controlled substance prescribing
- A practitioner must examine a patient every time he/she prescribes controlled substances.
FALSE: Once the initial examination has been made, the necessity for future examinations, and their frequency, is a matter of clinical judgment based on generally accepted medical standards.
- A practitioner can mail an Official Prescription to the patient or to the patient's pharmacy.
TRUE: The patient does not have to physically pick up the prescription at the practitioner's office.
- When a practitioner prescribes a large quantity of controlled substances, the practitioner's name is tagged in the state's monitoring system.
FALSE: The state does not monitor controlled substance prescribing solely based upon the quantity prescribed. A practitioner should utilize sound professional judgment when prescribing controlled substances and must maintain a patient record containing sufficient information to justify the diagnosis and warrant the treatment. Such information should include at least:
- patient identification data;
- chief complaint;
- patient condition; and
- the prescribed amount, strength and directions for use.
The record need not be distinct from the patient's medical record.
- Controlled substances may only be prescribed in a maximum thirty-day supply.
FALSE: A practitioner may issue a prescription for up to a three-month supply of a controlled substance, including human chorionic gonadotropin (hcg), or up to a six-month supply of an anabolic steroid by writing on the face of the prescription either the diagnosis or code for the treatment of the following conditions:
Code A Panic disorder Code B Attention deficit disorder (regardless of age) Code C Chronic debilitating neurological conditions characterized as a movement disorder or exhibiting seizure, convulsive or spasm activity Code D Relief of pain in patients suffering from diseases known to be chronic and incurable Code E Narcolepsy Code F Hormone deficiency states in males; gynecologic conditions that are responsive with anabolic steroids or chronic gonadotropin; metastatic breast cancer in women; anemia and angioedema - If a practitioner would like to obtain a stock of controlled substances for office administration he/she can write a prescription labeled "For Office Use " and have the prescription filled at a pharmacy.
FALSE: Controlled substance prescriptions must be patient-specific. Prescriptions for office use are prohibited. Practitioners must order controlled substances intended for office administration directly from a licensed distributor or manufacturer.
- If a practitioner makes a mistake on an Official Prescription form, he/she can cross out and initial the error.
TRUE: The practitioner is not required to issue a new Official Prescription form if he/she makes an error when writing the prescription. The practitioner should be aware that, in most situations, the pharmacist will call the practitioner to verify the alteration. Should the situation arise, a practitioner can authorize the pharmacist to change all prescription information except for practitioner name and signature, date written, patient name and drug name.
- Long-term opioid use is limited to the treatment of cancer pain.
FALSE: There are no such limits to long term opioid prescribing. Current statutory amendments are meant to encourage the use of controlled substances in treating patients with legitimate complaint of pain. A practitioner should utilize generally accepted medical standards and his or her professional judgment when treating any patient with controlled substances.
- An official New York State prescription is required only when a practitioner writes a prescription for a controlled substance.
FALSE: Effective April 19, 2006, an official prescription is required for every prescription written in New York, for both controlled and non-controlled substances.
- A practitioner may phone in a controlled substance prescription to the patient's pharmacy.
TRUE: A practitioner may orally prescribe up to a five-day supply of Schedule II, III and V controlled substances, as well as benzodiazepines. Practitioners may orally prescribe up to a 30-day supply or 100 dosage units of Schedule IV (nonbenzodiazepines) controlled substances, whichever is less.
Within 72 hours after authorizing an oral prescription for controlled substances, the practitioner must furnish the pharmacist with the written follow-up prescription. Prescriptions for Schedule II controlled substances and benzodiazepines may only be orally prescribed in an emergency situation. In addition to the information otherwise required, the follow-up prescription must also have written or typed on its face the words: "Authorization for Emergency Dispensing."
- Practitioners must date controlled substance prescriptions on the day that they sign the prescription.
TRUE:The date on a controlled substance prescription must be the date the prescription was actually signed by the practitioner. Controlled substance prescriptions can not be pre-dated or post-dated.
How to Reach Us
New York State Department of HealthBureau of Narcotic Enforcement
433 River Street, Suite 303
Troy, NY 12180-2299
Telephone: (866) 811-7957
E-Mail: narcotic@health.state.ny.us
Controlled Substance Regulations are available on the New York State Department of Health's Narcotic Enforcement page.
Funded in part by the Bureau of Justice Assistance, Office of Justice Program. Grant #2003-PM-BX-0007.