Who prescribes what?

I always thought that prescriptions were basic. But now I’m starting to question. I have heard your basic family doctor prescribing things such as ativan, valium, zyban. What is the limit on this?

On the other hand, psychaitrists prescribe the same thing. but cannot provide other things such as pain meds. What are the laws about this?

Who can prescribe what?

A medical doctor has unlimited prescribing rights, and as long as he is registered with the DEA can prescribe controlled substances to his heart’s content, except for himself. Physicians can prescribe controlled substances for their family members, however. Although that sort of thing is a tad unethical.

Other health care practitioners are limited to prescribing things that only fall within their scope of practice. A dentist, for example, would rarely ever be able to prescribe anti-psychotics, or anything else like that. They are limited mostly to antibiotics and pain medications and other things that are directly involved in the repair and maintenance of the teeth and mouth.

For the most part the laws determining these things are pretty straight forward.

In Australia (I’m not sure if this applies elsewhere):

S2 drugs (medical poisons): available from pharmacies or where there is no pharmacy, an agent with license.

S3 substances that need advice to be used safely: available from pharmacies, cannot be advertised.

S4 (restricted substances): must have prescription from medical doctor, dentist or vet. Cannot be advertised, must be kept in a locked container.

S5, S6 and S7 are non medical poisons.

S8 (contolled drugs (addiction causing)): prescription only from doctor, dentist or vet. Possession illegal without authority. Must be kept in a locked steel box, must be locked during transport, keys must be kept on person of doctor/dentist/vet. Cannot be distroyed without authorised witnesses, all records must be kept for three years.

Hope this helps a bit! :slight_smile:

Psychiatrists (in the US, at least) are physicians with extra training in psychiatry. So, they have the same prescribing rights as any other physician. If you mentioned to your psychiatrist that you had a urinary tract infection or a sprained ankle, he is entitled to prescribe drugs for those conditions.

Okay, so, I’m going to hijack my own thread…

If an MD wants to become a psychaitrist, what does this extra training entail? An MD is a lot of schooling… how much more does a psych need?

Psychiatry is a residency (usually 4 years) just the same as Surgery, Pediatrics, Internal Medicine, Family Practice, Ophthamology, Radiology, etc are. Any MD you see has had some residency training. You can be granted your permanent license after one year of residency, although you would be hard pressed to find a job, patients or a hospital that would give you privileges. The shortest residency programs are 3 years, the longest as many as 7, all after 4 years of medical school.

Keep in mind, BTW, that a large number of people who go to a “shrink” are not going to a pyschiatrist, but a psychotherapist of some sort. Terminology and exact details of licensing differ from state to state, but this will likely be a PhD in clinical psychology who has passed a state licensing exam to practice therapy. Some lower levels of training, specifically aimed at practicing certain types of therapy may also be licensed. They can’t prescribe, but many of them will refer to an MD if they think medication is warranted, and many MD’s will wind up following the therapist’s reccomendations, hopefully after making their own examination.

MD’s (and DO’s-don’t know about dentists) can prescribe whatever they like. In practice, however, docs generally don’t prescribe meds they are unfamiliar with. A patient needing therapy with an unfamiliar agent might be referred to a specialist for medical management.

As an example, I’m in dermatology. I could prescribe medication for high blood pressure and diabetes but I don’t. I refer these patients to an internist. I see many acne patients referred from pediarticians. The pediatricians could prescribe the same accutane that I’m going to but they don’t.

Management of pain medication (which you address specifically) has it’s own complexities. Psychiatrists definitely can write for pain meds, though they may elect not to do so. Narcotic analgesics aren’t used by psychiatrists to treat diseases in their sphere of practice.

I think a consensus exists that pain medications are best managed by a single practitioner (ideally, the practitioner treating the painful condition). This allows the most accurate assessment of pain control, side effects, and patient compliance.