Controlled Substances + RPh Rehabilitation

Question 1

What way (verbal, fax, electronic etc) can a provider order a CII/Benzo/Anabolic Steroid?

Answer 1

Verbal
Fax-to-fax

Question 2

What would determine a situation where emergency orders of CIIs/benzos/anabolic steroids may be prescribed?

Answer 2

Immediate administration of controlled substance is necessary

There is no appropriate alternative treatment available

Not possible to present written or electronic Rx

Question 3

What are the 5 RULES for pharmacists when taking an emergency order for a CII/benzo/anabolic steroid?

Answer 3

1. Reduce to writing
2. Rx should have everything law requires (except prescriber signature)
3. Write “telephone order”, Rx number, date filled, signature, time
4. Fed: Must receive hard copy (or electronic) within 7 days or contact DEA
5. NYS: Must receive hard copy (or electronic) within 3 days or contact BNE within 7 days

Question 4

What are the DEA forms to know?

Answer 4

DEA form 222 = movement of schedule 2 drugs

DEA form 41 = destruction of controlled substances

DEA form 106 = Theft/loss of controlled substances

DEA form 224 = new registration of a pharmacy to handle and distribute controlled substances

Question 5

What is the Drug Addiction Treatment Act (DATA) Waiver?

Answer 5

A. All DEA-registered prescribers can prescribe buprenorphine for opioid-use disorder (OUD)
B. X numbers no longer required
C. No more cap on number of OUD patients one prescriber can treat

Question 6

What is the day limit a prescriber can write for for acute conditions (pain)?

Answer 6

7 days maximum!

Question 7

What conditions are EXCEPTIONS of when prescribers prescribe controls for acute condition pain? (May prescribe for longer durations)

Answer 7

Chronic pain
Cancer pain
Hospice/end-of-life
Palliative care

Question 8

What is a general rule for opioid use?

Answer 8

*Opioids should not be used longer than 3 months.**
UNLESS chronic pain when appropriate, should be documented

Question 9

Who MUST check the PMP/I-STOP?

Answer 9

Prescribers
(RPh recommended to check, not required)

Question 10

Up to how many hours in advance can the PMP be checked before prescribing a control?

Answer 10

Up to 24 hrs before

Question 11

All pharmacies must report dispensing controls within ____ hrs to I-STOP/PMP.

Answer 11

24 hrs

Question 12

If a pharmacy has dispensed ZERO controls, it must be reported to I-STOP in ____ days following the most recent previously reported dispensing of a control.

Answer 12

14 days

Question 13

___% of pharmacists have drug or alcohol dependency problems

Answer 13

10%

Question 14

What is misuse?

Answer 14

Any deviation from prescribed use
- med use w/o prescription
- using more quantity or longer period than prescribed
- hoarding pills for future use
- obtaining Rx fraudulently
- changing route of administration to bypass safety feature (ie. Injected rather than oral)
- obtaining multiple Rxs for same/similar medications

Question 15

What is abuse?

Answer 15

The maladaptive pattern of use resulting in significant social/interpersonal/legal problems or hazardous use

Question 16

What is dependence?

Answer 16

Uncontrolled use resulting in significant physical/psychological problems and impairment

Question 17

How do RPhs get introduced to abusing prescription drugs?

Answer 17

• Started with recreational pot
• Start with legitimate prescription
  Used to relieve stress from career

Question 18

What are risk factors leading to Rx abuse by RPhs?

Answer 18

• Access to drugs
• Stressful work environment
• Culture of pharmacy (viewed as perk to take Motrin/muscle relaxer if needed)
• Education (RPhs know about drug positive effects)

Question 19

What is a resource in NYS for RPhs struggling with drug misuse and abuse?

Answer 19

Professional Assistant Program for Pharmacists