Office Policy for Prescribing Controlled Substances



Office Policy for Prescribing Controlled Substances

Confidential – do not share contents of this document with patients

Purpose:

To protect the patient, community and this office from potentially dangerous activity involving controlled substance abuse and misuse.

Before prescribing any controlled substance:

1. Check CSPMP*: multiple prescribers, multiple pharmacies or overlapping prescriptions warrants further investigation.

2. Administer SOAPP* 5: a score of 4 or higher warrants further investigation.

3. Evaluation inconsistent with complaint warrants further investigation.

Further investigation:

1. Obtain results from drug test: results inconsistent with patient’s statements indicates potential problem.

2. Administer and score SOAPP* 14: a score of 7 or higher indicates potential problem.

3. Check Public Access to Court Information: numerous cases indicates potential problem.

4. Confer with past prescribers and pharmacist(s) for their assessment.

Before prescribing for a treatment period that may extend beyond 30 days

or if a new patient requests or is already taking a controlled substance:

1. Obtain results from drug test: results inconsistent with patient’s statements indicates potential problem.

2. Have the patient complete a Controlled Substance Agreement and explain the agreement to the patient.

3. Should be seen at least once a month by provider extender for pill count, progress, side effects and problems (could be E&M level 1).

4. Should be examined by prescriber at least every three months.

5. D/C controlled substances if patient violates the Controlled Substance Agreement.

6. Drug test and COMM* if prescriber has any suspicion.

7. Full work up annually including a drug test and COMM.

New patients currently on a controlled substance must have medical records sent to this office directly from the previous provider and not hand carried by the patient prior to being prescribed any controlled substance.

Office staff and providers should never handle the patient’s controlled substance medications but should observe and chart the patient counting or destroying the medications.

Suspicious activity:

▪ Emergency calls/visits for controlled substance refills especially near end of office hours.

▪ Refusal to undergo appropriate examination, testing, or referral.

▪ Not following through with non opioid pain management suggestions.

▪ Repeated “loss” of prescriptions.

▪ Frequently running out early of controlled substances.

▪ Pill count inconsistent with medication directions.

▪ Tampering with prescriptions.

▪ Reluctance to provide medical records or contact information for prior physician(s).

▪ “Doctor shopping” for additional prescriptions.

* CSPMP: Controlled Substance Prescription Monitoring Program;

SOAPP: Screener and Opioid Assessment for Patients in Pain; COMM: Current Opioid Misuse Measure

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