{"id":56902,"date":"2023-02-09T09:30:51","date_gmt":"2023-02-09T14:30:51","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=56902"},"modified":"2024-10-25T10:52:06","modified_gmt":"2024-10-25T14:52:06","slug":"prescribing-controlled-substances","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/prescribing-controlled-substances\/","title":{"rendered":"How to help patients taking controlled medications"},"content":{"rendered":"

As a pharmacist, you are likely well aware of what the Drug Enforcement Agency (DEA) calls your “corresponding responsibility” in section Title 21 of the <\/span>Code of Federal Regulations<\/span><\/a>. The law states that a pharmacist must only fill a prescription for a controlled substance when it is issued for a legit medical reason by a legitimate practitioner acting within the usual scope of their professional practice. This responsibility can weigh heavily on pharmacists as they make decisions involving patients’ controlled substance prescriptions in daily practice. <\/span><\/p>\n

Definition of a controlled substance<\/span><\/h2>\n

The United States <\/span>Drug Enforcement Agency<\/span><\/a> (DEA) is the government agency responsible for regulating controlled substances at the federal level. The DEA defines a controlled substance as a drug or chemical known to be addictive or habit-forming. Examples of controlled substances include opioids, central nervous system (CNS) stimulants, CNS depressants, hallucinogens, and anabolic steroids. <\/span><\/p>\n

Community pharmacists are essential in ensuring patients take their controlled substances as intended. As the last healthcare professionals to interact with a patient before they take the drug, pharmacists play a critical role in ensuring patients know how to take their medications appropriately. Pharmacists and pharmacy technicians must remain vigilant to recognize an issue involving a controlled substance prescription. <\/span><\/p>\n

Pharmacists are like caring gatekeepers. It’s your job to know the rules for prescribing controlled substances and the regulations for ordering, storing, dispensing, and recordkeeping of controlled substances—while ensuring that patients understand the risks associated with the medication.<\/span><\/p>\n

Controlled substance categories<\/span><\/h3>\n

The DEA categorizes controlled substances into different schedules based on their potential for abuse and addiction, with Schedule I having the highest risk and Schedule V having the lowest risk. <\/span><\/p>\n

The chart below summarizes the DEA’s <\/span>definition of controlled substance schedules<\/span><\/a> and lists common examples.<\/span><\/p>\n\n\n\n\n\n\n\n\n
Schedule<\/b><\/td>\nDefinition<\/b><\/td>\nExamples<\/b><\/td>\n<\/tr>\n
Schedule I or C-I<\/span><\/p>\n

(Roman numeral one)<\/span><\/i><\/td>\n

Not accepted for any medical purpose and have a high potential for abuse (illicit drugs)<\/span><\/td>\nheroin, lysergic acid diethylamide (LSD), marijuana (cannabis), peyote<\/span><\/td>\n<\/tr>\n
Schedule II or C-II <\/span>(Roman numeral two)<\/span><\/i><\/td>\nHigh potential for abuse and may cause severe psychological or physiological dependence<\/span><\/td>\namphetamines, fentanyl, morphine, hydrocodone, oxycodone<\/span><\/td>\n<\/tr>\n
Schedule III or C-III <\/span>(Roman numeral three)<\/span><\/i><\/td>\nAbuse potential is lower than that C-I or C-II drugs and use may lead to moderate to low physical dependence or high psychological dependence<\/span><\/td>\nanabolic steroids, ketamine, combination codeine\/acetaminophen <\/span><\/td>\n<\/tr>\n
Schedule IV or C-IV <\/span>(Roman numeral four)<\/span><\/i><\/td>\nLow potential for abuse compared to the above schedules<\/span><\/td>\nalprazolam, carisoprodol, clonazepam, lorazepam<\/span><\/td>\n<\/tr>\n
Schedule V or C-V <\/span>(Roman numeral five)<\/span><\/i><\/td>\nLow potential for abuse compared to C-IV substances and usually contain limited quantities of certain drugs<\/span><\/td>\ncough medicines that contain a limited amount of codeine, such as promethazine\/codeine syrup<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

A complete list of controlled substances and their respective schedules are in the <\/span>Controlled Substance Act<\/span><\/a>. Note that some states have different laws or regulations that are more stringent than the federal level; in this case, the stricter law always takes precedence.<\/span><\/p>\n

Prescription drugs versus controlled substances<\/span><\/h3>\n

Some prescription drugs are controlled substances, but not all controlled substances are prescription drugs. The main <\/span>difference<\/span><\/a> is that the definition of controlled substances includes prescription and illicit drugs with abuse potential. Here’s a quick knowledge check to help illustrate this difference: Can a healthcare provider issue a prescription for heroin? No. While heroin is a controlled substance, it is not a prescription drug.<\/span><\/p>\n

However, pharmacists should be aware that even prescription drugs that are not controlled substances, such as quetiapine, carry risks of misuse. Even non-prescription drugs, such as dextromethorphan, have abuse potential. Pharmacy staff should be aware of the signs and patterns of substance use disorder to best help their at-risk patients.<\/span><\/p>\n

Controlled substances restrictions<\/span><\/h2>\n

Controlled substances have restrictions that govern each step of their manufacturing, distribution, and dispensing. Pharmacists are responsible for ensuring their pharmacy adheres to all restrictions around storing and dispensing these substances.<\/span><\/p>\n

Pharmacists are responsible for knowing when a controlled substance prescription is warranted and within the scope of a practitioner’s practice. Controlled substance prescribing limits for specific types of healthcare providers, such as nurse practitioners and physician assistants, can vary from state to state.<\/span><\/p>\n

Further, the expiration date and the number of refills for controlled substances vary from other prescription medications. According to <\/span>federal regulations<\/span><\/a>:<\/span><\/p>\n