Some addtions: Vicodin (and other CIII, -IV, and -V drugs) can have refills on them, and they can be called or faxed into the pharmacy; however, these prescriptions expire 6 months from the date written and are limited to 5 refills within these six months. Moreover, these prescriptions can only be transferred from one pharmacy to another once during their lives.
CII Rxs expire 1 year from the date written (though I don’t know a pharmacist who would fill one that old without first speaking to the prescriber). In addition, CII drugs cannot have refills and the Rx must be hand-delivered to the pharmacy. These prescriptions cannot be transferred from one pharmacy to another.
There are exceptions to the hand-delivery rule:
[ul][li]For emergency situations, where oral orders for CIIs are permitted – but there must be a written copy of the Rx delivered to the pharmacy within seven days of the oral order.[/li][li]For residents of a long-term care facility, faxed Rxs are permitted in place of hand-delivered ones.[/li][li]For patients under the care of certified hospice practitioners, faxed Rxs are also permitted.[/ul][/li]
There are other restrictions that vary by state, and I’m only familiar with those of Florida.
Prescriptions for non-controlled substances can have as many or as few refills as the prescriber wants and expire 1 year from the date written. In addition, anyone with prescribing authority can write for them (with certain exceptions, such as Clozaril, Tikosyn, and Accutane, off the top of my head). Controlled substances require that the prescriber be a doctor (as opposed to an PA, an ARNP, or a CNM) and that the doctor have a DEA number.
Anyone with any definitive information on any new or soon to come regulations allowing these scripts to be delivered by way of electronic prescribing systems (e-scribing)? Will that be regulated at a state or federal level?
Mild stimulant? How much are you taking? When I was in high school I took it recreationally sometimes and would take about 60mg at a time. That was enough to get me wired all day and night. And I knew people who took upwards of 100mg.
Of course I don’t recommend you violate your doctor’s directions but if you did happen to take more than the recommended dosage you would see just how powerful of a stimulant it really is. Ritalin is speed, straight up.
Edit: on reflection, I realize it was actually Adderall rather than Ritalin. They are very similar but I don’t know if one is more powerful than the other.
some prescriptions can be written by the doctor to allow a limited number of refills over a limited time. In my case, my scripts all last a year. So, even if I have refills left on the prescription, after a year the doctor has to get involved. Most prescriptions can be renewed over the phone-but the pharmacist does the calling. And they don’t need you to tell them the doctor’s phone number.
I work in the pharmacy management software field, and we are watching this one very closely. One of the big problems is in transmitting scheduled prescriptions for people in nursing homes and other long-term care facilities. There is some movement, but nothing definite yet. There are some indications that there might be a ruling as soon as July or August (2010), but nobody knows for sure.
The DEA had one document out for comments, and comments were supposed to be in by 6/1/2010.
Very nice post Bambi Hassenpfeffer. I just have some slight corrections to make.
The limit on transferring CIII-CV’s is actually at the state level, not the federal level. In my state (Georgia), you can’t get it transferred more then once, but there are states that don’t have this limitation.
Technically, CII scripts don’t expire, at least not federally or in my state. I could fill a CII script from 3 years ago if I really wanted to. However, I don’t know of a single Pharmacist who would actually fill something that old. Actually, there has been only once that I filled a CII older then a year, and it was actually for Adderall for a patient who got them filled at our pharmacy every month for the longest time.
Summary of the Wikipedia article:
[ul][li]Schedule I drugs have a high potential for abuse and no accepted medical use within the US.[/li][li]Schedule II drugs have a high potential for abuse that will lead to severe psychological or physical dependence, but do have an accepted medical use.[/li][li]Schedule III drugs have a potential for abuse lower than that of CI and -II substances. In addition, the abuse may lead to moderate or low physical dependence or high psychological dependence.[/li][li]Schedule IV drugs have a lower potential for abuse and a lower likelihood of physical or psychological dependence relative to CIII substances.[/li][li]Schedule V drugs have a lower potential for abuse and dependence than CIV substances.[/ul][/li]
I disagree with some of the categorizations here, as all the benzodiazepines (Xanax, Klonopin, Ativan, &c.) are in this category, and I’ve seen easily as many patients addicted to them as I have to the CIII painkillers (the various hydrocodone/acetaminophen blends). In fact, I concluded a couple months ago that if you are of an age eligible for Medicare and you go to a pharmacy regularly, you’re probably addicted to either a benzo or an opiate.
Thank you. I saw something about requiring two of: something you are, something you have, and something you know. That is password plus a physical “key” or biometric, to verify. That would be some significant hardware upgrades.
Am I understanding this right? Does this mean that someone in Khadaji’s situation must, every month, get an appointment with the doctor, go in, pay a co-pay (probably), hang around in the waiting room with sick people for half an hour or so, have his blood pressure taken, get shown to an examination room, hang around there for another 15 or 20 minutes (these things happen every time at at every US doctor’s office I have ever been to), and then meet with the doctor just so the doctor can write out another copy of the prescription he or she gave you last month? Then you have to take that down to the pharmacy, by hand, and wait another 20 minutes while they fill it? Do all the millions of teens (or the parents of those teens) who are on Ritalin long term for ADD have to do this every month?
Could this be yet another clue as to why the American medical system is so ludicrously costly? And just how much are the chances of the drug being abused reduced by forcing patients (and doctors, and pharmacists) to go through this ritual 12 times a year?
Actually, some doctors will let you come by the office and pick up a CII prescription without having to actually have another exam and see the doctor. I have no idea whether this is legal/ethical, but it happens.
Actually, there was a ruling recently that allowed a doctor to write up to three months worth of CII prescriptions at a time for a patient. However, they must be on separate prescription blanks, dated with the date it was actually written, and the ones for following months must have “Do Not Fill Before <date>” written on it. This allows a patient the ability of not dropping by the office every month for a medication given chronically.
However, even before this change, the patient normally did not sit around the office to see the doctor every month, as much as just swing by the front desk and receive the Rx that the doctor presigned and is waiting for them.
No, I am not very comfortable about Ritalin, or other psychoactive drugs, being prescribed to pre-teens (or teens). But that is beside the point. What I asked is whether this time consuming ritual (if it is, indeed, as I described it) actually achieves anything useful in terms of limiting abuse. I do not see why the relevant medicines could not be controlled just as well using the sorts of electronic communications and standing refill orders used with other drugs.
I have a couple of refillable prescriptions for (non-abuse) drugs that I take every day. My doctor does nothing like giving me scrip for a “random amount” that could last me for 10 years. I get a prescription for a month’s supply, that can be refilled once every month, a limited number of times (although more refills can be arranged by phone, if the doctor wants me to keep taking it and neither of us think he needs to examine me again). When I need to refill, I can phone in to the pharmacy in advance, so that I do not have to hang around when I get there. Because the stuff I take is not very dangerous (and does not tempt anyone to abuse it) they might not be particularly strict about things, so, if I wanted to, I might be able to get a prescription refilled a few days before before I strictly need to (but I know from experience that I cannot get it refilled more than perhaps a week early at most). I would not be able to get very much extra stuff that way.
It seems to me that this system would only need a limited amount of tightening up for it to be quite as safe as the present system for dealing with abusable drugs seems to be, but a lot less wasteful and inconvenient. Why should the doctor need to physically see you every month. After all, it is the pharmacist who actually has the drugs, and he does see you.
ETA: OK, the last two posts, that appeared while I was writing this, do answer it in large part.
Thirty Ritalin hitting the street might not seem like such a big deal in the world of drug dealing. But the other commonly prescribed CII substances (oxycodone and oxycodone combination products; morphine; methadone) are prescribed in much larger quantities for 30-day supplies. I have a patient who receives 360 30-mg oxycodone every month; at that quantity, the likelihood of them getting sold on the street increases.
For a 3-month supply, we’d have to give him 1,080 tablets. That’s a lot of drugs hitting the street. And this patient is in no way atypical. There’s no ceiling on opiates – your body needs more and more over time in order to relieve the same level of pain, so his 360 will eventually be 480, then on up. Multiply that 1,080 by our 20 patients on this level of opiate use, and then add in their other opiates, and you soon have thousands and thousands of tablets hitting the streets all at once.
Responsible practitioners with long-term patients on Ritalin, Adderall, methadone, OxyContin, Roxicodone, etc, can now write three prescriptions at once for these patients, and they can then only need to followup every three months.
I honestly don’t feel that the DEA rules are tight enough, but that’s probably because I live in a state that is covered with shady pain clinics selling CII prescriptions for $150 per office visit. Imagine if each one of those could write for a 90- or 180-day supply of a drug with an incredibly high street value.
An aside:
As far as the limit on early refills, if you’re paying cash for a prescription drug that’s not a scheduled substance, you can get all your refills at once if you want. It’s your insurance company not wanting to pay for it early that’s limiting you.
If it’s a controlled substance, then how early is early is ordinarily up to the pharmacist. My chain has generally settled on 3 days early (meaning we will refill a 30-day prescription 27 days after the last dispensing) but we do note repeated early refills and notify the patients’ doctors if it starts becoming excessive.
As far as I am aware, most doctors do not charge for writing a prescription. Mine does not.
I must call her office every month and ask that a prescription be written. The office staff asks her if this is OK and calls me back when it is ready. I go by and pick it up.
It is a pain to do every month mostly because I live in the sticks. This week for instance I did the 20 minute drive over to pick it up, stopped at Rite Aid to have it filled, was told by Rite Aid to come back in an hour and half. Drove 20 minutes home for a total of 40 minutes out of my day and I still didn’t have any pills. Since I couldn’t go back in an hour and half I did the full 40 minute round trip again the next day.
Not really a huge deal, but a pain in the ass - and one that must be done each month.
But I only pay when I see the doc. I’ve been seeing her once a quarter and at that time we re-access which drugs we agree I should be taking.
Professional standards deem it wise for physicians to actually have a face to face appointment with a patient on chronic Schedule II drugs at a minimum of every 3 months. There, the doc needs to document how the patient’s doing, verify the treatment plan is still appropriate, and document planned further follow-up.
This will generally satisfy the regulators (like the DEA) who wonder if the doc is just a pill mill giving out drugs for money, when they see chronic Sched II’s being filled.
