Multiple Schedule II Rxs: Road to Disaster?

Article excerpt

Joe 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.

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 Register. This policy stated that physicians may not issue multiple Schedule II prescriptions for the same patient for the same controlled substance with instructions to fill on subsequent 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.

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 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. …