Controlled Substances Flashcards
What are schedule I substances?
high potential for abuse & no accepted medical use in the US
What are schedule II substances?
substances that have high abuse potential with severe liability for psychic or physical dependence, but in general are substances that are approved by the FDA fro a therapeutic use
What are schedule III & IV substances?
include drugs with decreasing levels of abuse potential
What type of registration do you need to prescribe controlled substances?
MO-DNDD (mo-specific)
DEA
What are the four criteria for a legitimate prescription?
- practitioner has to be registered
- patient has to desire treatment for a legitimate illness
- practitioner has to establish a legitimate need through pertinent technical diagnostic modalities
- must be reasonable correlation between drug prescribed & the patient’s needs
What are the components for a legitimate prescription?
- dated & signed on date when issued
- patient’s full name & address
- practitioner’s full name, address & DEA registration number
- drug name
- drug strength
- drug dosage
- quantity prescribed
- directions for use
- number of refills authorized
- if a substitution is permitted
A practitioner must document reasoning for prescribing opiates over what number of days for acute pain?
7-day limit
What are the limitations in the mode of prescribing for a schedule II drug?
- signed in original ink of written
- verbal in an emergency by doctor only
- faxed if injectable to LTCF or hospice
- electronics per DEA guidelines
- mid-levels have 5 day supply hydrocodone only
What are the limitations in refills for schedule II drug?
Length of prescription validity?
no refills allowed; partial dispensing allowed
6 month validity
What are the quantity limitations for prescribing for a schedule II drug?
- 30 days for most
- over 30 days requires medical reason
- max is 90 day supply
- can write multiple & separate Rx w/ “do not fill until” date written on bottom
- can’t exceed 90 day supply
What are the limitations in the mode of prescribing for a schedule III & IV drug?
- signed in original ink if written
- phoned in or faxed
- electronic per DEA guidelines
- midlevels may prescribe
- 30 day supply buprenophine w/o refill for substance abuse treatment only
What are the limitations in refills for schedule III/IV drug?
Length of prescription validity?
max refill of 5 w/in 6 months of issuing prescription
6 month validity
What are the quantity limitations for prescribing for a schedule III / IV drug?
90 days
What are the limitations in the mode of prescribing for a schedule V drug?
- signed in original ink if written
- oral phoned-in
- faxed
- electronic per DEA guidelines
What are the limitations in refills for schedule V drug?
Length of prescription validity?
as authorized by the physician, can be refilled PRN as prescriber allows for 1 yr
one year validity
According to CDC guidelines, when should you consider opioid therapy for chronic pain?
if expected benefits for both pain & function are anticipated to outweigh the risks to the patients
if opioids are used - should be combined with nonpharmacologic therapy as appropriate
Before starting opioid therapy for chronic pain, clinicians should establish what treatment goals with patients?
realistic goals for pain & function
should how therapy will be discontinued if benefits do not outweigh risks
should only continue if clinically meaningful improvement
Before starting & periodically throughout opioid therapy, physicians should have what discussion with patients?
known risks & realistic benefits
clinician responsibility for managing therapy
When starting opioid therapy for chronic pain, what type of opioids should be prescribed?
immediate-release opioids instead of extended-release/long-acting
Opioids should be started at what dose?
lowest effective dose
Clinicians should carefully reassess evidence of individual benefit & risks when increasing opioid dosage above what value? Physicians should avoid / carefully justify increasing dosage to what level?
reassess - >50MME
avoid - >90 MME
What guidelines should you consider when prescribing opioids for acute pain?
lowest effective dose of immediate-release
no greater quantity than expected duration of pain severe enough to require opioids (usually 3 days or less; rarely > 7 days)
Clinicians should evaluate benefits & harm within what time period of starting opioid therapy? Then how long thereafter?
What should they do if they decide benefits do not outweigh harm?
within 1-4 weeks
every 3 months
if benefits do not outweigh harm → work with patients to taper to lower dosage or to discontinue
Clinicians should incorporate management plan strategies to mitigate risk, such as?
offering naloxone when increase factors for opioid overdose
(history of overdose, history substance abuse disorder, higher opioid dosage, concurrent benzodiazepine use)
How should physicians review patient’s history of controlled substance prescriptions?
state prescription drug monitoring program data
(starting for chronic pain & periodically during therapy; every prescription → ever 3 month)
When should clinicians use urine drug testing during opioid therapy?
when starting & consider annually throughout treatment
assess for prescribed medications & other controlled prescriptions / illicit drugs
What should clinicians offer or arrange for patients with opioid use disorder to manage chronic pain?
evidence-based treatment (usually w/ buprenorphine or methadone in combo w/ behavioraa therapies)
What are the characteristics of drug-seeking patients?
- feign physical problems
- early requests for refill
- eliciting sympathy or guilt or threat
- claim to be referred by another clinician
- unusual behavior in waiting rooms
- inconsistent signs of acute pain
- unusual knowledge of controlled substances
- requests a specific drug
- reluctance to try another drug
- demanding or abusive to staff
- more than one physician
- unusual appearance
- cutaneous signs of drug abuse
Wha information do you need from patients to prescribe opioids?
- what other practitioners they are seeing
- when they were last seen
- what drugs they have been previously prescribed
- what drugs they are currently taking
- have they ever been treated for alcohol or chemical dependency
- request picture ID or SSN
- call previous practitioner, pharmacist, or hospital
- confirm telephone number & address
- write for limited quantities
What are strategies to prevent diversion & abuse?
- lock unused prescription pads
- number prescription blanks
- never sign blank prescriptions
- write amount clearly & in arabic or roman numerals
- respond to pharmacists inquiry
- carbon or photocopies
What substances are you legally unable to prescribe for yourslef?
all schedule controlled substances
What are the suggestions for what you should do to keep yourself out of trouble?
examine and document, document, document
ask questions
talk to pharmacists
