Dispensing CS (slides 1-20) - NOV3

The lecture covers a review of federal law, in conjunction with Massachusetts law (Mass law).
The agenda includes discussion of Chapter 5, followed by details on controlled substances and counseling.
The instructor has jury duty next week but will manage to record the lecture if unable to attend.
There are only four weeks left in the semester, indicating urgency in the material coverage.

Discuss the dispensing of controlled substances.
Explore the prescription requirements for controlled substances in outpatient settings.
Understand the rules surrounding prescriptions in hospital settings.
Emphasize the importance of drafting prescriptions and recognizing common mistakes.

Outpatient Prescriptions: Issued for external patients, have specific rules that differ from inpatient settings.
Inpatient Medication Orders: Used in hospital settings, generally limited to specific protocols for drug administration.

Allowed Items: In Massachusetts, only one prescription per blank is allowed, whereas other states might permit multiple prescriptions.
Required Information on Prescriptions:
- Patient's Name
- Patient's Address
- Date of Birth (not required in Mass)
- Prescriber's Name
- Drug Name
- Quantity of the drug
- Directions for use
- Number of refills
- No substitution language indicating brand medication preference.
- Partial fill language for Schedule II drugs if applicable.

Doctors cannot write prescriptions for their office use; all medications must be tied to specific patients.
If a doctor requires controlled substances such as cocaine for office use, they must submit a form (e.g., Form 222 for Schedule I and II drugs).

Only individual practitioners can prescribe, and they must possess a DEA registration.
In Massachusetts, practitioners additionally require a Mass-controlled substance registration.
Agents or employees of doctors are not required to be registered unless they have prescriptive authority.

Agents of doctors may relay prescriptions to pharmacies but cannot authorize refills unless they have prescriptive authority.
Prescriptions can be prepared by agents except for the doctor’s signature.

Prescribers must be registered under the Drug Enforcement Administration (DEA) to prescribe controlled substances.
Key components of a DEA number:
- Nine digits, with two letters followed by seven numbers.
- The second letter typically corresponds with the first letter of the prescriber's last name.

Given a DEA number example, methods to verify it using specific calculations:
- Add the 1st, 3rd, and 5th digits and sum.
- Add the 2nd, 4th, and 6th digits, multiply by 2, then combine this with the previous sum.
- Validate if the last digit of the DEA number corresponds with the check digit.

Pharmacists share liability to ensure controlled substances are prescribed for legitimate medical purposes.
Examples of illegitimate prescriptions include those for narcotics without valid medical reasons, or prescriptions written without proper evaluations.

Pharmacists must exercise professional judgment when there is uncertainty about a prescription's legitimacy.
The opioid epidemic has heightened scrutiny regarding the dispensing of controlled substances.
Knowledge of the usual course of professional practice is crucial; for example, a pediatrician writing prescriptions for an adult is outside the norm.
Essential to recognize potentially red flags, such as repetitive filling of certain prescriptions.

In an emergency, a doctor may call in a CII prescription without a written order under specific conditions:
1. Immediate patient administration is necessary.
2. No alternative treatment is available.
3. It's not feasible to provide a written prescription.
A follow-up written prescription must be provided within a certain timeframe based on Massachusetts law.

Under federal law, partial fills are allowed upon request from the prescriber or patient.
The remaining amount does not need to be filled within 72 hours but can be between remaining up to 30 days.
Long-term care facilities have specific provisions for dispensing such substances.

Topics to continue in next class will include further discussion on controlled substances and subsequent dispensing protocols. Attention given to insurance implications will also be considered.