Current Concerns and Proposed Solutions:
Important information for everyone to know~!
DEA GUIDANCE AND DEMANDS FOR PHYSICIANS WHO PRESCRIBE CONTROLLED SUBSTANCES
THE PRACTITIONER’S MANUAL OF 2006*
Stated in 2 sentences on page 19: “A prescription for a controlled substance must be issued for a legitimate medical purpose by a practitioner acting in the usual course of professional practice. The practitioner is responsible for the proper prescribing and dispensing of controlled substances.
“ACCEPTABLE MEDICAL PRACTICE”
Stated on page 30: “The legal standard that a controlled substance may only be prescribed, administered, or dispensed for a legitimate medical purpose by a physician acting in the usual course of professional practice has been construed to mean that the prescription must be “in accordance with a standard of medical practice generally recognized and accepted in the United States”.
Federal courts have long recognized that it is not possible to expand on the phrase “legitimate medical purpose in the usual course of professional practice” in a way that will provide definitive guidelines to address all the varied situations physicians may encounter.
While there are no criteria to address every conceivable instance of prescribing, there are recurring patterns that may be indicative of inappropriate prescribing:
An inordinately large quantity of controlled substances prescribed or large numbers of prescriptions issued compared to other physicians in an area; No physical examination was given; Warnings to the patient to fill prescriptions at different drug stores; Issuing prescriptions knowing that the patient was delivering the drugs to others; Issuing prescriptions n exchange for sexual favors or for money; Prescribing of controlled drugs at intervals inconsistent with legitimate medical treatment; The use of street slang rather than medical terminology for the drugs prescribed; or, No logical relationship between the drugs prescribed and treatment of the condition allegedly existing.
Each case must be evaluated based on its own merits in view of the totality of circumstances particular to the physician and patient.
For example, what constitutes “an inordinately large quantity of a powerful Schedule II opioid might be blatantly excessive for the treatment of a particular patient’s mild temporary pain, yet insufficient to treat the severe unremitting pain of a cancer patient.
*This is the only written guidance from DEA published in the last 11 years.
Is prescribing medication for pain, at non-standard levels, or off label, a violation or not?
California Pain Patients Bill of Rights: PART 4.5. PAIN PATIENT’S BILL OF RIGHTS [124960 – 124961]
( Part 4.5 added by Stats. 1997, Ch. 839, Sec. 1. ) 124960.
The Legislature finds and declares all of the following:
(a) The state has a right and duty to control the illegal use of opiate drugs.
(b) Inadequate treatment of acute and chronic pain originating from cancer or noncancerous conditions is a significant health problem.
(c) For some patients, pain management is the single most important treatment a physician can provide.
(d) A patient suffering from severe chronic intractable pain should have access to proper treatment of his or her pain.
(e) Due to the complexity of their problems, many patients suffering from severe chronic intractable pain may require referral to a physician with expertise in the treatment of severe chronic intractable pain. In some cases, severe chronic intractable pain is best treated by a team of clinicians in order to address the associated physical, psychological, social, and vocational issues.
(f) In the hands of knowledgeable, ethical, and experienced pain management practitioners, opiates administered for severe acute pain and severe chronic intractable pain can be safe.
(g) Opiates can be an accepted treatment for patients in severe chronic intractable pain who have not obtained relief from any other means of treatment.
(h) A patient suffering from severe chronic intractable pain has the option to request or reject the use of any or all modalities to relieve his or her pain.
(i) A physician treating a patient who suffers from severe chronic intractable pain may prescribe a dosage deemed medically necessary to relieve pain as long as the prescribing is in conformance with Section 2241.5 of the Business and Professions Code.
(j) A patient who suffers from severe chronic intractable pain has the option to choose opiate medication for the treatment of the severe chronic intractable pain as long as the prescribing is in conformance with Section 2241.5 of the Business and Professions Code.
(k) The patient’s physician may refuse to prescribe opiate medication for a patient who requests the treatment for severe chronic intractable pain. However, that physician shall inform the patient that there are physicians who treat severe chronic intractable pain with methods that include the use of opiates.
(Amended by Stats. 2011, Ch. 396, Sec. 2. (AB 507) Effective January 1, 2012.) 124961.
Nothing in this section shall be construed to alter any of the provisions set forth in Section 2241.5 of the Business and Professions Code. This section shall be known as the Pain Patient’s Bill of Rights.
(a) A patient who suffers from severe chronic intractable pain has the option to request or reject the use of any or all modalities in order to relieve his or her pain.
(b) A patient who suffers from severe chronic intractable pain has the option to choose opiate medications to relieve that pain without first having to submit to an invasive medical procedure, which is defined as surgery, destruction of a nerve or other body tissue by manipulation, or the implantation of a drug delivery system or device, as long as the prescribing physician acts in conformance with the California Intractable Pain Treatment Act, Section 2241.5 of the Business and Professions Code.
(c) The patient’s physician may refuse to prescribe opiate medication for the patient who requests a treatment for severe chronic intractable pain. However, that physician shall inform the patient that there are physicians who treat pain and whose methods include the use of opiates.
(d) A physician who uses opiate therapy to relieve severe chronic intractable pain may prescribe a dosage deemed medically necessary to relieve the patient’s pain, as long as that prescribing is in conformance with Section 2241.5 of the Business and Professions Code.
(e) A patient may voluntarily request that his or her physician provide an identifying notice of the prescription for purposes of emergency treatment or law enforcement identification.
(f) Nothing in this section shall do either of the following:
(1) Limit any reporting or disciplinary provisions applicable to licensed physicians and surgeons who violate prescribing practices or other provisions set forth in the Medical Practice Act, Chapter 5 (commencing with Section 2000) of Division 2 of the Business and Professions Code, or the regulations adopted thereunder.
(2) Limit the applicability of any federal statute or federal regulation or any of the other statutes or regulations of this state that regulate dangerous drugs or controlled substances.
(Amended by Stats. 2011, Ch. 396, Sec. 3. (AB 507) Effective January 1, 2012.)