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Monday, August 18, 2014

Tramadol Is Federally Controlled Today!

...And there was much rejoicing...hooray...whatever...

Let's look at what happens when laws change.
Your state outlaws smoking in public places. If you light up in a bar, you get fined/arrested/whatever.

Your state changes the speed limit from 70mph down to 55mph. If you are speeding, you are expected to pay the fine because all the new signs are posted, it has been in the paper and the Highway Patrol Lady will not buy the "I didn't know" excuse. She also won't fall for "That's today?".

The point is, when laws change, we are all expected to abide by them. Even if we change states, we are expected to adopt the new laws as soon as we move.

Prescribers seem to be immune to this legal fact of life.
A controlled substance has many restrictions. Prescribers learn how to prescribe controlled substances and non-controlled substances. The fact that a medication changes from one designation to the other should mean a simple adjustment in prescribing habits. It is not as if this is new territory for the prescriber. However, today we are reminded that prescribers are above the law. Hear me out on this...

On Day Zero, the day a switch in classification occurs, pharmacies must conduct a DEA audit. We must change the refills remaining and the expiration date to no greater than 6 months from when the prescription was originally written. In my state, the quantity must be numerically written AND spelled to be valid. I must have the DEA# on the hard copy. I am not allowed to accept electronic prescriptions for this anymore (yet...), and faxed authorizations must have a wet ink signature, not an electronic one. Sorry, some state's laws are antiquated and rarely change.

On Day Zero, PRESCRIBERS can forget the law has changed. Why? Because pharmacists will call. We will remind them. WE need to document the change on the hard copy. WE need to comply with the law on the day it changes. WE need to be vigilant and catch THEIR mistakes so the State Board doesn't fine US. They would fine US because prescribers are allowed to "forget" the law has changed but WE have to comply NOW. It is now 8 months after the removal of Vicodin 5/500 from the market. We continue to see prescriptions written for it. Why? You cannot retrain prescribers from their habits...and they rely so heavily on the pharmacists they don't even realize how much we do for them. We need to change that.

People will just say "deal with it" or "that's your job" or "don't put the patient in the middle of your pissing contest". You do realize that this just perpetuates the problem, right? RIGHT? WE ignore the problem. WE fix the prescriber's mistakes. Why? Because our professional obligation conflicts with the "customer service metrics" of our companies.
Give the prescribers a one month grace period. Fax them the note I posted about this change. After that, start faxing the invalid prescriptions back or send them back with the patient. It is our professional duty to change with the laws. Prescribers should be forced to comply immediately as well.
Perhaps if they started receiving fines and cuts in their staff budgets, they might notice...Probably not...

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