“Office” or “For emergency” med prescriptions

[TeddyBoomBoom]

Hey everybody,

Let me start by saying that I am 100% NOT talking about any controlled meds, and I am posting this from my regular easily-identifiable SDN handle that I’ve had for 10+ years, so there is no question about anything shady.

I’m an ER doc living and practicing in FL. Because of my job and training, it’s not unlikely that if I were presented with an emergency while off work (asthma/anaphylaxis/OD/etc) I’d be able and qualified to do a little good in the world by treating someone before EMS arrived. I’d obviously activate EMS but there are times when a quick response is not available (rural, camping, etc.)

My question is regarding access to the meds. I’m thinking things like IM Epi, IM steroids/benadryl, Albuterol, narcan, etc. Again nothing controlled. I’ve read into this a lot, and I’m aware that “for office use” prescriptions aren’t a thing anymore. I’m also not going to prescribe myself the meds for multiple reasons. The production companies themselves would probably sell it to me as a “distributor” but that’s not what I do. I’m literally talking about a tiny number of doses of critical meds that I am well trained with, and could possibly help someone, but I’m not sure how to procure them.

Any thoughts? Thanks in advance.

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[owlegrad]

As you said, “for office use” just isn’t a thing anymore. As far as I can tell that’s the end of your inquiry.

To my knowledge there is no legitimate way for you to just have a cache of drugs to carry around and use as you see fit. Perhaps someone else will know a way that I am not familiar with.

 

[Sparda29]

I always wondered about that. If I were trying to create like a med kit for a go bag, bug out bag etc and I wanted to have like a weeks supply of all critical meds, could I just go to a doc and have him write prescriptions for those and then go to a pharmacy and fill them?

 

[TeddyBoomBoom]

Yes, I could certainly write you a script for these things, the same way that I could write myself for them. And I could get them filled. But when I write you a script it’s for “you.” Same if I write myself a script. It supposed to be for “me.”

Writing myself (or you) an Rx for meds that aren’t really for you isn’t kosher. Also, your life insurance/disability insurance company may wonder why you are prescribed these meds.

An Rx is person-specific for consumption, not just dispensing.

Hence my original question 🤷‍♀️

 

[Rockinacoustic]

I'm really curious why you'd want to do this. Not sure the good samaritan law will protect you if a bad outcome occurs.

 

[TeddyBoomBoom]

I'm really curious why you'd want to do this. Not sure the good samaritan law will protect you if a bad outcome occurs.

Honestly, treating anaphylaxis, OD, SOB are things that I’m super comfortable treating daily, albeit in the ED with backup. As an ER doc that does this for a living, if a neighbor/camping partner/wtvr ran up to me for help for a third party in extremis, it’d be great to have that person not die. Not every place has ems available in 15 min. It’s not like I have some kind of weird motive - I’d just like to be able to help with the most basic of meds.

 

[KidPharmD]

The answer is essentially no. The way it is supposed to work is that physicians are allowed to order meds from the distributers just like pharmacies are able to. If you aren't going to do this, there isn't a technically legal way for you to obtain meds for use "just in case" on someone other than yourself. (Narcan being the exception in most places)

 

[JustFillIt]

This is going to be very state specific and I am not familiar with Florida.

In my state - you can do office prescriptions if the pharmacist believes it is reasonable and records the ordering physician and who is taking responsibility of the medication. It also needs to be within reasonable quantity and not controlled.

If we were talking - Narcan, albuterol, injectable antihistamine, Epipen, IM steroid.. I would fill it no problem. Maybe I am wrong but even so I do not see a problem with this whatsoever and in my opinion we need all the medical professionals we can get out there with Narcan accessible. I can’t imagine a scenario where the above meds were dispensed to a physician, “for office use”, that would result in board intervention.

Only catch is you would have to pay cash. These medications save lives and have zero potential for abuse. The rationale for dispensing is there and seems perfectly reasonable.

But if you wanted to put together a kit of maintenance medications that just don’t make sense in the setting which I was presented I would decline it.

 

[panicatthepharmacy]

IMO, as others have said, you're going to need to get an account with a pharmaceutical wholesaler/distributor to purchase these.

 

[VA Hopeful Dr]

IMO, as others have said, you're going to need to get an account with a pharmaceutical wholesaler/distributor to purchase these.

That's the easiest thing to do. I have an account here for just this reason: Anda Online

 

[TeddyBoomBoom]

Thanks everyone for being helpful. I’ll continue to look into it.

That's the easiest thing to do. I have an account here for just this reason: Anda Online

I’ll specifically check this out. 👍

 

[Rockinacoustic]

Honestly, treating anaphylaxis, OD, SOB are things that I’m super comfortable treating daily, albeit in the ED with backup. As an ER doc that does this for a living, if a neighbor/camping partner/wtvr ran up to me for help for a third party in extremis, it’d be great to have that person not die. Not every place has ems available in 15 min. It’s not like I have some kind of weird motive - I’d just like to be able to help with the most basic of meds.

Not arguing this isn't in your wheelhouse to treat, but now I'm curious: do you have EM colleagues who do this? I've worked in the ED for 7 years and either our docs don't do this or aren't openly advertising it.

 

[JustFillIt]

Not arguing this isn't in your wheelhouse to treat, but now I'm curious: do you have EM colleagues who do this? I've worked in the ED for 7 years and either our docs don't do this or aren't openly advertising it.

I have a very close friend that is an ER doc. My son had a nasty fall and needed several stitches. I brought him over to his house and he gave him stitches on the kitchen counter. Then sent in an Rx for antibiotic.

He offered to give me a free vasectomy, on his kitchen counter, next - but I declined. He has a surgical kit at home.

I don’t think it’s unusual - and I certainly do not think we should discourage a physician to only be a physician during working hours.

Liability is on them, and in the cases discussed above are astronomically low.. I support it 100%.

 

[thumbz]

Had bees for a while out in the middle of nowhere, closest EMS would be 45 mins (maybe 30 by helicopter). I wrote myself for an epi pen to keep on the property in case visitors/contractors had an unknown or unprepared anaphylactic reaction. I never once considered that this may be not kosher, so this thread has been very eye opening.

 

[JustFillIt]

Had bees for a while out in the middle of nowhere, closest EMS would be 45 mins (maybe 30 by helicopter). I wrote myself for an epi pen to keep on the property in case visitors/contractors had an unknown or unprepared anaphylactic reaction. I never once considered that this may be not kosher, so this thread has been very eye opening.

What you describe is not an issue. I honestly don’t care what state I’m in and what the laws say I would dispense you (a physician) an epipen for just about any reason that makes sense.

Although this won’t happen - If I EVER found myself in front of a board of pharmacy under investigation - I would strictly demand that they explain to me how exactly I am putting the public at risk by doing so. If I got cited, I would move to a different state

 

[TeddyBoomBoom]

Not arguing this isn't in your wheelhouse to treat, but now I'm curious: do you have EM colleagues who do this? I've worked in the ED for 7 years and either our docs don't do this or aren't openly advertising it.

I’m not talking about being some EM vigilante trying to get in before EMS. I’m talking about super rare critical emergencies like:
- a bunch of ppl on a road trip with no cell coverage and somebody forgot their inhaler
- anaphylactic rxn while a group is camping far from EMS response
- somebody OD’s during a hurricane party and lines are down or roads impassible
- etc

Again, I’m not trying to skirt the law or pre-empt EMS, or practice inappropriately. I’d just like to have the tools to help someone if the opportunity presented itself and there was no other appropriate option.

 

[lord999]

As you said, “for office use” just isn’t a thing anymore. As far as I can tell that’s the end of your inquiry.

To my knowledge there is no legitimate way for you to just have a cache of drugs to carry around and use as you see fit. Perhaps someone else will know a way that I am not familiar with.

No, FL doesn't require any special matters for a physician carrying around legend meds outside some limits on Scheduled. That is their prerogative.

Op, straightforwardedly, contact one of the wholesalers (AmerisourceBergen, Cardinal, McKesson). They will set you up with an medical office aka "medical practice") account to buy medications from their distribution network. They will send an account rep physically to your office to set that up and confirm bona fides as well as literally give you some storage furniture for it. You are not buying as a distributor (that's a fairly high amount), but purely for the office which is a standard part of most practices. This is not unusual, and the quantities involved should be around $700 or so, not distribution amounts.

Also, those of you who are licensed in FL. You know you can literally just sell legend meds to a physician directly as a pharmacist/pharmacy, no prescription required? You can establish a medical practice account and directly invoice the practice/physician. It's completely legal and above board. It is not illegal at all for direct sales in FL, you just have to record them as direct sales and not prescriptions which is a paperwork matter.

By the way, I'll leave it to you, but you need to be aware of the charting rules for office meds in FL, lest you get investigated for Mafia sub rosa practicing (and FL absolutely is aware of how that works). If you are going to do this for professional enrichment, make sure to chart properly. The distributor is going to ask at times to prevent sub rosa practice.

The relevant part of the statutes is 465.0276:

Chapter 465 Section 0276 - 2018 Florida Statutes - The Florida Senate

www.flsenate.gov

 

[Sabril]

What you describe is not an issue. I honestly don’t care what state I’m in and what the laws say I would dispense you (a physician) an epipen for just about any reason that makes sense.

Remind me of that time when several doctors call in to self-prescribe a "large" bottle of hydroxychloroquine for malaria prophylaxis

 

[JustFillIt]

Remind me of that time when several doctors call in to self-prescribe a "large" bottle of hydroxychloroquine for malaria prophylaxis

Give me a break - that’s a whole other subject. No one on this thread brought up hydroxychloroquine, Donald trump, Joe Biden, the big lie, Cher, or whatever other buzzword out there that would upset the masses fickle delicacies.

I would dispense a physician a reasonable/legal request. I stand by that, especially if it’s in the favor of public health.

 

[Chrish]

Don’t see any issue. But I am not exactly sure how you would enter than in the system ie. full name and DOB? Do you just use physician’s personal info for that purpose?

 

[JustFillIt]

Don’t see any issue. But I am not exactly sure how you would enter than in the system ie. full name and DOB? Do you just use physician’s personal info for that purpose?

In this particular circumstance - I would enter in the physician name/dob and office location as address. Clearly document notes in the profile about the intentions of the drug (for extra security you may document your expectations of the use and have the physician sign it to be retained in pharmacy).

I would take the physician name vs. the “for office use” approach because the physician actually wants to keep the medication for himself, in a kit, in case of emergency.


Charge cash (huge amount)…. Be done..

 

[TeddyBoomBoom]

OP here,

Just wanted to give a final update.

Thanks everybody be for the contributions to the thread. At the end of the day, I really didn’t want to prescribe myself a bunch of meds to ultimately potentially be used emergently for someone else. I’m a physician not a pharmacist, but that didn’t seem kosher. I also appreciate your discussion of “for office use” med rxs.

I ended up going through:

HealthFirst® Official Site

HealthFirst provides healthcare facilities with emergency medical supplies, infection prevention tools, waste management options and more.

www.healthfirst.com

I was able to purchase single-use amounts of epi, dex, narcan, Benadryl, Albuterol via invoice at somewhat reasonable prices.

As I said in the op, these are for emergency use not office distribution so they will probably never be used, but I’m pleased to have a venue to purchase these types of things while staying within the bounds of both the letter and spirit of prescribing laws.

✅

 

[sadface]

Don’t forget to watch the expiration dates 🙂