Pain Management And Prescribing Controlled Drugs

1. 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

2. Legal Aspects Of Prescribing • What is the problem ? • What constitutes legitimate practice? • How can I avoid problems in my practice

3. What Is The Problem? • EDUCATION • Tolerance • Addiction

4. Lack of Education Leads to: • Desire to avoid the patient/Rx • “Just say no” attitude • Blame law enforcement for hesitation in treating/prescribing

5. WHAT CONSTITUTES LEGITIMATE PRACTICE?

6. Factors For Determining A Schedule • Actual or relative potential for abuse • Scientific evidence of the drug’s pharmacologic effects • State of current scientific knowledge regarding the substance • Its history and pattern of abuse

7. Factors (continued) • The scope, duration, and significance of abuse • What, if any, risk there is to the public health • The drugs “psychic” or physiologic dependence liability • Whether a substance is an immediate precursor of a substance already controlled

8. What Constitutes Legitimate Practice? Ohio Administrative Code Rule 4729-5-30(A) • Physician/pharmacist responsibility

9. What Constitutes Legitimate Practice? Ohio Revised Code - 4731.22(B) • 4731.22(B)(2) • 4731.22(B)(3) • 4731.22(B)(6)

10. What Constitutes Legitimate Practice? Ohio Revised Code – 2925.03 • 2925.03(A) • 2925.03(B)

11. What Constitutes Legitimate Practice? Ohio Administrative Code – 4731-21-02 • Physician Requirements

12. How Can I Avoid Problems in My Practice? • Understand the requirements for proper prescribing • Communication – most important • Documentation • Drug Therapy – is it appropriate?

13. Case Review • No Individualized Treatment • Duplication of Therapy • Pain Management Physician seeing 50-70 patients daily • Logistics – patient/prescriber/pharmacy

14. 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

15. OARRS • Registration at www.ohiopmp.gov • Obtain up to 2 years of Rx history • Average time to obtain report is 15 seconds