Louisiana Controlled Substance Law and Pharmacy Practice

Vocabulary-style flashcards covering Louisiana pharmacy law, controlled substance regulations, and medical marijuana protocols based on lecture notes.

One day supply

The maximum amount of a controlled substance a practitioner may administer and dispense; not for more than 3 days total unless another physician takes over in a hospital setting.

SB 223 (2011)

Louisiana legislation that authorized the Controlled Substances Act (CSA) to be amended to include 'electronic prescription' and allowed for reimbursement.

2745 F

The administrative rule allowing for electronic prescribing in Louisiana once the DEA creates necessary guidelines.

LABP E-prescribing requirements

Systems must be compatible; CII-CV may be e-scribed, but nothing 'must' be e-scribed.

LABME

Louisiana Board of Medical Examiners; they require system compatibility and allow CII-CV e-prescribing, though it is not mandatory.

Prescription Orders

Orders typically used in nursing homes, hospitals, or institutions, as distinguished from standard retail prescriptions.

CII Oral Prescription (Emergency)

Must be for a limited quantity for the emergency period, immediately reduced to writing, and followed by a written form within 7 days.

Pharmacist verification for unknown prescribers

In an emergency oral CII situation where the prescriber is unknown, the pharmacist must attempt to verify the identity.

Emergency (CII Definition)

Immediate administration is necessary, no appropriate alternative is available, and it is not reasonably possible to provide a written prescription.

Faxing CIIs: Home infusion

An original CII prescription may be faxed for parenteral use or when a nurse is administering it and the patient does not take control of the medicine.

Faxing CIIs: LTCF

A faxed CII may serve as the original for residents of Long-Term Care Facilities where the nurse administers the medication.

Hospice enrolled patients (CII Faxing)

A faxed CII serves as the original if the prescription explicitly states 'hospice patient'.

Partial fill: CII terminal/LTCF patients

Information must be recorded on the back of the prescription including date, quantity dispensed, remaining quantity, and pharmacist ID.

CII Partial fill timeframe (LTCF/Hospice)

All partial fills must be completed within 60 days from the date the prescription was written.

CII Prescription lifespan (Louisiana)

A CII prescription is valid for 90 days from the date it was written.

Comprehensive Addiction and Recovery Act (CARA) 2016

Federal law allowing partial CII filling for all patients if requested by the patient or prescriber.

CII Partial fill timeframe (CARA request)

The medication may be partial filled for up to 30 days from the date the prescription is written.

Out of stock partial fill (CII)

The pharmacist may provide a $72\,hour$ supply; the remaining portion must be picked up within 72 hours.

CII Label: Serial Number

A required element on the prescription label that must be made up of numerical characters.

Controlled substance warning

A cautionary statement required on the label of CII, CIII, and CIV prescriptions.

Institution labeling exemption (CII)

Labeling requirements do not apply if not more than a 7 day supply is dispensed and the ultimate user does not possess it.

CIII, CIV, and CV Transmission

May be dispensed via written prescription, fax of a signed written prescription from the prescriber's office, or oral prescription.

CIII and CIV Refill limit

May have a maximum of 5 refills within a 6 month period.

CV Refill limit (Federal Law)

Under federal law, CV prescriptions may have as many refills as written.

CV Expiration in Louisiana

Matches federal law; CV prescriptions are now valid for an entire year and treated like non-controls.

Refill Documentation

Pharmacists must record name/dosage form, date filled, quantity, initials, and total number of refills for CIII-CV.

Adding refills to a CIII-CV

May be done but cannot exceed 5 refills in 6 months; it is often better to issue a new prescription.

End of day computer report

Must be signed by each pharmacist working that day to verify all prescriptions were filled correctly.

CV Cautionary labeling (Louisiana)

Unlike federal law which exempts them, Louisiana state law requires cautionary labeling on CV medications.

Institution labeling exemption (CIII-CV)

Applies if supply is not more than 34 days or $100\,units$, and the pharmacist retains records of supplier and product.

Transferring unfilled CII

Not allowed if written, faxed, or oral; however, it is allowed to be forwarded if the original was electronic.

Transferring unfilled CIII-CV

Federal law generally only allows refills to be transferred, unless the prescription was escribed.

CV dispensing without prescription (LA status)

Generally not done in Louisiana, but federally allowed under strict requirements if certain conditions are met.

Non-prescription CV purchaser requirements

Must be at least 18 years old, known to the pharmacist or provide ID, and sign a log book.

DEA Form 41

The specific form required for the destruction of controlled substances.

Blanket authorization (Destruction)

Authority granted for destruction based on frequency, method, registrant history, and security.

Destruction witnesses

Typically requires a pharmacist plus another healthcare professional or law enforcement officer.

Secure and Responsible Drug Disposal Act of 2010

Act allowing pharmacies to amend their DEA license to become 'collectors' for the collection and destruction of controlled substances.

Prescriber record-keeping

Prescribers are only required to record the controlled substances they actually dispense, not those they simply prescribe.

Midlevel Protocols

PAs and NPs must have written protocols mandated by licensing agencies that list the specific drugs they are permitted to prescribe.

Weight loss medications (Louisiana PA restriction)

Physician assistants are not allowed to prescribe any medications for weight loss, whether controlled or not.

Chronic Pain (Louisiana PA restriction)

The treatment of long-term or chronic pain is not allowable for PAs in the state of Louisiana.

Federal Inventory frequency

Requires an inventory of controlled substances every 2 years.

Louisiana State Inventory frequency

Requires an inventory of controlled substances yearly, within a 365-day period.

Inventory of CII

Must be kept separate from other records and requires an exact physical count.

Inventory of CIII-CV

May be an estimate unless the bottle size is greater than $1000\,units$, which then requires an exact count.

Initial Inventory requirement

Must be taken on the day a drug becomes scheduled as a controlled substance.

DEA Form 106

The form used to report the loss or theft of controlled substances.

Immediate theft notification

The DEA must be notified verbally, by email, or in writing as soon as theft or significant loss is discovered.

Full Theft/Loss Report timeframe

The DEA and the Board of Pharmacy require a full report and everything turned in within 30 days.

Reverse 222 Form

Used when a pharmacy acts as the seller to return outdated or unneeded CII medications to a wholesaler.

Form 41 witnessing in hospitals

Destruction on the floor may be witnessed by 2 nurses who then notify the pharmacy.

US vs Poulin

Case where a pharmacy was fined $60,000$ for missing forms (DEA 222, 106, 41) and fraudulent dispensing counts.

DEA Number: First Letter A, B, E, or F

Indicates a provider or a pharmacy.

DEA Number: First Letter M

Indicates a midlevel practitioner, such as a PA or NP.

DEA Number: First Letter P or R

Indicates a distributor or wholesaler.

DEA Number: Second Letter

Usually represents the last initial of the practitioner.

DEA Validation Step 1

Add the 1st, 3rd, and 5th numbers to get sum (A).

DEA Validation Step 2

Add the 2nd, 4th, and 6th numbers and multiply the result by 2 to get sum (B).

DEA Validation Step 3

Add (A) + (B) to get (C); the 2nd digit of (C) should match the last digit of the DEA number.

Felony dealing with CS

Registrants must notify the DEA if an employee has such a history; though an appeals process exists, they may be barred from working with controlled substances.

Controlled Substances Export Reform Act of 2005

Allows manufacturers to export controlled substances as long as the recipient is DEA licensed.

Combat Methamphetamine Epidemic Act

2005 law that restricts all pseudoephedrine (PSE) sales.

PSE Daily retail limit

No more than $3.6\,g$ of pseudoephedrine per day.

PSE 30-day retail limit

No more than $9\,g$ of pseudoephedrine per 30-day period.

PSE Mail order limit

Restricted to $7.5\,g$ of pseudoephedrine per 30-day period.

PSE Storage

All pseudoephedrine products must be kept out of the reach of customers.

Haskell Lee Evans, Jr. Case

Oklahoma pharmacist indicted for selling PSE without following law and charging 6x the national average price.

Evans Case: Fine

The pharmacist agreed to pay $75,000$ in fines to the board and forfeited his license forever.

Sally Harpold

An Indiana grandmother arrested for purchasing two packages of PSE in one week, violating state law.

LCSA Marketing of ephedrine

In Louisiana, the marketing of ephedrine is strictly limited to asthma use only.

PSE status in Louisiana

Pseudoephedrine is a CV in Louisiana, though it is not reported as a controlled substance to the PMP.

LCSA ID Requirement

A photo ID or personal knowledge of the patient by the pharmacist is required for controlled substance prescriptions.

Poppers

Refers to Nitrous Oxide, which is illegal in Louisiana.

Dextromethorphan (DM) Age restriction

Selling to or purchasing DM for someone under 18 is a crime in Louisiana, unless it is for a prescription.

LCSA Out-of-state CII limit

If a prescriber is not licensed in Louisiana, there is a 10 day max supply for any CII or CIII opioid derivative every 60 days.

PMP check mandated

All prescribers must access the PMP prior to CII prescribing for non-cancer or intractable pain, and at least once every 90 days thereafter.

PMP checking exemption supply

Not applicable if a supply of less than 7 days is prescribed.

Naloxone First Responder

Includes peace officers, EMS, firefighters (including volunteers), and licensed medical providers.

CDS License renewal (3 hours CE)

All prescribers of Controlled Dangerous Substances must complete 3 hours of continuing education per year.

Opioid acute issue limit

A seven day limit applies to all opioid prescriptions for acute issues unless specifically documented as medically necessary.

Anabolic Steroids (LCSA 964)

Promote muscle growth; prescribing for bodybuilding or increasing muscle bulk in a healthy person is not a valid medical purpose.

LCSA 971.2 Prohibitions

Bans obtaining CDS via misrepresentation, fraud, or forgery, and writing prescriptions for fictitious persons.

LCSA 1021 Fentanyl Test Strips

Specifically excluded from the drug paraphernalia law in Louisiana as of 2020.

Marijuana Authorized Clinicians

Includes Physicians, Nurse Practitioners, and Medical Psychologists.

Marijuana for Children (Louisiana)

Requires a pediatric subspecialist, defined as someone providing care for children with autism.

Marijuana 'Recommendation'

In Louisiana, clinicians 'recommend' marijuana rather than 'prescribing' it, and no registration is required to do so.

Raw Marijuana Limit

No more than $2.5\,ounces$ ($71\,grams$) of raw form may be dispensed every 14 days.

Marijuana Pharmacy License 10

The tenth license is reserved for the region with the highest density of patients in the state.

Satellite Marijuana Pharmacy threshold

A satellite location may be opened once an existing pharmacy serves over 3500 qualified patients.

Marijuana Pharmacy limit

There can be no more than 30 marijuana pharmacies in the state of Louisiana.

Out-of-state Marijuana Patients

May be dispensed to if they have a medical marijuana card from another state, a photo ID, and a signed waiver.

PMP Purpose

To monitor prescription uses by relying on pharmacists and physicians to check patient histories.

PMP Delegation (2014)

Louisiana law allowed pharmacists and physicians to delegate PMP access to others, such as technicians.

Parole officer PMP access

A 2020 law allows parole officers to check the records of paroleees.

Pharmacy CSS Collector

A retail or hospital pharmacy registered with the DEA as a 'collector' to set up take-back collection boxes.

Narcan Education by Pharmacist

Must include techniques to recognize overdose, storage/administration of product, and emergency follow-up.

Marijuana Decriminalization

Possession of less than 14 grams results in a $100\,penalty$ rather than arrest.

2015 Act 261 (Marijuana)

Approved marijuana for a limited number of diseases, primarily cancer and wasting syndrome.

2016 Act 96 (Marijuana)

Expanded the list of approved diseases for medical marijuana to 20.