Are pts on my allowed to be prescribed c2?

[PikminOC]

I think dea rules prohibit mj people to get controlled subs. What dea regs do you know for c2? Links are helpful.

Thanks

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[ldiot]

I think dea rules prohibit mj people to get controlled subs. What dea regs do you know for c2? Links are helpful.

Thanks

Are you asking if people on medical marijuana can be prescribed C2s? I haven't heard any rules against it. As a matter of fact I think the DEA is considering downgrading marijuana to C2 this year, though I don't personally favor this.

 

[PikminOC]

Not on meds mj, just users of mj.

 

[WVUPharm2007]

I have no idea wtf you are talking about. Yes, someone on just about anything can be prescribed controlled substances as long as there is a legitimate medical purpose.

 

[Digsbe]

Are you asking if you can prescribe CIIs for patients that use marijuana?

 

[PikminOC]

Yes. I think dea doesn’t allow this. Violation of dea law

 

[PikminOC]

diversion is very high for c2, includes stims. Docs shouldn't give controls to addicts. Not including suboxone

 

[maria1oh]

I know a friend who works at a doctor's office who prescribes a lot of controls. He requires a clean drug test from patients before he prescribes. If they fail they are kicked out of his practice. My friend said marijuana has been the only drug found in the few patients who were banned. I don't know if it's law or just practice.

 

[npage148]

diversion is very high for c2, includes stims. Docs shouldn't give controls to addicts. Not including suboxone

Mj use =/= addict.

 

[PikminOC]

I know a friend who works at a doctor's office who prescribes a lot of controls. He requires a clean drug test from patients before he prescribes. If they fail they are kicked out of his practice. My friend said marijuana has been the only drug found in the few patients who were banned. I don't know if it's law or just practice.

Thanks. Yes. It's dea law

 

[PikminOC]

Does he do uds in his office?

 

[PikminOC]

It counts as abusing drugs. Anyone got a dea link?

 

[lord999]

Depends on the definition of "abusing". I think GroverPsychMD is referring to this section in 21 USC:

http://www.deadiversion.usdoj.gov/21cfr/21usc/829.htm
http://www.deadiversion.usdoj.gov/21cfr/21usc/841.htm

with respect to illegal distribution. Yes, in the past, some of the more overzealous field offices had that interpretation and it's been challenged in court (that's part of the reason the CAP law is going into effect).

I am not a lawyer and this is not legal advice. The federal practitioner version of this is that it's ok to prescribe knowing the patient is on illicit substances (marijuana or otherwise) and specifically is permissible if methadone is used in the right protocols for the opioid addiction issues. If this wasn't the case, there's a sizable portion of the veteran population that we couldn't treat. If you are practicing in a federal facility, you may not write for marijuana whole directly as it is still a Schedule I. I don't see anything out there from the memos that I get from DEA and DoJ in the last two years about this specific issue besides that there is caution warranted on someone who abuses/is an addict to drugs.

The funny part is that everyone who did write for medical marijuana is still in violation of 21 USC but there's a memo from the AG to all DoJ US Attorneys NOT to enforce this solely:

https://www.justice.gov/iso/opa/resources/3052013829132756857467.pdf

, but this only applies for the duration of the current political structure. HOWEVER, if a future president someday has a more zealous US AG enforcer of 21 USC provisions (like say a Civiletti (D) or Meese (R)), who knows what statute of limitations get interpreted and that prescriber would be criminally prosecuted for writing for a Schedule I substance.

If marijuana whole is sent to C-II, it'll be very interesting as the C-II provisions are much more complicated to disentangle than C-I. I don't think it's a pro-marijuana matter for this to be reclassified because either the law changes, or there's going to be a lot of nasty legal fights for discriminating based on the type of drug (think about the additional enforcement penalties for cocaine anhydrous and crack cocaine different than the rest of the C-II's).

 

[Vandalia]

Out of my specific area of expertise, but that rarely stops me here. Also, I tend to look at the extreme cases first when examining an issue:

It is not at all unusual for someone with polysubstance abuse to end up in the ED with injuries that require IV opiates, or eventually require anesthesia, so there is obviously not an absolute prohibition on them receiving opiates. And obviously, hospital care is a different situation from a prescription to be filled as an outpatient.

In the same way, people with serious current illegal substance abuse often end up with metastatic cancer, and end up prescribed outpatient opiates. So again, there does not appear to be an out-right prohibition. The prescriber may have to take extra efforts to monitor the situation, but as long as the patient isn't diverting the medication (still a legitimate concern) if someone has cancer and a short life expectancy just about every other concern goes out the window.

Based on what I have seen in EM, I do not believe there is a specific (currently enforced) law that prohibits anyone taking "illegal drugs" from receiving a prescription for a C-II as long as the prescription itself is medically justified. There, of course, is the rub. It is one thing for a hem-onc or pain med to prescribe fentanyl patches for someone they know is taking marijuana who also has bone cancer and has six months to live. On the other hand, a physician (or to some extent a pharmacist if they were aware of the issue, which I don't think is likely) may decide that the risk is too great to prescribe 60 lortab a month for someone with long-term low-back pain and who has a drug screen positive for marijuana.

Now, you can make something up for your patients saying "Federal law prohibits me from prescribing controlled substances to anyone taking marijuana." This happens surprisingly often in medicine. My favorite was one of our primary care physicians who put this sign up in his office right after 'ObamaCare' passed; "ObamaCare requires that every patient pay their estimated bill in full before seeing a physician." More accurately, as a physician, you are certainly free to make the medical judgement that it is inappropriate to prescribe a C-II to anyone taking any illegal drug. Now, since I believe the OP is a psychiatrist, I doubt he would face the "bone-cancer" example where the "standard of care" essentially demands that he prescribe an C-2.

 

[RPh Who]

Are you looking at the stimulants to help them focus/pay attention due to side effects from mj use (laziness, amotivational behavior)?

 

[PikminOC]

It's hard to tell if the mj caused that or if they have underlying addhd, in my state, docs are getting disciplined over this, that's why I'm asking.

 

[PikminOC]

Out of my specific area of expertise, but that rarely stops me here. Also, I tend to look at the extreme cases first when examining an issue:

It is not at all unusual for someone with polysubstance abuse to end up in the ED with injuries that require IV opiates, or eventually require anesthesia, so there is obviously not an absolute prohibition on them receiving opiates. And obviously, hospital care is a different situation from a prescription to be filled as an outpatient.

In the same way, people with serious current illegal substance abuse often end up with metastatic cancer, and end up prescribed outpatient opiates. So again, there does not appear to be an out-right prohibition. The prescriber may have to take extra efforts to monitor the situation, but as long as the patient isn't diverting the medication (still a legitimate concern) if someone has cancer and a short life expectancy just about every other concern goes out the window.

Based on what I have seen in EM, I do not believe there is a specific (currently enforced) law that prohibits anyone taking "illegal drugs" from receiving a prescription for a C-II as long as the prescription itself is medically justified. There, of course, is the rub. It is one thing for a hem-onc or pain med to prescribe fentanyl patches for someone they know is taking marijuana who also has bone cancer and has six months to live. On the other hand, a physician (or to some extent a pharmacist if they were aware of the issue, which I don't think is likely) may decide that the risk is too great to prescribe 60 lortab a month for someone with long-term low-back pain and who has a drug screen positive for marijuana.

Now, you can make something up for your patients saying "Federal law prohibits me from prescribing controlled substances to anyone taking marijuana." This happens surprisingly often in medicine. My favorite was one of our primary care physicians who put this sign up in his office right after 'ObamaCare' passed; "ObamaCare requires that every patient pay their estimated bill in full before seeing a physician." More accurately, as a physician, you are certainly free to make the medical judgement that it is inappropriate to prescribe a C-II to anyone taking any illegal drug. Now, since I believe the OP is a psychiatrist, I doubt he would face the "bone-cancer" example where the "standard of care" essentially demands that he prescribe an C-2.

My meds are given long term so the er example doesn't apply. Yes, I agree more with the diversion, that's more the issue. Patients are smart and can pass uds and pill counts and still divert.

 

[PikminOC]

Mj use =/= addict.

Gunjan Goel, MD of San Diego, California had tested positively for THC in hair test, negative in urine. She also admitted to smoking pot "socially" 3-4 times. Dr. Goel did NOT have a medical marijuana card. In her defense, there was no proof that patient care was affected, that she smoked pot while or the job, or had a DUI. Had to enter state impaired doctors program

http://www2.mbc.ca.gov/BreezePDL/document.aspx?...

 

[PikminOC]

Depends on the definition of "abusing". I think GroverPsychMD is referring to this section in 21 USC:

http://www.deadiversion.usdoj.gov/21cfr/21usc/829.htm
http://www.deadiversion.usdoj.gov/21cfr/21usc/841.htm

with respect to illegal distribution. Yes, in the past, some of the more overzealous field offices had that interpretation and it's been challenged in court (that's part of the reason the CAP law is going into effect).

I am not a lawyer and this is not legal advice. The federal practitioner version of this is that it's ok to prescribe knowing the patient is on illicit substances (marijuana or otherwise) and specifically is permissible if methadone is used in the right protocols for the opioid addiction issues. If this wasn't the case, there's a sizable portion of the veteran population that we couldn't treat. If you are practicing in a federal facility, you may not write for marijuana whole directly as it is still a Schedule I. I don't see anything out there from the memos that I get from DEA and DoJ in the last two years about this specific issue besides that there is caution warranted on someone who abuses/is an addict to drugs.

The funny part is that everyone who did write for medical marijuana is still in violation of 21 USC but there's a memo from the AG to all DoJ US Attorneys NOT to enforce this solely:

https://www.justice.gov/iso/opa/resources/3052013829132756857467.pdf

, but this only applies for the duration of the current political structure. HOWEVER, if a future president someday has a more zealous US AG enforcer of 21 USC provisions (like say a Civiletti (D) or Meese (R)), who knows what statute of limitations get interpreted and that prescriber would be criminally prosecuted for writing for a Schedule I substance.

If marijuana whole is sent to C-II, it'll be very interesting as the C-II provisions are much more complicated to disentangle than C-I. I don't think it's a pro-marijuana matter for this to be reclassified because either the law changes, or there's going to be a lot of nasty legal fights for discriminating based on the type of drug (think about the additional enforcement penalties for cocaine anhydrous and crack cocaine different than the rest of the C-II's).

Thank you. Any other links regarding prescribing? The most stringent and conservative view is what's been held up by the state..

 

[lord999]

Thank you. Any other links regarding prescribing? The most stringent and conservative view is what's been held up by the state..

If it's CA and not working for the federals, I'd recommend contacting the local DEA field office for something called a "Memo Opinion." That's a question that they would have to give you an official answer for. I understand your position as even though National does have overriding authority, you deal with the Field office most of the time. If you are working for the VA, VISN 21 and 22 already are under the VA general opinion through OLC (and I'll send you the internal link to the current ruling if you PM me).

By the way, the issue of writing is different than taking as you brought up for that neurosurgeon. It's not just on the books, but if a clinician is caught with THC in their system and it's not from the C-III form, it's prosecuted as standard possession like normal. The board citation is quite correct and shouldn't have been a surprise, and even if it were medical marijuana, a licensed provider who partakes of a C-I drug is considered impaired. That part is quite unambiguous even now for us.