Drug Distribution in Washington

1
Drug Distribution in Washington

• Richard D. Morrison, Pharmacist
• Chief Investigator
• Washington State Board of Pharmacy

2
Objectives

• Describe who may prescribe drugs in WA
• Describe drug classifications
• Describe drug regulation process
• Discuss Board of Pharmacy inspection process
• Discuss the importance of outdated drug disposal

3
Prescribing Authority

• Must be authorized under State Law
• Governed by
• Legend Drug Act
• Food Drug and Cosmetic Act
• Uniform Controlled Substances Act
• Professions Practice Act
• Rules adopted under above laws

4
Drug Classifications

• Over the Counter (OTC)
• Prescription Drugs (Legend drugs)
• Caution Federal law prohibits dispensing except
  on the prescription of a physician
• Prescription only
• Controlled Substances
• Classified in five Schedules according to
  potential for abuse
• Schedules I, II, III, IV, IV, V

5
Controlled Substances Schedules

• I Heroin, marihuana, LSD, illegal substances
• II Morphine, oxycodone (Percodan, Percocet,
  OxyContin), codeine, cocaine, meperidine
  (Demerol), Ritalin, amphetamines, secobarbital,
  pentobarbital
• III Codeine combinations (Tylenol w/ codeine),
  hydrocodone combinations (Vicodin, Lortabs),
  Marinol
• IV Phenobarbital, benzodiazepines (Librium,
  Valium), propoxyphene (Darvon), Talwin
• V Codeine cough syrups, antidiarrheals

6
Who Regulates Drugs

• FDA
• Initial approval
• Manufacture/distribution
• DEA
• Controlled Substances
• Mfr/dist/storage/disposal
• States
• Board of Pharmacy
• Boards - Professionals

7
Prescribing Authority

• Profession Restriction
• Physician (MD) None
• Physician (DO) None
• Dentist (DMD/DDS) Dental practice only
• ARNP Legend Schedule V
• Schedule II-IV if joint practice
  agreements with MD/DO

8
Prescribing Authority

• Profession Restriction
• CRNA Legend Schedule II-V for anesthesia
  per order and per facility protocols
• Physician Assistant As approved by the
  Medical Commission
• Physician Assistant As above
• Certified (PA-C)

9
Prescribing Authority

• Profession Restriction
• Optometrist (OD) Topical eye Rx only for
  diagnosis or treatment (DX or TX on
  Rx). NO controlled substances
• Naturopath (ND) Limited list of drugs NO
  controlled substances
• Veterinarian (DVM) Animal treatment only

10
Prescribing Authority

• Profession Restriction
• Pharmacist (RPh) Initiate or modify Rx
  therapy under protocol with authorized
  prescriber
• Podiatric Physician Foot treatment only
• (DPM)

11
General Limitations on Prescribing

• No self-prescribing of controlled substances
• Okay, but not advisable to prescribe for family
  members
• Medications must be for therapeutic purpose
• There must be valid doctor-patient relationship
• Medications must be within scope of practice

12
Drug Administration Authority

• Profession
• Licensed Midwife
• Restriction
• Administer medications prescribed by a physician
  and may use certain other drugs on own (e.g.,
  postpartum oxytocin, vitamin K, Rho immune
  globulin, local anesthetics, lactated ringers
  solution, heparin locks, Magnesium Sulfate per
  protocol, and epinephrine for allergic reactions)

13
Drug Administration Authority

• Profession Restriction
• RN Prescribed drugs
• LPN Prescribed drugs
• Respiratory Care Prescribed respiratory drugs
• Physical Therapist Prescribed topical drugs
• Dental Hygienist Local anesthetics/topical
  fluoride
• EMT Prescribed drugs/Epinephrine
• School employee Per Rx order, school policy

14
Prescribing Limitations

• Members of the following professions may not
  prescribe, administer, or dispense drugs
• Acupuncturist Counselor
• Chiropractor Dietitian/Nutritionist Dispensing
  Optician Lay Midwife
• Ocularist Occupational Therapist Massage
  Practitioner Psychologist
• Pharmacy Technician

15
How many people have prescribing authority?

• MD 18,879
• DO 688
• DDS 5,237
• DPM 263
• DVM 2,113
• ARNP 2,000
• ND 466
• PA 1,422
• OD 1,134

16
Where are drugs used/stored?

• Pharmacies (1200)
• Drug Wholesalers (80)
• Hospitals (110)
• Outpatient Surgery Centers (50)
• Practitioner Offices/Clinics (10,000)
• Nursing Homes (400)
• Adult Family Homes/Boarding Homes (500)

17
What is the scope of the drug disposal issue?

• Thousands of sites
• Thousands of people
• Lack of knowledge about proper disposal
• Lack of information

18
Board of Pharmacy - Inspections

• Inspection of pharmacies, drug wholesalers, drug
  manufacturers, outpatient surgery centers,
  researchers, humane societies, etc.
• About every 18 months
• Appropriate professional practices
• Proper records
• Proper storage
• Proper control of Controlled Substances
• Outdated Drugs

19
Board of Pharmacy - Investigations

• Investigation Process
• Investigate drug law violations by any licensee
• Pharmacy dispensing without prescription
• Theft of controlled substances
• Diversion for personal use
• Other health professionals
• Diversion of drugs for sale or personal use
• Forgeries, theft, substitution, records fraud,
  etc.

20
Importance of proper prompt disposal of
outdated drugs

• Outdates are set aside to deal with later
• No one pays much attention to them
• They are subject to theft and abuse
• The registrant is still responsible
• It takes longer to investigate losses

21
Summary

• Described who may prescribe drugs in WA
• Described drug classifications
• Described drug regulation process
• Discussed Board of Pharmacy inspection and
  investigation process
• Discussed the importance of disposal of outdated
  drugs