Laws on Controlled Substances

Schedule I

Highest potential for abuse; no medical use

Schedule II

High potential with accepted medical use

Schedule III

Moderate or low physical dependence or high psychological dependence

Schedule IV

Less potential, limited physical or psychological dependence

Schedule V

Low potential for abuse and limited physical or psychological dependence; cough suppressants or antidiarrheals

Schedule II Refills

None

Schedule II Partial fills

Remainder must be dispensed within 72 hours or prescription is void

Schedule II Storage

Locked Safe

Schedule III Refills

No more than 5 times (or 6 months from date the prescription was written if indicated on the original prescription)

Schedule III Partial Refills

Remainder must be dispensed before prescription expires if refills were indicated on the original prescription

Schedule IV Refills

No more than 5 times (or 6 months from date the prescription was written if indicated on the original prescription)

Schedule IV Partial Refill

Remainder must be dispensed before prescription expires if refills were indicated on the original prescription

Schedule V Refills

Varies by state and medication

Schedule V Partial Refills

Remainder must be dispensed before prescription expires if refills were indicated on the original prescription

Noncontrolled Refills

Indicated or 1 year from prescription written if prn for refills

Noncontrolled Partial Refills

Remainder until prescription expires

Comprehensive Addiction and Recovery Act (CARA)

Deal opioid crisis: prevention, treatment, recovery, law enforcement, criminal justice reform, and overdose reversal

DEA Form for Schedule II Transfer

DEA Form 222

Hours for partials for schedule II

72 hours; exemptions for long-term care facility

Number of days for emergency dispensing prescriptions

7

Ordering Schedule II

DEA Form 222 or DEA’s Controlled Substance Ordering System

Cough medicine (Schedule V) limit

4 oz/pt in 48-hours

Diarrhea limit

8 oz/ pt in 48 hours

Pseudoephedrine limit

3.6 g/day

9 g/ month

7.5 g/ month - mobile seller

First letter of DEA number- A

DEA number before 1985

First letter of DEA number- B and F

After 1985

First letter of DEA number- M

Midlevel practitioners: PA and NP

First letter of DEA number- X

Practitioners in buprenorphine- and naloxone- prescribing program

Second letter of DEA

First letter of prescriber’s last name

DEA numbers

Add 1st, 3rd, and 5th
Add 2nd, 4th, 6th * 2
Add odd and event
= Last digit = 7th digit

Destruction of controlled substances

Reverse Distributor = send it back to manufacturer

DEA Form for destruction

To manufacturer = 222
To DEA = 41 (once/year)

DEA Form for Theft

DEA Form 106

Withdraw Symptoms

Restlessness
Aggressive
Sweating
Insomnia

Dilated Pupils
Watery eyes
Muscle spasms
Hot and Cold flashes
Nauseas
Rapid breathing

Employee Assistance Programs

Help with abuse

Acamprosate (Campral)

Alcohol dependence

Disulfiram (Antabuse)

Alcohol dependence

Naltrexone (Vivitrol)

Alcohol and Opioid dependence

Buprenorphine (Buprenex, Bustrans, Probuphine, Sublocade, Belbuca)

Opioid dependence

Buprenorphine-naloxone (Suboxone)

Opioid dependence

Naloxone (Narcan)

Opioid overdose

Bupropion (Zyban)

Nicotine dependence

Nicotine replacement therapy (NicoDerm CQ, Nicorette gum, NicotroINS)

Nicotine dependence

Varenicline (Chantix)

Nicotine dependence

Examples of C-I

Heroin, mescaline, peyote, and lysergic acid diethylamide

Examples of CII

morphine, methadone, oxycodone, hydromorphone, hydrocodone, fentanyl, levorphanol, meperidine, methylphenidate, secobarbital, methamphetamine

Example of CIII

Ketamine, acetaminophen with codeine, butabarbital, dronabinol, thiopental, anabolic steroids, and testosterone

CIV

Phenobarbital, chloral hydrate, diazepam, zolpidem, eszopiclone, alprazolam, chlordiazepoxide, pentazocine, temazepam, triazolam, and clonazepam

CV Examples

Antidiarrheal, antitussive, and analgesic

Atropine, pregabalin, lacosamide, guaifenesin with codeine, kaolin, and pectin with belladonna

Number of days hospice pt and for parenteral narcotics from home-infusion pharmacy

7

Control sheet for?

Hospital pharmacy staff indicate time of administration of CII

Amount of time can transfer for controlled

Once

Age for Behind the counter (BTC)

18

Is electronic Rx for controlled allowed?

Yes and software conforms the DEA’s rules and standards

Controlled without Rx

Some CV- narcotics

Prescription Drug Monitoring Program (PDMP)

Tracks controlled substance prescriptions

Perpetual Inventory

Constant inventory of schedule II

Drug Monitoring Programs

Monthly report of all controlled dispensed + medication information