modifying CIIs in CA

[chicagoboy1984]

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Hi all.

I need some input on what you CA RPh’s would do. If a patient comes in with a CII script (say, methadone 40mg tablets, 1 tablet po qday, #30), and you didn’t have methadone 40mg tabs but had enough 10mg tabs, could you change it to methadone 10mg tabs, 4 tabs po qday, #120 without consulting the MD? Or would you need to consult the MD before dispensing the script as 10mg tabs?

Any input would be appreciated. Thanks.

 

[ravingrabbid]

If I'm not mistaken, the only things you cannot change on a CII are the prescriber's signature and the date. Otherwise, if you do make a change to the med/dose/qty or whatever, you'll need to consult the prescriber first.

From the CA BOP website: Can a pharmacist fill a prescription for a controlled substance if an error is found on the prescription?

The prescriber's signature and the date written are required to be written by the prescriber. Everything else can be written by the prescriber or his or her agent. Therefore, the pharmacist can make changes to any other information on the prescription as long as the pharmacist verifies the change with the prescriber first.

Here's where I looked: http://www.pharmacy.ca.gov/licensing/prescribe_dispense.shtml

 

[BrightLight]

Hi all.

I need some input on what you CA RPh's would do. If a patient comes in with a CII script (say, methadone 40mg tablets, 1 tablet po qday, #30), and you didn't have methadone 40mg tabs but had enough 10mg tabs, could you change it to methadone 10mg tabs, 4 tabs po qday, #120 without consulting the MD? Or would you need to consult the MD before dispensing the script as 10mg tabs?

Any input would be appreciated. Thanks.

yes, no need to call, per Q&A in the most recent Script

 

[g40631]

That is, in my understanding, completely illegal. For multiple reasons.

1. Methadone 40 mg has been restricted for opiate detoxification. Pharmacists cannot dispense methadone 40 mg for opiate detox at the retail level. They can only be dispensed at a certified methadone dispensary. So I'd hand the script back to the patient and inform the prescriber.

2. The DEA, as far as I'm aware, is more concerned about controlled drugs, and in particular CIIs, as individual UNITS, not actual metric quantities. So dispensing 120 methadone 10 mg to equate to the same metric quantity as 30 methadone 40 mg is diversion, in my opinion. However, if anyone can cite legal sources that state otherwise, I would be happy to recant that statement.

The following powerpoint from the DEA is a great source.

http://www.deadiversion.usdoj.gov/m...500&rdepth=0&sufs=2&order=r&cq=&id=4fba46fe4a

Essentially, the core elements of the prescription (patient name, prescriber, drug name, strength, dosage form, and quantity) cannot be modified orally. It appears that the DEA has conflicting rules regarding this, however, nothing in the controlled substance act explicitly allows pharmacists to do this. Remember, the CSA is opposite from other laws in that it specifically tells you what you CAN legally do. Other types of laws tell you what you CANNOT do. So I would say, no, doing what you just said in the above example would be violating the controlled substance act in multiple ways.

In conclusion, I'd offer to either order the drug (as long as it was not methadone 40 mg) or hand the script back to the patient.

 

[g40631]

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[BrightLight]

Jus to clarify, by "Q&A" I meant Questions & Answers.

 

[BrightLight]

Here:

Q. If a physician writes a prescription for Dilaudid 8mg qty 20 : 1 tab po q6h prn severe pain, can we change it to Dilaudid or Hydromorphone 4mg qty 40 : 2 tablets (8mg) po q6h prn severe pain without requesting a revised prescription? We currently have 4mg, not 8mg, in stock. Can we legally change the strength to what we have in stock as well as the quantity so that the dose and total number of doses match with those in the original prescription?

A. The use of Dilaudid/hydromorphone 4mg in place of Dilaudid 8mg is allowed under B&PC 4052.5. If the change does take place, the patient must be advised. Also, if the generic hydromorphone is used, the patient must be advised of this as well (B&PC 4073[e]).

 

[pezdispenser]

1. Methadone 40 mg has been restricted for opiate detoxification. Pharmacists cannot dispense methadone 40 mg for opiate detox at the retail level. They can only be dispensed at a certified methadone dispensary. So I'd hand the script back to the patient and inform the prescriber.

^^ This. Not sure if the OP was using methadone 40 mg as an actual example. Anyway, for other C-IIs, the DEA has let the states determine what can be changed.

 

[chicagoboy1984]

Here:

Q. If a physician writes a prescription for Dilaudid 8mg qty 20 : 1 tab po q6h prn severe pain, can we change it to Dilaudid or Hydromorphone 4mg qty 40 : 2 tablets (8mg) po q6h prn severe pain without requesting a revised prescription? We currently have 4mg, not 8mg, in stock. Can we legally change the strength to what we have in stock as well as the quantity so that the dose and total number of doses match with those in the original prescription?

A. The use of Dilaudid/hydromorphone 4mg in place of Dilaudid 8mg is allowed under B&PC 4052.5. If the change does take place, the patient must be advised. Also, if the generic hydromorphone is used, the patient must be advised of this as well (B&PC 4073[e]).

Thanks so much. I appreciate your help 🙂

 

[xiphoid2010]

1. Methadone 40 mg has been restricted for opiate detoxification. Pharmacists cannot dispense methadone 40 mg for opiate detox at the retail level. They can only be dispensed at a certified methadone dispensary. So I'd hand the script back to the patient and inform the prescriber.

Hospitals are exempt. But I stopped ours since methadone is so cheap and detox use is not common (keep in mind that detox licensed MD needs to register for an X number and we have only one).