Controlled Substances

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Controlled Substances

• Robert S. Crausman, MD, MMS

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Controlled substances are used to treat a wide
variety of medical conditions

• Pain
• Depression
• Anxiety
• attention deficit
• muscle wasting

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Controlled substances can often cause atypical
problems

• abuse of the drugs
• physical dependence
• psychological

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Controlled Substance Act

• Federal and state governments have categorized
  these drugs into useful groupings
• Controlled Substances Act Uniform Controlled
  Substances Act 21-28, available at
  http//www.rilin.state.ri.us/statutes/title21/212
  D28/index.htm

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5-tier classification schedules

• I opiates, depressants, hallucinogens,
  stimulants
• II - stimulants, opiates morphine, oxycodone,
  amphetamine
• III stimulants, anabolic steroids,
  hallucinogens, depressants 5 refills
• IV antianxiety, pain medications valium,
  barbital 5 refills
• V antidiarrheals codeine 5 refills

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5-tier classification schedules

• I- no medicinal value. Cannot be prescribed. High
  abuse potential. THC a borderline exception.
  MD/DO w/ CSR cannot Rx schedule I
• II-V require medical license and CSR
• Rx good for 30 days from issue
• Oral Rx OK, but
• II valid in emergencies x 72 hours authorization
  for emergency dispensing

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Schedule II

• No refills
• 30 day supply only
• Maximum 250 doses
• Stimulants are an exception 60 day supply
• Fax for NH patients, hospice

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Schedule III - V

• Lower abuse potential than II
• 5 refills/ 180 days
• Maximum 100 doses

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Electronic prescribing

• Not yet a RI option for controlled substances

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Requirements

• Physician-patient relationship
• Medical record

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Suspension/Revocation

• Abuse, excessive use or diversion is
  unprofessional conduct
• Non-legitimate purposes including sex for drugs,
  money for drugs
• Inappropriate prescription

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Controversial

• Prescribing for close friends, colleagues and
  family
• Prescribing for oneself
• Minimum documentation
• Palliative care vs. drug seeking