Re: DEA question

[Guest guest]

1, but not important

The law was changed agian A doc may give up to three staggered do not fill

before ...scripts for cat 2's.

2 .Do what is right

She has no records You are not a shrink and you cannot take care of her

becasue she lives in a nother ocuntry(I have a woman who comes home one

month a year In bewteen s he wants this and that inlcuding having me call

so and so other hospital about her bill there I just say polite things " yes

i remcommbded we do more about this when i saw you in August and hope i am

re orienting her )

You can help her but you(cannot? in my not so humble opinion) prescribe

adderall .except for a month,you help her but saying go get an evaluation

there are plenty of UK citizens who have the sx you do and UK docs treat

them in perfectly adeqaute ways .i can treat you for a month if you are not

back in a montht then you have time to get your eval in London.

and don't forget Annie when she is home she eats cookies and when she is

ther e it is bisquits.!

good luck

YOur [atietns alwasy seem like fat peo a wt loss probolem easy to know

something that will work but terribly hard to implement the action of it.

DEA question

Lovely young lady in today, new patient, but daughter of established

patients. She is 20, self pay and home on vacation from England. She

just graduated with an MA from some school in London, and took a job

there.

Did her undergrad at Xavier in Cincinnati, and while there, got started

on Adderall. Once she went to the UK, she says they don't have Adderall

available, so her parents have been buying it here and mailing it to

her. They have been getting the prescriptions from the same doc who

prescribed it in Cinci. She did not bring records, but brought the most

recent Rx, which Kentucky pharmacies have started refusing to fill

because they are not written on the special controlled substance Rx

paper required in KY.

I don't doubt her story, or that she finds it beneficial. Her mom would

probably do well on something for ADD too. My question is about the

legal implications. The DEA says no refills on Adderall, we're supposed

to follow her monthly. We can no longer write " do not fill before___ "

on the Rx because the DEA says no. Obviously she can't come in monthly.

How much trouble can I get into by handing her folks a year's worth of

post-dated scripts? I recommended she speak to a UK pharmacy when she

goes back about what IS available there, but if there is no option, what

can I do to help her and not get myself into trouble?

Thanks,

Annie

[Guest guest]

I agree --

1) I read the DEA rule too, in the AMA Newsletter, but not doing yet until I talk with local pharmacists. Think the rule is to reduce number of monthly visits for narc monitoring, in an effort to "streamline" care. (Not sure if this is good idea or not.)

2) Without full dx, and a comfort level to "treat to the standard of care of the specialist" you are leaving yourself wide open, and the pt and family know it!! They sound like they KNOW they're asking too much of you.

I agree with -- appologize and pt needs to see "specialist." I'm certain that for self-pay, there's a psych in the community who will evaluate and monitor pt, or else send her to the "great tertiary care" facility in the "big city" near you and let them provide the "best care"; this would be one liability that you can only loose on.

Matt in Western PA

Did prescribe these meds for an outpt psych community clinic in their facility over the summer. Of all the kids that I wrote it for, none died by missing a dosage -- parents might not have been too happy, though.

I followed their rules, not an expert though.

M

DEA question

Lovely young lady in today, new patient, but daughter of established patients. She is 20, self pay and home on vacation from England. She just graduated with an MA from some school in London, and took a job there.

Did her undergrad at Xavier in Cincinnati, and while there, got started on Adderall. Once she went to the UK, she says they don’t have Adderall available, so her parents have been buying it here and mailing it to her. They have been getting the prescriptions from the same doc who prescribed it in Cinci. She did not bring records, but brought the most recent Rx, which Kentucky pharmacies have started refusing to fill because they are not written on the special controlled substance Rx paper required in KY.

I don’t doubt her story, or that she finds it beneficial. Her mom would probably do well on something for ADD too. My question is about the legal implications. The DEA says no refills on Adderall, we’re supposed to follow her monthly. We can no longer write “do not fill before___” on the Rx because the DEA says no. Obviously she can’t come in monthly. How much trouble can I get into by handing her folks a year’s worth of post-dated scripts? I recommended she speak to a UK pharmacy when she goes back about what IS available there, but if there is no option, what can I do to help her and not get myself into trouble?

Thanks,

Annie

[Guest guest]

I see most of them monthly and bill them. They are free to go elsewhere. If she

is in the UK, she can care for free, and they have the meds there, why would you

risk this?

________________________________

From: on behalf of Dr Levin

Sent: Wed 1/2/2008 5:46 PM

To:

Subject: Re: DEA question

I agree --

1) I read the DEA rule too, in the AMA Newsletter, but not doing yet until I

talk with local pharmacists. Think the rule is to reduce number of monthly

visits for narc monitoring, in an effort to " streamline " care. (Not sure if

this is good idea or not.)

2) Without full dx, and a comfort level to " treat to the standard of care of the

specialist " you are leaving yourself wide open, and the pt and family know it!!

They sound like they KNOW they're asking too much of you.

I agree with -- appologize and pt needs to see " specialist. " I'm certain

that for self-pay, there's a psych in the community who will evaluate and

monitor pt, or else send her to the " great tertiary care " facility in the " big

city " near you and let them provide the " best care " ; this would be one liability

that you can only loose on.

Matt in Western PA

Did prescribe these meds for an outpt psych community clinic in their facility

over the summer. Of all the kids that I wrote it for, none died by missing a

dosage -- parents might not have been too happy, though.

I followed their rules, not an expert though.

M

DEA question

Lovely young lady in today, new patient, but daughter of established patients.

She is 20, self pay and home on vacation from England. She just graduated with

an MA from some school in London, and took a job there.

Did her undergrad at Xavier in Cincinnati, and while there, got started on

Adderall. Once she went to the UK, she says they don't have Adderall available,

so her parents have been buying it here and mailing it to her. They have been

getting the prescriptions from the same doc who prescribed it in Cinci. She did

not bring records, but brought the most recent Rx, which Kentucky pharmacies

have started refusing to fill because they are not written on the special

controlled substance Rx paper required in KY.

I don't doubt her story, or that she finds it beneficial. Her mom would

probably do well on something for ADD too. My question is about the legal

implications. The DEA says no refills on Adderall, we're supposed to follow her

monthly. We can no longer write " do not fill before___ " on the Rx because the

DEA says no. Obviously she can't come in monthly. How much trouble can I get

into by handing her folks a year's worth of post-dated scripts? I recommended

she speak to a UK pharmacy when she goes back about what IS available there, but

if there is no option, what can I do to help her and not get myself into

trouble?

Thanks,

Annie

[Guest guest]

I think this would be a great situation for virtual

visits. If the patient is stable on a given dose of Adderall,

you could use IMH, or even a screening template of your own design to ask the

questions you want to ask. I personally would require that the

patient get their blood pressure and weight checked monthly, wherever they are,

and send them to you as well as fill out a virtual visit form every month.

I would then have the parents pick up the prescription every month, after I had

reviewed the virtual visit form.

This does not address the issues of sending amphetamines to a

foreign country (which the parents would be doing), or the other important

issue of not facilitating the patient’s avoidance getting appropriate

medical care in the UK, but I am sure that if you used either IMH or your own

form emailed to the patient , you would be providing a better quality of care and

documentation than most providers.

dts

From:

[mailto: ] On Behalf Of Annie Skaggs

Sent: Wednesday, January 02, 2008 4:10 PM

To:

Subject: DEA question

Lovely young lady in today, new patient,

but daughter of established patients. She is 20, self pay and home on

vacation from England. She just graduated with an MA from some school in

London, and took a job there.

Did her undergrad at Xavier in

Cincinnati, and while there, got started on Adderall. Once she went to

the UK, she says they don’t have Adderall available, so her parents have

been buying it here and mailing it to her. They have been getting the

prescriptions from the same doc who prescribed it in Cinci. She did not bring

records, but brought the most recent Rx, which Kentucky pharmacies have started

refusing to fill because they are not written on the special controlled

substance Rx paper required in KY.

I don’t doubt her story, or that

she finds it beneficial. Her mom would probably do well on something for

ADD too. My question is about the legal implications. The DEA says

no refills on Adderall, we’re supposed to follow her monthly. We

can no longer write “do not fill before___” on the Rx because the

DEA says no. Obviously she can’t come in monthly. How much

trouble can I get into by handing her folks a year’s worth of post-dated

scripts? I recommended she speak to a UK pharmacy when she goes back

about what IS available there, but if there is no option, what can I do to help

her and not get myself into trouble?

Thanks,

Annie