It’s a great idea to consider some other state specific controlled substance regulations. Some of these may be:
State Controlled Substance Monitoring Program
Not all states, however most states have a controlled substance monitoring program that allows prescribers and pharmacists to evaluate a patient’s prescription drug history. Each state can specify what information is reportable, how soon after dispensing it must be reported, how it is reviewed and documented, which medications are included, specific exemptions and how long records must be kept. Some states also require a zero report be filed even if a pharmacy does not dispense controlled substances.
State Specific Controlled Substances
Some states designate a medication as a controlled substance or a stricter class of controlled substance even if federal law does not. Some examples of medications to look at for this are: growth hormone, HCG, testosterone, Epidiolex (cannabidiol), Neurontin (gabapentin), Ultam (tramadol), butalbital containing products, Donnatol (phenobarbital and belladonna alkaloids), Librax (chlordiazepoxide and clinidium), ephedrine, pseudoephedrine, Soma (carisoprodol), etc.
Mid-Level Practitioners Prescribing Authority
Prescriber authority for mid-level practitioners such as nurse practitioners or physician assistants can vary state to state. Some are limited as to what controls they may prescribe, day supply allowed, what setting they may prescribe in, etc. The button below is a link to the DEA website that provides a listing by state.
Some states allow pharmacists to dispense Naloxone without a prescription under a collaborative practice agreement, statewide protocol or standing order. There are different limitations and documentation required state to state.
When taking the exam it’s important to read each question carefully and concentrate on which law, general concept or principle the question is testing.
When a drug name is given in a question, identify if it is OTC, prescription only or a controlled substance. Then, use that information to determine which laws apply and how they apply to the question at hand.
Always remember, state law may be stricter and if so STATE LAW APPLIES.
Preparations containing limited quantities of certain narcotics
Generally used for antidiarrheals, antitussives, and analgesic purposes
Examples: Cough preparations with ≤ 200mg of codeine per 100mL or 100g (Robitussin AC, Phenergan with Codeine), Lomotil, Lyrica
CIII-CV Valid Types of Prescriptions
Written signed prescription
Fax of written prescription
Erx
Verbal
Containing all information except prescriber signature
Transfer
ONE TIME for the purpose of REFILL dispensing
Pharmacies electronically sharing a real-time system may transfer up to max refills permitted by law and prescription
CIII-CIV Refills (and CV in Most States)
No more than 5 refills within a 6 month period
Must keep information on the back of the original prescription or in a computerized record-keeping system
Must be accessible within 48 hours
Must record: Prescriber name, Name and address of the patient, Quantity dispensed on each refill, Date of dispensing for each refill, Name or ID code of the dispensing pharmacist and Number of the original prescription order
CIII-CV Partial Filling
Partial filling is allowed
Each partial should be recorded in the same manner as a refill
The total quantity dispensed in all partial fillings cannot exceed the total quantity prescribed
No dispensing may occur beyond 6 months after the date Rx was written
Filling a CV Without a Prescription/Limitations
Only a pharmacist may dispense an over the counter CV
A non-pharmacist may complete the money transfer at the register
Purchaser must be ≥ 18 years old (Rph can require proof of age)
Furnish identification
Bound record book must be maintained by the pharmacist: Name and address of the purchaser, Name and quantity of the CV purchased, Date of purchase, Name or initials of pharmacist that dispensed, Records must be kept for 2 years
Not more than _______ in a 48 hourperiod to the same purchaser
240mL (8 ounces) of any controlled substance containing opium
48 dosage units of any such controlled substance containing opium
120mL (4 ounces) of any other controlled substance
24 dosage units of any other controlled substance
Therefore, MAX is 4 fluid ounces of codeine containing cough syrup over the counter to a given purchaser in a 48 hour period.
