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Narcotics & Dangerous Drugs

New DEA Schedule II Prescribing Rule (multiple prescriptions)

The DEA amended their regulations to allow practitioners to issue multiple Schedule II prescriptions to a patient on the same date.  The practitioner can issue a prescription today and then issue additional prescriptions that may be filled at a later date.  Each of these are separate prescriptions because Schedule II drugs cannot be refilled.  The new DEA regulation is 21 CFR 1306.12.  To comply in Missouri, the key elements are listed below.

1. Missouri statutes and regulations already allow for this so there is no need to change existing Missouri law to match the federal regulation.
2. A Schedule II prescription written for greater than a 30-day supply must also contain a medical reason for the extended supply. (returning to college or traveling is not a medical reason)
3. The practitioner may issue a Schedule II prescription with today’s current date and sign the prescription so that a pharmacy may dispense it today.  The practitioner may issue additional prescriptions, that must bear today’s date, that instructs the pharmacy, “do not fill until   date   .”   The patient may hold these prescriptions for future use.
4. On the additional prescriptions, no pharmacy may dispense the Schedule II drugs before the date indicated.
5. When a practitioner issues multiple Schedule II prescriptions, the practitioner cannot exceed a 90-day supply.
6. Practitioner are reminded to make sure they have charted all of the prescriptions in the patient’s chart, that includes the dates they are approved to be filled.

Electronic Prescribing Proposed—But Not Approved Yet

Controlled substance prescriptions are communicated in various ways.  The rules vary according to drug schedules and types of facilities and care being provided.  Controlled substance prescriptions may be handwritten, some may be telephoned, some may be faxed and emergency prescriptions may be telephoned and followed up on later.  The DEA has not authorized the transmission of controlled substance prescriptions from computers in practitioner’s offices.  Although there are software systems and electronic medical records systems that allow practitioners to transmit a prescription from an office computer to a pharmacy’s fax machine, this is not allowed by federal law.  Digital signatures are not permissible.  A prescription with the words, “signature on file” is not permissible.  The DEA has currently proposed a new regulation that would allow for the electronic transmission of controlled substance prescriptions.  At this time, the rule has been published in the federal register and the entire rule is open for the public’s review and public comment.  Once the DEA has received the comments, the DEA will review and respond to the comments and publish a final rule.

Advance Practice Nurses to Receive Limited Controlled Substance Authority

The Missouri Legislature passed and Governor Blunt signed SB724 that provides some limited controlled substance authority to advanced practice nurses. (APRN)  The statute goes into effect on August 28, 2008. However, several agencies have to promulgate rules before the controlled substance privileges can be granted.  The Missouri Board of Nursing and the Missouri State Board of Registration for the Healing Arts are reviewing rules.  The Bureau of Narcotics and Dangerous Drugs must promulgate rules regarding the applications, review of collaborative practice agreements and the controlled substance activities.  The Office of the Missouri Attorney General must submit an opinion to the United States Drug Enforcement Administration regarding the new statute.  The DEA will make a decision whether the APRNs are acting independently and if a DEA number shall be issued.  The Missouri Board of Nursing has published more information on their website to keep APRNs informed and prevent them applying for controlled substance registrations too early.

Although APRNs in Missouri cannot prescribe controlled substances at this time, other APRNs from other states with DEA numbers may begin having their prescriptions dispensed from Missouri pharmacies on August 28, 2008.  Missouri mail order pharmacies receiving controlled substance prescriptions from APRNs in other states may dispense the drugs as long as the APRN has a DEA number from a state other than Missouri.