RE: Controlled Substance Prescriptions

November 30, 2008

there are guidelines, they are published by the federation of state

medical boards; i'm sure they're available online.

myria is right on; something's wrong with this picture. if this

patient just wants you to continue how another doctor did it, and

you're not comfortable with that, and it doesn't meet required

standards, you not only have no obligation to the patient to do what

they want, rather you are required to uphold the standard of care.

that doesn't mean you play policeman; decline her as a patient, and

let her seek care elsewhere. otherwise, you're only asking for

trouble.

nothing trumps the appropriate practice of medicine, even if it's an

inconvenience or hardship to the patient, economy notwithstanding.

it's your license. another reason to interview potential patients.

in my new position, i just had a patient request a post-dated

prescription for dilaudid. i declined.

some view us as instruments of fulfillment for their desire.

i think of us as doctors, upholding a standard of care with the

purpose of helping our patients achieve a state of good health.

sometimes patients have difficulty seeing that; don't argue with them,

pass on their care, concentrate on those who accept our standard.

LL

November 30, 2008

I have the local DEA officer number. When I have a patient I'm suspicious of I call and give name and birthdate. He "runs" the name and calls me that day or the next to tell me if he found anything. I got his card when he caught the patient who hoodwinked me after two years and called me from the pharmacy that had called to complain about being threatened.

From: Lynn Ho <lynnhrihotmail (DOT) com>Subject: RE: [Practiceimprovemen t1] Controlled Substance PrescriptionsTo: practiceimprovement 1yahoogroups (DOT) comDate: Saturday, November 29, 2008, 8:01 AM

Hi Rian!I asked the head of the RI medical licensure board about this, because I had a patient on oxycontin for chronic pancreatitis and I was reading the DEA verbiage about what you could and couldn't do and it isn't clear. The patient lived about 45 minutes away and I didn't want to make him come down every month to get a new prescription - seemed like a waste of his and my time - chronic, stable no change in dose, no suspicion of abuse. He looked into it, with regard to DEA regulations etc., and what he said was, it was NOT illegal to mail him a presciption every month, without seeing him. The patient would call and leave me a message about a week before he was going to be out and I would mail him a rxn. He came down every 4-6 months for a visit.But you are perfectly within your right to do it the way you please - the way I did it, I was working for free. I didn't mind with this patient and it

streamlined his care, BUT If you don't want to work for free, or you don't feel comfortable, have her come in. Depends on your comfort level. I got bored of having the patient come in so much, so I devolved to the method above which worked for us and apparently is not illegal (at least via RI law interpretation) . Lynn Ho

To: Practiceimprovement 1yahoogroups (DOT) comFrom: mintekcharter (DOT) netDate: Sat, 29 Nov 2008 10:31:07 -0500Subject: [Practiceimprovemen t1] Controlled Substance Prescriptions

Here is a question: how to deal with a request for Methadone prescription. A new patient calls, and requests a call-back before scheduling appointment, so that she won't waste a trip. She explains that she is suffering chronic pain, despite surgery (diskectomy and fusion procedure, for cervical disc disease), 6 years ago. She has been to the Chronic Pain Management consultants (45 minutes drive from our little town), and has tried numerous drugs, and is now relying on Methadone. She is disabled by her pain, and driving to that chronic pain clinic is a hassle. A few months ago, she pushed the Chronic Pain Management specialist to agree that the patient would only need to drive that far once a year, and that the responsibility to write the Methadone prescriptions could be carried by the patient's local family doctor (a member of a group practice, here in our small

town.)Actually, most of the time those prescriptions would be written-out by hand on paper prescription, by that family doctor, and just left for the patient at the reception desk; the patient would just stop over to the F.P. clinic and pick-up her prescription right there at the desk, without needing to fork-out a co-pay, or waste time with scheduling appointment, waiting in the waiting room, bothering with the nuisance of vital signs, interval history, or exam ...Now, she has learned that the family doctor in that scenario is leaving our town. So, the patient (who used to see me, like 11 years ago, when I used to work like a cog in that same machine), calls and says how much she always used to like me, and please wouldn't I help her, the way Dr. X. was helping her ...My answer was that I would be happy to see her again in my little solo office, but I would need to review her records, and

repeat the history/physical about her pain, and I would generally require visits every time she needed a new prescription for Methadone. That hit a stalemate.So, to get back to the general question: if a Schedule II Controlled Substance is regulated with rules that disallow telephone prescriptions, FAX'ed prescriptions, or refills, and instead requires that every single prescription must be hand-signed in ink by prescribing physician, doesn't that imply that the physician is seeing that patient that often ? ...Rian Mintek, M.D. ... Allegan, Michigan ... re-connected to the list- serve with a new computer, and typing speed finally fast enough to pose a question; sorry if this issue has already been addressed by the I.M.P.'s ...

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November 30, 2008