Pediatrician prescribing oxycodone as a maintenance pain control rx? Out of scope?

[doublehh03]

So I encountered an rx from a pediatrician for an adult for oxy 30mg month supply. I refused to fill because it was out of scope since any high dose maintenance pain control rx should be by a pain management specialist. Was this the correct way? Thank you

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[PharmDminus]

So I encountered an rx from a pediatrician for an adult for oxy 30mg month supply. I refused to fill because it was out of scope since any high dose maintenance pain control rx should be by a pain management specialist. Was this the correct way? Thank you

pediatrician is an MD. they can prescribe for adults with full authority. would need more context but i might have filled it

 

[owlegrad]

It’s not “out of scope”. It might be outside the usual course of practice or otherwise be inappropriate though. Frankly I probably wouldn’t fill it unless I had a reason to.

 

[doublehh03]

pediatrician is an MD. they can prescribe for adults with full authority. would need more context but i might have filled it

It’s a maintenance pain control prescription, esp oxy 30mg, not an acute. Shouldn’t that be prescribed by a pain specialist?

 

[PharmDminus]

It’s a maintenance pain control prescription, esp oxy 30mg, not an acute. Shouldn’t that be prescribed by a pain specialist?

ideally, but what if this rx is for one month to prevent some sort of gap in care. the pediatrician could be a friend or relative of the pt and helping them out until they can get into see a new pain doc. what if its a cancer pt who has been on oxys for years and has had to find a new provider for some reason. i could see a pediatrician writing a one month supply. better than pt going into withdrawal

 

[doublehh03]

ideally, but what if this rx is for one month to prevent some sort of gap in care. the pediatrician could be a friend or relative of the pt and helping them out until they can get into see a new pain doc. what if its a cancer pt who has been on oxys for years and has had to find a new provider for some reason. i could see a pediatrician writing a one month supply. better than pt going into withdrawal

It’s not. It’s a refill from the same pediatrician. That’s the issue. A brand new rx to cover the gap I would fill like you said. This is a refill from the previous month which we did fill but it’s still the same pediatrician prescribing it. That was my issue.

 

[PharmDminus]

It’s not. It’s a refill from the same pediatrician. That’s the issue. A brand new rx to cover the gap I would fill like you said. This is a refill from the previous month which we did fill but it’s still the same pediatrician prescribing it. That was my issue.

yah i dont like that either. would probably want to speak to prescriber directly for an explanation before filling

 

[doublehh03]

yah i dont like that either. would probably want to speak to prescriber directly for an explanation before filling

Well we did last month. But according to patient it’s a maintenance med so I was uncomfortable filling it long term under a pediatrician. I did speak to the doctor (since it’s still early by like 5 days) that’s it’s best to go to a pain management doctor.

Because to me, a pediatrician prescribing a high strength narcotic long term to an adult is not in the usual course of practice, esp with a oxycodone strength of 30mg.

Just want to get others opinions because patient was very mad although doctor was understanding.

 

[PharmDminus]

Well we did last month. But according to patient it’s a maintenance med so I was uncomfortable filling it long term under a pediatrician. I did speak to the doctor (since it’s still early by like 5 days) that’s it’s best to go to a pain management doctor.

Because to me, a pediatrician prescribing a high strength narcotic long term to an adult is not in the usual course of practice, esp with a oxycodone strength of 30mg.

Just want to get others opinions because patient was very mad although doctor was understanding.

i think u handled this correctly

 

[owlegrad]

the pediatrician could be a friend or relative of the pt

Ok well that would make me even less likely to fill the script, 😂

 

[PharmDminus]

Ok well that would make me even less likely to fill the script, 😂

to each their own. policing narcotics is highly subjective and rph judgements will vary widely

 

[owlegrad]

to each their own. policing narcotics is highly subjective and rph judgements will vary widely

This is true. I know at CVS it was specifically against policy to fill a controlled substance if the prescriber was a family member of the patient. I thought it was against some DEA policy or statement but I couldn’t find that so perhaps I am wrong.

Also the AMA says it is unethical: AMA Code of Medical Ethics’ Opinion on Physicians Treating Family Members

Still I support the idea that professionals should use their own judgements when deciding if something should be filled or not and I am sure there are scenarios where I would fill a controlled substance for a prescriber’s family member.

 

[Chrish]

Shouldn’t that be prescribed by a pain specialist?

Shouldn’t be prescribed by anyone barring malignancy..

 

[Chrish]

Anyone being on Oxycodone 30 for non-malignant/ non-palliative pain is a failure of health system..

 

[Dred Pirate]

I would want more info, but obviously very questionable for a variety of reasons.
1. what is the dose?
2. Same do prescribing for a long term? Some IM docs could be managing an adults chronic pain based on advice form a previous pain specialist. But like @Chrish says- (although I don't agree completely with what they say) this is not the best chronic pain control med.

 

[WVUPharm2007]

Come up with an over the top lie. "We lost our DEA license and can't dispense narcs. Sorry."

 

[Chrish]

1 mg of plain Oxy gets sold for $1 on the street; so each 30 mg pill will go for $30..

If I get a prescription for Oxy 30, I call dr office to get the diagnosis and deny it immediately unless it’s for palliative care, regardless of the type of doctor who wrote it. I tell patient I don’t feel comfortable with the script and they need to go elsewhere. No further explanation is given.

 

[Dred Pirate]

1 mg of plain Oxy gets sold for $1 on the street; so each 30 mg pill will go for $30..

If I get a prescription for Oxy 30, I call dr office to get the diagnosis and deny it immediately unless it’s for palliative care, regardless of the type of doctor who wrote it. I tell patient I don’t feel comfortable with the script and they need to go elsewhere. No further explanation is given.

prices haven't gone up? that is what it was 15 years ago

 

[GrandTheftAutumn]

This is true. I know at CVS it was specifically against policy to fill a controlled substance if the prescriber was a family member of the patient. I thought it was against some DEA policy or statement but I couldn’t find that so perhaps I am wrong.

Also the AMA says it is unethical: AMA Code of Medical Ethics’ Opinion on Physicians Treating Family Members

Still I support the idea that professionals should use their own judgements when deciding if something should be filled or not and I am sure there are scenarios where I would fill a controlled substance for a prescriber’s family member.

For an owl, you're pretty reasonable.
Now, only if you could mod that reasonably.

 

[GrandTheftAutumn]

me and the pharmacists I worked with often tell them we don't have it in stock.

Can't you get terminated for that?

 

[VA Hopeful Dr]

This is true. I know at CVS it was specifically against policy to fill a controlled substance if the prescriber was a family member of the patient. I thought it was against some DEA policy or statement but I couldn’t find that so perhaps I am wrong.

Also the AMA says it is unethical: AMA Code of Medical Ethics’ Opinion on Physicians Treating Family Members

Still I support the idea that professionals should use their own judgements when deciding if something should be filled or not and I am sure there are scenarios where I would fill a controlled substance for a prescriber’s family member.

Most state medical boards have rules against prescribing controlled meds to family members outside of emergency situations.

 

[wholeheartedly]

how old is the adult?

 

[wysdoc]

Most state medical boards have rules against prescribing controlled meds to family members outside of emergency situations.

It's a common cause of Board reprimand and/or sanction in Texas (prescribing controlled substances to family and friends)

 

[Dr Wario]

And we are asking this question after CVS/Wag/WMT got fined 13.5 billion dollars for propagating the opiate crisis? It really amazes me how we as pharmacists have locked ourselves into our own small section of practice but MD, NP etc can do whatever they feel like?

That script would be refused so fast it would give the drug dealer whiplash.

 

[Sakonji]

I got a medical resident threatened me because I refused to take his verbal prescription for metformin for his mom. He was like, "I'm a doctor" and I said "Yeah, but you are not your mom's doctor, and be careful with that hospital's NPI of yours"

Invalid prescriber-patient relationship is the issue here, not that they are MD, DO or whatever even for a non CS

 

[RxPreceptor]

I got a medical resident threatened me because I refused to take his verbal prescription for metformin for his mom. He was like, "I'm a doctor" and I said "Yeah, but you are not your mom's doctor, and be careful with that hospital's NPI of yours"

Invalid prescriber-patient relationship is the issue here, not that they are MD, DO or whatever even for a non CS

I’m quite tempted to force these type of Rxs be sent as e-scripts. They seem to think more about the morality/appropriateness of the patient-provider relationship if there is an actual paper trail their employer can back track

I mean, like why are these always done as verbal orders? Lazy, half *** prescribing (often just doing a favor and getting info from RPh) and nepotism