Be Aware of Federal, State Guidelines When Prescribing

The Centers for Disease Control and Prevention (CDC) and numerous other regulatory agencies have declared the abuse of prescription drugs to be a national epidemic. The statistics are staggering: 15 million people aged 12 and over have used prescription drugs non-medically and 44 people die each day from an overdose of prescription pain medications.

As such, there is heightened scrutiny surrounding prescribing practices and national initiatives to improve prescribing practices in order to reduce instances of drug overdoses, death, and diversion. Whether or not you prescribe controlled substances on a regular basis, the increased regulatory scrutiny is likely to impact your practice at some point.

Psychiatrists have an important role in helping to ensure the safe and effective use of prescription medications and the avoidance of drug diversion. Utilizing prescribing best practices can help to reduce the risk of patient misuse, abuse, or overdose of prescription medications, specifically controlled substances.

It is critical to be aware of both federal and state guidelines when prescribing. Prescribing regulations vary among states; when federal laws are different from state laws, the more stringent rule applies.

It is important to be aware of what is available and what you may be required to do prior to prescribing. Forty-nine states and the District of Columbia have passed statutes establishing Prescription Drug Monitoring Programs (PDMPs), which are state-run electronic databases used to track the prescribing and dispensing of controlled prescription drugs to patients.

PDMPs can provide the prescriber with information regarding a patient’s controlled substance prescription history. This information helps prescribers identify high-risk patients.

There are several questions to consider about PDMPs before prescribing or issuing a refill:

• What are your state and federal regulations regarding reporting, accessing, and sharing prescription drug monitoring information?

• Are you first required to check your state PDMP database before you prescribe or issue a refill?

• What do your state regulations say about whether your office staff or a designated person can search the PDMP database on your behalf?

• Are you required to register with the PDMP?

• Are you required to check the PDMP and, if so, how often?

• Do you need to have an established physician-patient relationship before you can prescribe?

• Do you first need to examine the patient in person prior to prescribing?

• What are your state’s telemedicine guidelines and can you prescribe via telemedicine?

• Are you required to notify your patient that their information may be accessed via the PDMP?

• Are there circumstances in which you are immune from liability under your state PDMP (such as accessing, failing to access, or reporting data)?

There are many issues to consider regarding PDMPs, and advances in the ability to electronically track patients’ prescription medications are likely to continue to evolve in the years to come.

Online resources are available to prescribers concerning PDMPs. In addition, should you have any questions, consult with an attorney or risk management professional. ■