Prescribing Controlled Substances – What you Need to Know

In a widely circulated national news article, the  FDA recently voted to change hydrocodone along with some other controlled substances to the more restrictive Schedule II classification. There was much confusion among nurse practitioners when some of the news articles erroneously reported that this change would prevent all nurse practitioners and physician assistants from prescribing the medication. While there are a few states that do not allow NPs to prescribe schedule II medications, the majority of states do allow the prescribing of this medication. The American Association of Nurse Practitioners is working at the national level to assist those states where NPs would be affected.

One thing to particularly note is the (incorrect) assumption that NPs (and PAs) are somehow responsible for some patients  out of control addictions to opiod  controlled substances. This is simply not true.

Here is a link to the FDAs presentation on the issue.

Did you know? The difference between a Schedule II medication and Schedule III – V**?

(**Please note that  states can set their own standards that can supersede the Federal regulations – the information below is from Federal regulations).

Schedule II

  • Schedule II prescriptions require written prescriptions signed by the prescriber
  • No refills are permitted for Schedule II medications
  • While some states and many insurance carriers limit the quantity of a controlled substance dispensed for a 30-day supply, there are no specific federal limits to quantities of drugs dispensed via prescription.

 Schedule III-V

  • Schedule III – V medications may be communicated either orally, in writing, or by facsimile
  • May be refilled if so authorized on the prescription or by call in
  • Schedule III and IV controlled substances may be refilled if authorized on the prescription. However, the prescription may only be refilled up to five times within six months after the date on which the prescription was issued. After five refills or after six months, whichever occurs first, a new prescription is required.

(adapted from: http://www.deadiversion.usdoj.gov/pubs/manuals/pract/section5.htm)

New York is among a handful of states that is also addressing prescription narcotic abuse. The I-STOP law will go into effect on August 27, 2013. I-STOP stands for Internet System for Tracking Over-Prescribing.

The I-STOP law does the following:

  • requires the Department of Health to establish and maintain an on-line, real-time controlled substance reporting system to track the prescription and dispensing of controlled substances;
  • requires practitioners to review a patient’s controlled substance prescription history on the system prior to prescribing;
  • requires practitioners or their agents to report a prescription for such controlled substances to the system at the time of issuance;
  • requires pharmacists to review the system to confirm the person presenting such a prescription possesses a legitimate prescription prior to dispensing such substance;
  • requires pharmacists or their agents to report dispensation of such prescriptions at the time the drug is dispensed.

We can expect many other states to soon follow suit to address these issues.

It is so important to be familiar with your state’s prescribing laws and I highly encourage you to check with your state’s NP association for the latest information for narcotic prescribing.