Doctor's self Rx. your state's policy & your educated stance

[geldrop]

So I am currently a resident physician and read an article discussing about self prescribing among residents. I was talking among colleagues and many of them admit to self prescribing or having a friend or wife/ husband write them an Rx. Several even admit to having prescribed class IV medications for themselves (valium, vicodin, ambien) were some of the examples.

What is the teaching from your pharmacy school and what is your state pharmacy boards policy?

On a personal note I have Rx myself non-controlled substances for my chronic illness and it was oked. On the other hand after my wife hurt her back I wrote her an Rx for valium and the pharmacist got her panties in a knot....

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[WVUPharm2007]

It's considered a faux pas. I don't think its specifically illegal to write for family...though you technically have to have a "legitimate medical relationship" to treat a patient. It's sketchy...I could see where many retail pharmacists would refuse...I wouldn't mess with the DEA. They don't F' around.

 

[Aznfarmerboi]

It varies by state. For NYS and most other states, the consensus is that as long as you are a physician with a MD/DO degree, you can prescribe whatever you want for who you want. If you are a resident physician for dental or PDM, it has to be related to your scope of practice. With that said, there are a few reasons why prescribing for your friends and family is frown upon especially if the script is not related to your speciality.

http://www.op.nysed.gov/article131-a.htm

3. Practicing the profession with negligence on more than one occasion;

Negligence is really subjective and that would depend on the situation.

24. Practicing or offering to practice beyond the scope permitted by law, or accepting and performing professional responsibilities which the licensee knows or has reason to know that he or she is not competent to perform, or performing without adequate supervision professional services which the licensee is authorized to perform only under the supervision of a licensed professional, except in an emergency situation where a person's life or health is in danger;

Performing professional responsiblities which the licensee knows or has reason to know that he or she is not competant to perform is subjective. However, I have opthamologists who have been practicing medicine for 30 years but might not know how to dose insulin properly because he hasnt written a prescription for it for a long time.

32. Failing to maintain a record for each patient which accurately reflects the evaluation and treatment of the patient, provided, however, that a physician who transfers an original mammogram to a medical institution, or to a physician or health care provider of the patient, or to the patient directly, as otherwise provided by law, shall have no obligation under this section to maintain the original or a copy thereof. Unless otherwise provided by law, all patient records must be retained for at least six years. Obstetrical records and records of minor patients must be retained for at least six years, and until one year after the minor patient reaches the age of eighteen years;

Lastly, if you do write a prescription for a family or friend, be sure to document everything. This might include any baseline blood tests, pregnancy tests, pap smears, etc etc etc.

Writing prescriptions for your family and friends is a bad idea in general. Besides legal issues, there might also be issues relating to your malpractice liability (are you covered for the scripts you write to your friends or family? If you are not covered, can you still write it then?). Lastly, lets say that a pharmacist fills the prescription as a "professional courtesy". The pharmacist is doing it as a courtesy because an insurance company might not reemburse the pharmacy for the medication if it is not written properly.

For me, as long as you are a MD/DO... I will fill the prescription provided everything else is okay. I hope this helps.

 

[geldrop]

I really don't see why it matters if your impartial or not. One can't sue oneself. If one has a chronic condition that they have had for 10+ years what is really the harm in managing it yourself on a daily basis. Doctor's relationships with patient's is hardly impartial i have seen it time and time again a patient asks for xyz and physician feels obligated to give patient xyz because medical care in this country has become much like a restaurant serving patrons.

 

[Aznfarmerboi]

It's considered a faux pas. I don't think its specifically illegal to write for family...though you technically have to have a "legitimate medical relationship" to treat a patient. It's sketchy...I could see where many retail pharmacists would refuse...I wouldn't mess with the DEA. They don't F' around.

Pretty much. From what I remember, most medical boards will frown upon this. However you wont lose your license over it.

 

[Aznfarmerboi]

I really don't see why it matters if your impartial or not. One can't sue oneself. If one has a chronic condition that they have had for 10+ years what is really the harm in managing it yourself on a daily basis. Doctor's relationships with patient's is hardly impartial i have seen it time and time again a patient asks for xyz and physician feels obligated to give patient xyz because medical care in this country has become much like a restaurant serving patrons.

Exactly. Nobody cares. I dont care and would fill it provided everything is okay. I mean a lot of your colleagues have janitors with no medical experiences calling in RXs for them whichis a violation of NYS law but who cares?

The reason why it might matter to some pharmacists is because in pharmacy, we deal with a lot of regulatory boards that are looking for any reasons to crack down on us. These boards need to justify their reason for being there and hence any small violation is written up on. We also have a big bullseye for insurance companies because they can easily take back millions of dollars (and they do) for scripts that are not filled properly.

 

[Pharmavixen]

I might question why you think Valium works for a back injury...

Officially scripts for family are frowned upon, but it's going to happen sometimes, and if you don't do it habitually, should be okay. I seriously doubt there's a doctor out there who's never ever done this.

 

[bigpharmD]

I might question why you think Valium works for a back injury...

Officially scripts for family are frowned upon, but it's going to happen sometimes, and if you don't do it habitually, should be okay. I seriously doubt there's a doctor out there who's never ever done this.

if being used for back spams it works well...better than flexeril in my opinion

I dont really care about self prescribing as long as it is not for controlled substances or drugs that maybe are not but could be abused. If you want to write a zpak for your kid i could care less (although i dont think they need it)

 

[geldrop]

same effectiveness as any of the muscle relaxants and a lot less expensive.

I might question why you think Valium works for a back injury...

Officially scripts for family are frowned upon, but it's going to happen sometimes, and if you don't do it habitually, should be okay. I seriously doubt there's a doctor out there who's never ever done this.

 

[PharmaTope]

So I am currently a resident physician and read an article discussing about self prescribing among residents. I was talking among colleagues and many of them admit to self prescribing or having a friend or wife/ husband write them an Rx. Several even admit to having prescribed class IV medications for themselves (valium, vicodin, ambien) were some of the examples.

What is the teaching from your pharmacy school and what is your state pharmacy boards policy?

On a personal note I have Rx myself non-controlled substances for my chronic illness and it was oked. On the other hand after my wife hurt her back I wrote her an Rx for valium and the pharmacist got her panties in a knot....

honestly, i see NO PROBLEM with self prescribing. You have the right and the license and that is fine. I know plenty of people who do it, they are fully capable of making diagnostic decisions and medication decisions on strangers but not themselves? I find that hard to believe. Sounds like that pharmacist is trying to be the "Drug Police".

 

[WVUPharm2007]

I find that hard to believe. Sounds like that pharmacist is trying to be the "Drug Police".

Tell that to the DEA. According to them it is our duty to monitor and prevent drug diversion. I don't **** with the DEA...you can...go ahead...see what happens...

 

[teri78]

I can't believe I'm saying this, but I agree with WVU on this one. I am also a resident. I don't think it is a big deal to prescribe a non-controlled substance to self, family, or friends once in a while. However, I would definitely avoid doing this with controlled substances. There are too many things that are involved.

 

[Vitamin K]

My state doesn't specifically state that prescribing controlled substances to yourself is illegal, but it does state that prescribing controls for you or your family is considered "unprofessional conduct" and then later in the law it says that "unprofessional conduct" is unlawful. Sooo...

I have no problem with docs writing for non-control meds, but if they were writing for a controlled substance for themselves or their family, I would refuse to fill it. Usually doesn't happen around here.

 

[Quiksilver]

same effectiveness as any of the muscle relaxants and a lot less expensive.

flexeril is generic. and you don't have to worry about potentially fatal withdrawl from the benzo

 

[bigpharmD]

flexeril is generic. and you don't have to worry about potentially fatal withdrawl from the benzo

WTF? give me a break...

 

[eightball]

there is a ceiling to the level of CNS depression with benzos....as opposed to barbs or good ol' booze. Much safer...flexeril can be VERY sedating. But ya, you do have to worry about some dependence with long term use.

 

[The Sonoran]

Vicodin = Schedule III

I don't think most pharmacists would have a problem filling self-prescribed non-controlled meds, but you may face problems with controlled substances.

I once refused to fill a controlled med for a women whose son wrote the Rx. It didn't make her too happy, so she complained to the AZBOP. The board staff sided with my decision, informed me that it's not appropriate for MDs to write controlled substances for themselves or family members, but that dentists could do so. Strange, huh.

I'll also say that I've had my share of prescribers with substance abuse problems. IMO, if they want to risk everything they've attained in life to abuse drugs, go right ahead. Just don't try to involve me in those schemes.

 

[JackBeanstalk]

honestly, i see NO PROBLEM with self prescribing. You have the right and the license and that is fine. I know plenty of people who do it, they are fully capable of making diagnostic decisions and medication decisions on strangers but not themselves? I find that hard to believe. Sounds like that pharmacist is trying to be the "Drug Police".

It's nice that you have that much bravado in the way you are going to practice, but bottom line it is unethical to prescribe meds for anyone (including yourself) unless the patient have been properly evaluated. Physicians can't accept themselves as patients and I doubt they would accept immediate family members either. Self-prescribing and prescribing for family is a reportable "offense", though that probably means nothing in the real world. The pharmacist is the drug police, because its his/her job. My sentiments is the same as everyone else here, if its not controlled then prescribe away. I would question a controlled script if I believed it was written by a family member AND if it was for more than a week supply. If anyone thinks that I would be at fault for refusing to dispense such a script, we can take it to the regulatory boards.

 

[PharmaTope]

It's nice that you have that much bravado in the way you are going to practice, but bottom line it is unethical to prescribe meds for anyone (including yourself) unless the patient have been properly evaluated. Physicians can't accept themselves as patients and I doubt they would accept immediate family members either. Self-prescribing and prescribing for family is a reportable "offense", though that probably means nothing in the real world. The pharmacist is the drug police, because its his/her job. My sentiments is the same as everyone else here, if its not controlled then prescribe away. I would question a controlled script if I believed it was written by a family member AND if it was for more than a week supply. If anyone thinks that I would be at fault for refusing to dispense such a script, we can take it to the regulatory boards.

interesting point you raise, but who decides what is ethical and not?

ironic how retired physicians can maintain a limited license where they CAN prescribe for themselves and family but no others.

i see no reason with busting someone's balls who is not breaking the law we are imposed upon to follow. do you not think a physician is capable of getting a prescription strength cream? or hey, this looks like cellulitis perhaps ill write myself an amoxicillin rx. you are really gonna give someone a hassle for this? if so, i understand the public's opinion of pharmacists then.

 

[Aznfarmerboi]

interesting point you raise, but who decides what is ethical and not?

ironic how retired physicians can maintain a limited license where they CAN prescribe for themselves and family but no others.

i see no reason with busting someone's balls who is not breaking the law we are imposed upon to follow. do you not think a physician is capable of getting a prescription strength cream? or hey, this looks like cellulitis perhaps ill write myself an amoxicillin rx. you are really gonna give someone a hassle for this? if so, i understand the public's opinion of pharmacists then.

Unfortunely, they are breaking the law. Physicians are required to document everything they did for the patient leading to the requirements of the prescription. Us filling non-control prescriptions is a professional courtesy because we are overlooking that they probably did not document the things required for that prescription (ie physical exams etc). However for control substances, that is not okay because the DEA is involve.

In terms of ethics, If you can remember from your ethical class past the covered subjects like physician assisted suicide and pro life subjects, you will see the ethics are decided through different areas. They include human rights, law, popular culture, and religion. The laws here say that it is not okay while popular culture say that it is okay with the exception of controlled substance.

 

[MountainPharmD]

Quoted from the Pharmacists Letter. Detail-Document; Pharmacist's Letter 2009; 25(4):250412

Prescribing for oneself or a family member may have legal or ethical implications. The Health and Ethics Policies of the American Medical Association (AMA) (http://www.ama-assn.org/ad-com/polfind/Hlth-Ethics.pdf) state that physicians should not generally treat themselves or their immediate family for several reasons. These include loss of objectivity; embarrassment caused by a thorough exam and medical history; tendency to treat conditions outside their specialty when treating self or family; and potential for bad outcomes causing bad personal feelings. In addition, the patient/family member may feel obligated to follow their family member's advice or avoid getting a second opinion for fear of harming the personal relationship. In an emergency, treatment of oneself or a family member is appropriate until another qualified physician is available. Treatment of short-term, minor problems is also acceptable. However, controlled substances should not be written for oneself or immediate family members, except in an emergency.1 Several states have adopted the AMA statement, or have a similar policy. A few are more restrictive (e.g., prohibiting self-prescribing of controlled substances, even in an emergency). The American College of Physicians also advises against treating close friends or employees. Moreover, some third party payers (e.g., Blue Cross Blue Shield, Medicare) may refuse to pay for care and prescriptions provided by a family member

From the Texas State Board of Pharmacy Rules and Regulations.

Inappropriate prescribing of dangerous drugs or controlled substances to self, family, or others with whom there is a close personal relationship is considered practice inconsistent with public health and welfare. Inappropriate prescribing includes prescribing dangerous or controlled substances without taking a history, performing an exam, and maintaining adequate records. Prescribing of these medications limited to 72 hours. The physician runs the risk of close scrutiny by pharmacies, the medical board, DEA, etc. in the case of prescribing controlled substances for self or family. No specific language prohibits the prescribing of noncontrolled substances for self or family. Physicians should keep detailed medical records/patient history on relatives and on him/herself, as in the case of any other patient.

Here are my feelings. You are a resident. Yeah, yeah you graduated medical school and you can officially put MD after your name but still, you are a resident. You are still in training. Why risk bringing unwanted attention to yourself so early in you career.

 

[MountainPharmD]

if so, i understand the public's opinion of pharmacists then.

Oh, please share your knowledge concerning the public's opinion of pharmacists.....Since it is apparent you have no knowledge of anything else that pertains to this discussion.

 

[VCU07]

So I am currently a resident physician and read an article discussing about self prescribing among residents. I was talking among colleagues and many of them admit to self prescribing or having a friend or wife/ husband write them an Rx. Several even admit to having prescribed class IV medications for themselves (valium, vicodin, ambien) were some of the examples.

What is the teaching from your pharmacy school and what is your state pharmacy boards policy?

On a personal note I have Rx myself non-controlled substances for my chronic illness and it was oked. On the other hand after my wife hurt her back I wrote her an Rx for valium and the pharmacist got her panties in a knot....

When I was a student on my community rotation a resident I recognized from a previous rotation came in for a cpl. of meds (effexor and ultram). Apparently, his wife, also a resident called them in for him. D/t the potential DDI we questioned it when they came in and they demanded we give it to them, which we did. The problem was, they went through insurance. We found out a few days later she called in 180 lortab to another pharmacy down the street. Needless to say, they are being followed by the ins and the DEA...dunno what happened to them since though. Moral of the story, don't get yourself into this type of mess, esp. after going through 8yrs of college and then residency.

 

[Carboxide]

Well...as a completely uneducated person in this regard...

If you are a doctor and you actually need a controlled substance such as Vicodin, and it is a LEGITIMATE medical concern, shouldn't it be easy to get a colleague to write it for you? This kinda makes me think that you shouldn't be allowed to prescribe for yourself.

 

[rxlynn]

Oh, and one other somewhat related side note - as a physician, if you come into my pharmacy and ask for a script pad so you can write Augmentin for your wife, don't get all pissy if I ask to see your medical license, since I have no idea who you really are. And then, if it turns out that you are from another state and can't produce your license, then don't start screaming at me and the rest of the pharmacy staff when we refuse to take the Rx (yeah - true story).

 

[npage148]

In NY. It's illegal to write CS for yourself and frowned upon for your family. I've shut down Docs doing it. It's that whole pt/dr relationship that becomes involved. For Non-CS, i really don't care. It's not appropriate and I think it should be illegal but it's low on my priority list. and if you think you can efficiently manage your own condition go ahead and try. I had a radiologist try to control his cholesterol. He had his therapy so jacked up that he finally went to a cardiologist who had it controlled with 1/2 the meds with 1/2 the doses.

 

[PharmaTope]

Unfortunely, they are breaking the law. Physicians are required to document everything they did for the patient leading to the requirements of the prescription. Us filling non-control prescriptions is a professional courtesy because we are overlooking that they probably did not document the things required for that prescription (ie physical exams etc). However for control substances, that is not okay because the DEA is involve.

In terms of ethics, If you can remember from your ethical class past the covered subjects like physician assisted suicide and pro life subjects, you will see the ethics are decided through different areas. They include human rights, law, popular culture, and religion. The laws here say that it is not okay while popular culture say that it is okay with the exception of controlled substance.

so you are "overlooking" as a favor? so you assume that since the rx is for themselves that they don't document things? strong assumptions there.

actually my ethics classes were much different an also examined philosophical basis and thought. they didnt dictate what is right and wrong. so you agree that they are complicated issues. i don't know how you came to a conclusion that a physician writing for his/herself is "unethical".

 

[quietmedic]

In NY. It's illegal to write CS for yourself and frowned upon for your family. I've shut down Docs doing it. It's that whole pt/dr relationship that becomes involved. For Non-CS, i really don't care. It's not appropriate and I think it should be illegal but it's low on my priority list. and if you think you can efficiently manage your own condition go ahead and try. I had a radiologist try to control his cholesterol. He had his therapy so jacked up that he finally went to a cardiologist who had it controlled with 1/2 the meds with 1/2 the doses.

this response is a few years late, but I just spoke to the New York State Bureau of Narcotics enforcement, and they specifically stated they have no legal problem with somebody prescribing controlled substances to themselves. I was surprised, but that is exactly what they said.

 

[Old Timer]

Your state laws and your employers policy will control your actions. In the great Commonwealth of Pennsylvania, they have a level of license called active-retired. When you retire if you kick in for the license fee, you can prescribe for yourself and your family. No malpractice insurance or CE requirements. As long as the state gets to "Wet their beak". It's all good. You are however required to keep medical records. CVS does not permit the filling of controlled substances for prescribers or their families.

Back in the 1980's we had a patient who had a spinal issue. Her neurosurgeon prescribed Demerol injection. Her physician husband began writing the prescriptions for the convenience. One day she had a car accident and the police found the vial of Demerol with the pharmacy label. The state inspector comes into the store to investigate and they attempted to take away his license for....... not keeping medical records. The fact he was giving his wife C-II narcotics was okay, but not keeping medical records cost him a fortune in legal fees to keep his license.

So, I always warn doctors if the call in for themselves to keep medical records...... Caveat Emptor.....

 

[Carboxide]

Non-controls: IDGAF. The only things I'd look sideways at are gabapentin (repeated Rx or large quantity) or something like insulin that is a high risk drug.

Controls: No way, not for self or family. If your relationship with the person is more personal than professional, you shouldn't be giving them any CS.

 

[ChalupaBatman86]

They can also order controls directly from a wholesaler and they can even carry them around in their pockets if they want to. They are allowed to dispense, possess, and administer in most states.

 

[Lnsean]

I don't dispense controls if doc is writing for himself. I refused a few of them already from NPs and such. They should have the ethical conduct to not even do such a thing. Non-controls...I don't care...oh yea non of that high risk clozaril-like sht either. Do I trust that you're gonna monitor yourself? no. Oh you're a dentist and you want some Chantix? no.

 

[BidingMyTime]

In IL, it is illegal for prescribers to prescribe a controlled drug for themselves or a a family member. This law is pretty recent, I think within the past 1 or 2 years. Other than that, I don't think anyone cares--whether or not its a good idea is debatable. I don't think most doctors routinely prescribe for themselves or family members.

 

[BidingMyTime]

or hey, this looks like cellulitis perhaps ill write myself an amoxicillin rx. you are really gonna give someone a hassle for this? if so, i understand the public's opinion of pharmacists then.

Well, I wouldn't hassle them, but I would question their thought process that let them to think amoxicillin was a first line agent for cellulitis.

 

[ldiot]

I wouldn't fill controlled substances for self or family, but anything else is fine.

I have seen a doctor and his entire family on a CII, all prescribed by his partner. A gray area here in my opinion.

 

[zelman]

I don't dispense controls if doc is writing for himself. I refused a few of them already from NPs and such. They should have the ethical conduct to not even do such a thing. Non-controls...I don't care...oh yea non of that high risk clozaril-like sht either. Do I trust that you're gonna monitor yourself? no. Oh you're a dentist and you want some Chantix? no.

One could make an argument that smoking cessation is within a dentist's scope of practice.

 

[ldiot]

One could make an argument that smoking cessation is within a dentist's scope of practice.

Lol it's Chantix... I'd fill it. Birth control for his wife... no.

 

[Old Timer]

They can also order controls directly from a wholesaler and they can even carry them around in their pockets if they want to. They are allowed to dispense, possess, and administer in most states.

As long as they comply with the record keeping requirements.....

 

[quietmedic]

Another update. I checked with the NY Office of Professions Medical Board, specifically asking about physician assistants self-prescribing. I was told that as far as they are concerned, it is not illegal to self-prescribe; However, beyond legality, there are ethics considerations which also come into play, and a prescriber must be prepared to defend themselves against such things as well. A pharmacist may refuse a script, and can trigger and ethics investigation as well. However, they said that this was really only an issue with prescribing controlled substances...as far as they were concerned, self-prescribing things such as antibiotics and blood pressure medication was fine from their perspective, and would not be an ethical issue. The ethics concerns apply primarily to controlled substances.

So as far as I can tell, in NY, as long as you keep medical records, and, if you are a PA, as long as your supervising doc is kept in the loop, there should be no issues in self-prescribing routine/non-risky meds.

 

[lord999]

This is a bit dated (MN has changed to disallow CII self-prescribing as that was/is considered ludicrous).

(Not relevant anymore to me as I'm only a federal practitioner now and VA's policy is extremely clear about not treating conflict of interest patients):
Controlled substances - Provided that it wasn't disallowed in the statutes or regulations, if written by the prescriber for himself/herself or KNOWN family or for someone who is KNOWN to be an employee (MA or something) of said prescriber, I would dispense upon a promise that a copy of the chart noting said prescription was faxed to me within two days of me filling it (and then I would staple the relevant page to the prescription), or I would call the local DEA office explaining that a reasonable request for adequate documentation for a self-prescribed schedule substance prescription was not followed through by the practitioner. I actually did so every time that was 'forgotten', and it didn't go too well for the practitioners involved as they either failed the documentation or the legitimate rule for them. The local DEA put it out there that they had dim view on it and had the prosecution resources to spare going after even weak cases.

Noncontrolled substances (AZ) - I always ask whether this really is for the patient written if for himself/herself, the office staff, or the family just because if it's for office use, I can just invoice it and it's not even a prescription (that's actually federal policy if the state doesn't have a stronger rule). If it really is, I'll note in the prescription that I did verify it wasn't for office use and the prescriber acknowledged that they did the documentation rules relevant to their practice for this prescription. Been called on it twice, and it wasn't a problem for me as while I did dispense, I did a reasonable check on the conditions.

And yes, DEA has a longstanding precedent that does hold pharmacist licenses responsible for questionable conduct in trends as well as individual prescriptions (the South Florida sales for example). That's why the law changed in a way that the DEA has to get real evidence before charging.

http://www.latimes.com/local/california/la-me-pharma-bill-20160728-snap-story.html

This was actually also aimed at chain pharmacies because basically line pharmacists were being held to account for dispensing "excessive" quantities under pressure from chain management, even though they did question those matters. DEA presumes you guilty and forces you to prove innocence. The law now allows for a CAP to be written rather than being an immediate shutdown/charge everyone blast.

Shameless plug and I don't make any money off this. If you are going to subscribe to a trade publication, the Pharmacist Letter is one that I hope you consider. It is usually one of the most practical publications for real practice out there.