Drug Topics - January 28, 2008 - (Page 32) 32 DRUG TOPICS JANUARY 28, 2008 www.drugtopics.com VIEWPOINT Jennifer A. Fass, Pharm.D., and Matthew J. Seamon, Pharm.D., JD Multiple Schedule II Rxs: Road to disaster? oe suffers from chronic back pain and requests a prescription for OxyContin because he heard from a friend that “this stuff really works.” The physician can clearly see that Joe is in pain, so he writes out three prescriptions for OxyContin. The physician says, “To make things more convenient for you, why don’t you come back in about three months to see if you’re feeling better.” Can patients truly receive multiple prescriptions for OxyContin from the same physician? The answer is yes, so let’s see how this ruling unfolded and what lies ahead for pharmacists. J controlled substance, equaling up to a 90-day supply. Under these regulations, written instructions will be provided on each prescription indicating the earliest date on which a pharmacy may fill each prescription. However, all prescriptions must be dated on the day when initially issued to the patient, since practitioners are prohibited from post-dating. The final rule became effective December 19, 2007. Additionally, the DEA emphasized that issuing multiple prescriptions is not mandatory for practitioners, and professional judgment should be exercised. Implications for pharmacists Background to DEA change The Drug Enforcement Administration first established its position regarding multiple Schedule II prescriptions on November 16, 2004, as an interim policy in the Federal There should be more Register. This policy stated restrictive prescribing that physicians may not issue multiple Schedule II measures put into place, prescriptions for the same especially for Schedule II patient for the same controlled substance with incontrolled substances, structions to fill on subserather than more leniency. quent dates. The DEA emphasized that this practice is tantamount to authorizing refills for Schedule II drugs, an act clearly prohibited under the Controlled Substances Act. On September 6, 2006, the DEA proposed a rule that would allow physicians to issue multiple prescriptions for Schedule II drugs. Comments were solicited from the public until November 6, 2006. After considering public comments, the DEA issued a final ruling on November 19, 2007, permitting the issuance of multiple Schedule II prescriptions. Organizations including the American Pharmacists Association, a slew of physicians, and many patients applauded the ruling. Everyone knows that prescription drug abuse is increasing. We may be in the minority, but we strongly feel that there should be more restrictive prescribing measures put into place, especially for Schedule II controlled substances, rather than more leniency, which, we believe, the final rule promotes. Methadone-related deaths have been growing. DEA is concerned about these rising statistics, but it does not set up any limitations on methadone prescribing under these regulations. Is this appropriate? As a profession, pharmacy should side with organizations that lobby for more stringent controlled substance laws. This ruling carries a potential for disaster on many different levels. Drug diversion and “doctor shopping” will no doubt increase as the number of prescriptions issued to each patient rises. Patients may be less inclined to return to their physician when problems arise, since a 90-day supply of medication is at their disposal. Pharmacists will probably have to spend more time “policing prescriptions,” such as verifying the order with the physician and checking for forged prescriptions, instead of acting as drug therapy experts. Patients prescribed pain medications should be seen on a monthly basis to assess for adverse events and dosage adjustments. It is disappointing to realize that as deaths are rising from prescription drug abuse, DEA would pass a rule that would only compound the problem. Pharmacists should voice their concerns about this ruling so that it is reversed. is a drug information resident, and MATTHEW SEAMON is assistant professor at Nova Southeastern University, College of Pharmacy, Fort Lauderdale, Fla. JENNIFER FASS The new rules These regulations amend the DEA’s stance toward issuing multiple prescriptions. Practitioners are now permitted to issue multiple prescriptions to individual patients to be filled sequentially for the same Schedule II http://www.drugtopics.com
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