Lecture 14 - Controlled Substance Transfers and Unique Scenarios Flashcards
When can an electronic prescription be transferred to another pharmacy before being filled?
-Allowed by state law
-The prescription was electronically prescribed
-If communicated between two licensed pharmacists
-If the prescription is maintained in an electronic format
Which control schedules can be non-electronically transferred?
-C3-5
-Must have been filled at least once before being eligible to be transferred
What must the transferring pharmacist do after transferring a prescription?
-Write VOID on the face of the invalidated prescription, or for an electronic prescription, note that the prescription has been transferred in the prescription record
-Record the name, address, and DEA number of the receiving pharmacy
-Record the date of transfer and the name of the transferring pharmacist
What must the receiving pharmacist note when receiving a transferred prescription?
-The date of issue of original prescription
-Original number of refills authorized
-Date of original dispensing
-Number of refills remaining, and the dates and locations of previous refills
-Transferring pharmacy name, address, DEA number, and prescription number
-Name of transferring pharmacist
-Original pharmacy name, address, DEA number, and prescription number
Definition of substance use disorder
The problematic pattern of using a substance that results in impairment in daily life or noticeable distress
Definition of detoxification
Dispensing a narcotic drug in decreasing doses to bring a patient to a drug-free state
How long is short-term detoxification?
30 days or less
How long is long-term detoxification?
30-180 days
What is maintenance in regards to substance use treatment?
Maintaining a patient on a stable dose of a narcotic drug for more than 180 days
Which prescriptions can be issued for the treatment of substance use disorder?
A prescription may not be issued for detoxification treatment or maintenance treatment unless it is a C3-5 narcotic drug approved by the FDA specifically for use in maintenance or detoxification treatment and the practitioner complies with requirements
What are the exceptions to the provision on substance use disorder?
-Practitioner registered with DEA as a narcotic or opioid treatment program
-Practitioner dispensing from their office supply
-Hospitalized patient
-Prescription for direct administration
Can methadone clinics prescribe?
No
Can methadone be prescribed?
No, it is not indicated for detoxification or maintenance treatment by the FDA
What are the rules a prescriber must follow when they dispense a narcotic for a patient for the purpose of maintenance/detoxification?
-Limited to a three-day supply of medication to be dispensed
-No extensions on the three days, it is one and done
When can a prescriber administer a narcotic for the purpose of maintenance/detoxification in a hospital setting?
-Must be hospitalized due to an issue outside of substance use disorder
-Goal is to not interrupt their treatment
When can a pharmacist deliver a controlled substance to a practitioners office based on a prescription for an individual patient for the practitioner to administer to the patient?
-The controlled substance must be administered by injection or implantation
-It must be administered to the patient named in the prescription within 14 days of receiving the product from the pharmacy
When can a pharmacy distribute controlled substances to registrants?
-Distributing to another registrant that wants to dispense the medication to their patients
-Pharmacy sending drugs to a reverse distributor registered as such
When can a dispensing registrant distribute a controlled substance to another registrant?
-The registrant is appropriately registered with the DEA
-The pharmacy records the distribution and receiving as required
-If a C1 or C2, a DEA form 222 is completed by both parties
-The number of dosage units does not exceed 5% of the total dosage units of all controlled substances distributed and dispensed in the same calendar year
What must be done to distribute to a reverse distributor?
-The pharmacy contacts the reverse distributor with a list of all drugs needing disposal
-The reverse distributor creates an invoice of the pharmacy with exact quantities of substances to be destroyed (DEA form 222 for C1/C2)
-Pharmacy completes suppliers requirements and sends drugs to reverse distributor for destruction
-Reverse distributor fills out a DEA form 41
What are the four methods of disposal of controlled substances?
-On-site destruction: two employees handle the destruction, which renders the substance non-retrievable (wasting)
-Delivery to a reverse distributor
-Sending product back to distributor, warehouse, or manufacturer: only done related to recall or return
-Request assistance directly from local DEA field office: only done by practitioners
What is done with a DEA form 41 when it is filled out?
Maintained with other CS records. It does not need to be sent to the DEA unless requested
What must you do when you experience a theft or loss of controlled substances?
-Any theft or significant loss must be reported to the local DEA field office and Board of Pharmacy within one day of discovery
-A DEA form 106 must be filed within 45 days of discovery (electronic submission)
-All theft (1 tablet to 10,000) must be reported, but only significant (non-theft) losses must be reported
What is considered a significant loss?
-Actual quantity lost in relation to the type of business
-Specific controlled substances lost
-Whether the loss can be attributed to specific individuals or unique activities
-If a patter of loss is present, and the results of efforts taken to resolve losses
-Whether the substance is a likely candidate for diversion
-Local trends/indications of diversion potential of the missing substance
What is included in a DEA form 106?
-Date of issue occurrence or discovery
-theft or significant loss
-Name, dosage form, strength, and quantity of all controlled substances lost or stolen
-Any executed DEA form 106 should be forwarded to the DEA field office and likely the state board of pharmacy as well
