Pain Management And Prescribing Controlled Drugs

• Timothy J. Benedict, RPh

• Assistant Executive Director

• Ohio State Board of Pharmacy

• tim.benedict@bop.ohio.gov

• 614-466-4143

Legal Aspects Of Prescribing

• What is the problem ?

• What constitutes legitimate practice?

• How can I avoid problems in my practice

What Is The Problem?

• EDUCATION– Tolerance– Addiction

Lack of Education Leads to:

• Desire to avoid the patient/Rx

• “Just say no” attitude

• Blame law enforcement for hesitation in treating/prescribing

• WHAT CONSTITUTES LEGITIMATE PRACTICE?

Factors For Determining A Schedule

1. Actual or relative potential for abuse

2. Scientific evidence of the drug’s pharmacologic effects

3. State of current scientific knowledge regarding the substance

4. Its history and pattern of abuse

Factors (continued)

5. The scope, duration, and significance of abuse

6. What, if any, risk there is to the public health

7. The drugs “psychic” or physiologic dependence liability

8. Whether a substance is an immediate precursor of a substance already controlled

What Constitutes Legitimate Practice?

Ohio Administrative Code Rule

4729-5-30(A)

• Physician/pharmacist responsibility

What Constitutes Legitimate Practice?

Ohio Revised Code - 4731.22(B)

• 4731.22(B)(2)

• 4731.22(B)(3)

• 4731.22(B)(6)

What Constitutes Legitimate Practice?

Ohio Revised Code – 2925.03

• 2925.03(A)

• 2925.03(B)

What Constitutes Legitimate Practice?

Ohio Administrative Code – 4731-21-02

• Physician Requirements

How Can I Avoid Problems in My Practice?

• Understand the requirements for proper prescribing

• Communication – most important

• Documentation

• Drug Therapy – is it appropriate?

Case Review

• No Individualized Treatment

• Duplication of Therapy

• Pain Management Physician seeing 50-70 patients daily

• Logistics – patient/prescriber/pharmacy

Case Review

• Unclear Diagnosis – back pain

• Patient determines what is appropriate

• Ignoring problems– Drugs in Toilet– Complaints from family about drug abuse– Patient refusal for other treatment/diagnostic

procedures – just wants drugs

OARRS

• Registration at www.ohiopmp.gov

• Obtain up to 2 years of Rx history

• Average time to obtain report is 15 seconds