Managing Addictions

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10 Prescription Rules Every Washington Prescriber Should Know

by Dr. Mike on


A specific 2013 change in Washington State law, limits schedule III-V controlled substance refills to expire after 180 days. These include sleep medications like zoldipiem, anxiolytics like alprazolam, short acting analgesics like hydrocodone, and even some anticonvulsants like pregabalin. While the rules apply to pharmacists, it represents a substantive impact on physician practices where the physician may otherwise wish the patient to receive refills over the course of an entire year. With this change, an improperly generated prescription (e.g. “11 refills”) may generate workflow confusion between the physician, the medical record, and the pharmacy. In the worst case scenario, if a patient suffered a medication related outcome during the first 180 days, on a prescription that was generated with “11 refills”, the error wouldn’t be the source of the bad outcome but it could be used to demonstrate the physician is not current with community standards or other unflattering suggestions by plaintiffs. It is also possible the pharmacy may ignore the new law, and claims related to a bad outcome in the 6-12 month window may not be singularly directed at the pharmacist.
There are many existing requirements on controlled substances. Let’s take the time to review some of the other technical standards put forth by Washington State and in some cases the Federal government:
1. Never write a controlled substance prescription for yourself.
2. All controlled substances should be prescribed in the course of usual medical practice, which means for well documented conditions, with relevant exam, and follow up.
3. Schedule II medications can only be written for up to a 90 days’ supply.
4. Only 90 days of a schedule II medication (e.g. Oxycodone) may be authorized at a time, which can be in the form of three 30 day prescriptions, nine 10 day prescriptions, etc. The date the prescription was issued should be placed on the signed prescription. Do not “post date” the prescription, but you should indicate “do not dispense until ”.
5. When treating chronic pain, always write “for pain” on the prescription per state law, and “Pharmacist: please check ID”.
6. Do not prescribe long acting opioids including methadone as “prn” or “as needed”. The use of Long Acting Opioids including methadone for chronic pain requires 4 hours CME in the use of Long Acting Opioids including methadone.
7. While opioid analgesics are indicated for pain, prescribers are prohibited from using opioid analgesics where the indication is withdrawal or dependence, per federal law.
8. Patients treated with opioids for chronic pain at levels greater than 120 Morphine Equivalent Dose (MED) should be referred to a pain specialist for consultation, per WA state law.
9. Do not use cursive, and paper prescriptions should be printed on approved Washington State tamper resistant paper.
10. Do not accept unused controlled substance medications from patients for disposal. Do not store prescriptions, or direct staff to pick up controlled prescriptions intended for use in an office procedure, if they are issued with the patient’s name on the bottle. The patient (or their representative) must maintain sole custody of their own medications.

About Dr. Mike

Michael Schiesser MD is a physician, speaker, consultant and expert in addictions. View all posts by Dr. Mike →