I'm starting my pgy1 year in July, and out of curiosity, I was wondering what the legalities / ethics is behind prescribing non-controlled substances to oneself. Ie. Flonase, or Claritin. Obviously not any super serious meds, and definitely not Benzos or opioids. Sorry for my ignorance; I know it's probably frowned upon, but prescribing allergy meds for myself seems very benign. I've read some posts here about self-prescribing, but they're circa 2009. I was wondering if laws / consensus has changed since. Thanks!
-
CycleTrack and SDN are teaming up to make medical school admissions more transparent and accessible! Read the announcement to learn how we’re supporting the future of CycleTrack’s free application-tracking tools .
Self-prescribing
Started by sc1988
Get help with your application
Use all the free resources available to you from SDN: articles, guides, expert advising, forums discussions, and school research.
C'mon Man!
Strictly prohibited, this doesn't even pass the common sense test. I'd never, EVER do this. Would you get caught? Probably not but all it takes is a pharmacist to actually read all the information. A resident in a hospital a couple hours away was fired for self-prescribing Vicodin, I know you asked about non-narcotics but the idea is the same.
Most people just ask their friends for prescriptions (I've done Celebrex more recently). You'll have tons of other PGY-1/2/3 to ask. Don't ask your friends for narcotics scripts, obviously.
Also, you know that both Flonase and Claritin are over the counter, right? I buy both for my family all the time...
Meh, I've prescribed myself simple things- refills for medications I've taken for years such as albuterol. Or an antibiotic for a UTI. We don't have time to see a doc in residency for little things like getting refills. I think if you're considering trying a new medication or your ailment is out of your scope, then you really should go see an appropriate doctor, which I've certainly done. When I had persistent fevers and SOB, I went to urgent care, I'm not going to try to treat myself for asthma exacerbation and pneumonia lol.
And it goes without saying, don't prescribe yourself or your family members narcotics or anything close to it. I had a family member ask me for Adderall [emoji19], and I refused.
Personally I don't think I would ever prescribe anything for my family members. I've always encouraged my family to get see their doctor whenever they ask me for medical advice.
Sent from my iPhone using SDN mobile
You definitely can prescribe yourself non-controlled substances, but its really not hard to ask a fellow resident to do it.
No big deal most of the time. Just don't even think about anything controlled. I'd also typically avoid anything psychoactive (SSRIs, antipsychotics, etc) or that would require regular lab monitoring (levothyroxine, etc).
I prescribed myself some abx before. Or allergy nasal spray to one of my coresidents. Simple things.
I prescribed myself some abx before. Or allergy nasal spray to one of my coresidents. Simple things.
Most likely, as a resident, you will have a training license. A training license only allows you to prescribe under supervision. Since no one would be supervising you prescribing for yourself, you're practicing outside your license. This is a very bad idea.
I agree the chances of getting "caught" are low, and even if found it's likely you'd be OK. Asking a co-resident generates the same problem (although if someone has a full license, then not an issue).
I tell all of my residents to just ask a faculty member. Many of us will prescribe minor things for you without a visit.
I agree the chances of getting "caught" are low, and even if found it's likely you'd be OK. Asking a co-resident generates the same problem (although if someone has a full license, then not an issue).
I tell all of my residents to just ask a faculty member. Many of us will prescribe minor things for you without a visit.
So, as an attending, I don't prescribe myself anything, period. And actually, I don't typically prescribe for family members unless it's an extreme circumstance (like a cold, rainy night and my 85 year old mother has a cough and runny nose and my 79 y/o father thinks its serious enough to try to drag her out to a UC or freestanding ER -- went up to their house and did an old fashioned house call using my pre-med son as an MA -- complete with paperchart and called the med in, went and picked it up and delivered it -- told them to f/u with their PCP on Monday). I get no end of grief when people find out that I'm a physician and want me to call in refills -- I had to break my wife of the habit of "Oh, here, let me ask JPB and see what he thinks". Don't get in the habit -- just learn to ask a colleague or your faculty when you're in residency.
And as a side bar issue -- be wary of offering casual medical opinions -- we were told during a residency retreat block regarding malpractice about a case ---
ER attending was working with an ER nurse he had pulled a few shifts with -- she casually mentioned her husband had been having some heartburn for a day or 2 that wasn't relieved with tums. ER Doc, without thinking, casually stated, "Ah, just give him some Zantac, he'll be fine". Husband later died of MI. RN sued and won -- jury ruled the ER Doc had rendered a professional medical opinion and was therefore responsible. Bad juju.
I now treat that stuff like I'm a lawyer --- lawyers typically don't offer legal opinions unless you're willing to pay for it. I usually give them what they can get on WebMD -- anything else, come see me in clinic. Everyone wants free medical advice and treatment -- few want to pay for it.
And as a side bar issue -- be wary of offering casual medical opinions -- we were told during a residency retreat block regarding malpractice about a case ---
ER attending was working with an ER nurse he had pulled a few shifts with -- she casually mentioned her husband had been having some heartburn for a day or 2 that wasn't relieved with tums. ER Doc, without thinking, casually stated, "Ah, just give him some Zantac, he'll be fine". Husband later died of MI. RN sued and won -- jury ruled the ER Doc had rendered a professional medical opinion and was therefore responsible. Bad juju.
I now treat that stuff like I'm a lawyer --- lawyers typically don't offer legal opinions unless you're willing to pay for it. I usually give them what they can get on WebMD -- anything else, come see me in clinic. Everyone wants free medical advice and treatment -- few want to pay for it.
Practically speaking, I personally don't see a problem self-prescribing non-controlled basic things for a chronic, well-controlled issue (e.g. chronic eczema for which you need a topical steroid cream). You could go into the ethics of things, but come on -- if you have a well-controlled chronic issue like what I described above, are you doing anyone a favor by using their time (in addition to yours) to get the prescription? What if you don't feel comfortable asking your attending/co-residents for a prescription, for whatever reason? Maybe you'd prefer that your colleagues not know that you're dealing with some chronic medical issue? Not only that, if you're asking your friend/co-resident to write you a prescription without a formal doctor-patient relationship, you're kind of skirting some of the underlying ethical issues without really addressing them...kind of hypocritical to call one thing wrong but a loophole to the same goal okay.
Several factors/caveats play into this:
1) You're a physician...not a layperson who isn't aware of side effects or when a medical condition is becoming too much to handle on your own.
2) It's not some controlled substance for which there may even be a semblance of abuse.
3) You're not prescribing for someone else, nor are you prescribing some medication that you've never taken before with known common side effects.
I feel like this is one of those areas where bureaucratic nonsense or ethical considerations taken to the extreme sometimes ignore the practical aspects of such an action.
Some of you bring up points like Vicodin prescriptions or prescribing a "benign" medication for someone else that went wrong, but...that is clearly not the scenario that the OP brought up here.
Several factors/caveats play into this:
1) You're a physician...not a layperson who isn't aware of side effects or when a medical condition is becoming too much to handle on your own.
2) It's not some controlled substance for which there may even be a semblance of abuse.
3) You're not prescribing for someone else, nor are you prescribing some medication that you've never taken before with known common side effects.
I feel like this is one of those areas where bureaucratic nonsense or ethical considerations taken to the extreme sometimes ignore the practical aspects of such an action.
Some of you bring up points like Vicodin prescriptions or prescribing a "benign" medication for someone else that went wrong, but...that is clearly not the scenario that the OP brought up here.
Last edited:
I don't get how this isn't everyone's answer. The question of self-prescribing as a doctor out of residency is one thing, but as a PGY-1 it's quite another thing.
If you need something, just ask your attendings to prescribe it for you. More than a few attendings have written scripts for albuterol or whatever. I personally have had two scripts written--the first for Zofran when I felt awful one day intern year. The second was chloroquine for malaria prophylaxis, because evidently, our insurance doesn't cover the travel clinic. I also had my PD give me an epipen when I was having an allergic reaction to something, and she made the nurse in the ED override Benadryl from the Pixis, but that wasn't technically a prescription. Everything else, I've gone to my regular doctor for.
Light at end of tunnel
Dangerous to be right when government is wrong
Removed
Lifetime Donor
5+ Year Member
I'm not aware of any resident who self precribed for valid reasons and got in trouble fot it. If anyone happens to know, please share details.
Otherwise, all the above remains anecdotal. Still makes sense to err on the side of caution.
Otherwise, all the above remains anecdotal. Still makes sense to err on the side of caution.
Are you aware of any PGY-1 who self-prescribed not under the supervision of an atrending?
I'm aware of a number that did that. Even before they had a license, you can often call a prescription in just with an NPI (which I find insane given you can just Google those). Never heard of anyone getting in trouble (though it was all abx, steroid creams, allergy meds).
Light at end of tunnel
Dangerous to be right when government is wrong
Removed
Lifetime Donor
5+ Year Member
Yes, and its almost encouraged. Everything within reason, though.
Because I am trying to put your posts in context, can you clarify where you are in the MD/PhD process? Preclinical years, PhD years, clinical years?
Wasn't it Mark Twain who said, " A physician who treats himself has a fool for a patient? "
Never done this for myself but have had others call in prescriptions for me (for zofran).
This is 100% accurate. Don't prescribe yourself anything, its just not worth it. We had a resident fired but he decided it would be a great idea for a fellow resident to prescribe him a controlled substances.
Med Ed are strict don't screw with them. Keep your head down and make it thru residency.
I don't think anyone is advocating this.
D
deleted109597
A doctor and a lawyer were talking at a party. Their conversation was constantly interrupted by people describing their ailments and asking the doctor for free medical advice.
After an hour of this, the exasperated doctor asked the lawyer, "What do you do to stop people from asking you for legal advice when you're out of the office?"
"I give it to them," replied the lawyer, "and then I send them a bill."
The doctor was shocked, but agreed to give it a try. The next day, still feeling slightly guilty, the doctor prepared the bills.
When he went to place them in his mailbox, he found a bill from the lawyer.
I self prescribe myself stuff sometimes although I have an unrestricted license. My good buddy self prescribes and titrated Zoloft and Wellbutrin for all 3 years of residency. He saw a psychiatrist in med school was put on that combo although he says he's been on and off of it for years before and now he just ups his dose of he feels down lol. I don't advocate for that at all, esp psychoactive meds and mental health.
Sent from my iPhone using SDN mobile
Sent from my iPhone using SDN mobile
I don't self prescribe all that often, mainly because I don't really take anything other than the occaisional nsaid. I've prescribed for my SO plenty of times (refills of chronic meds when she ran out, as well as the occaisional antibiotic or other low complexity treatment). Honestly, when you consider that my copay to see a doctor is $50, I'd be stupid not to. I wouldn't prescribe anything controlled, anything that requires monitoring (other than a refill at the same dose), or anything outside your field of expertise (ie, I, as an EM doc, would not Rx someone a statin).
At intern orientation, I tell all my new interns that they will make mistakes and learn from them. All new interns are worried they will make a mistake that will kill someone. But that's not where the danger lies, there are several mistakes that are just not worth making:
1. Lying / documenting something you didn't do. Once you lose our trust, it's hard to gain it back.
2. Self prescribing anything, or prescribing to a friend or family member. Not just narcotics. Anything. Just ask us, we'll get it for you without a visit (if reasonable).
3. Not bringing to attention anyone in the institution who you fear is impaired. I'd rather 10 false alarms to catch and help one. This includes yourself.
4. Not reporting a needlestick. We need to know, immediately.
1. Lying / documenting something you didn't do. Once you lose our trust, it's hard to gain it back.
2. Self prescribing anything, or prescribing to a friend or family member. Not just narcotics. Anything. Just ask us, we'll get it for you without a visit (if reasonable).
3. Not bringing to attention anyone in the institution who you fear is impaired. I'd rather 10 false alarms to catch and help one. This includes yourself.
4. Not reporting a needlestick. We need to know, immediately.
Light at end of tunnel
Dangerous to be right when government is wrong
Removed
Lifetime Donor
5+ Year Member
Can your residents progressively earn more independence in prescribing for family and friends or is that sort of a line in the sand until they graduate?
Your residents are lucky to have an understanding and approachable PD, btw.
The issue is more that under a training license you technically can't prescribe anything unless it's under the supervision of a licensed doctor. It isn't legal to prescribe to family and friends under a training license. With an unrestricted license you could though some feel it's a violation of ethics because you shouldn't prescribe to anyone you don't have a doctor-patient relationship with. In theory if you went and created a paper chart with complete H&P, exam, etc then that would fulfill your professional duty. But doesn't necessarily take care of the ethics discussion. And even in that setting narcotics are a no no.
Last edited:
... officially no place will ever allow "independence" to do this. How would you ever defend this to the ACGME if they found out? People do it all the time, but at their own risk.
Bingo. Here's what my state has to say about it - but keep in mind its for fully licensed physicians only
LLR
This is state dependent. In my state for example, the official policy of the medical board is that you cannot self prescribe narcotics, however, prescribing them to friends or family is technically completely legal. The board does go out of the way to say that they don't recommend prescribing to a spouse or family member that lives with you due to the potential for abuse, but they don't prohibit it either.
Sorry I should have been more clear. I meant ethically. Most states prohibit it and yes there are some that do not. But essentially every medical organization strongly discourages it. I think the vast majority would agree that prescribing controlled substances to family and friends is a recipe for disaster. I think you and I are saying essentially the same thing.
It is still an absolutely terrible idea to prescribe controlled substances to anyone where there's any potential for conflict. I mean, a course of bactrim for some folliculitis? Sure. A course of norco for their sprained ankle? Hell no. Tell them to take some ibuprofen and go see someone else.
And it depends what drug and who for. A handful of Ativan for my mother on her flight to Thailand, not likely to cause a big problem. 2 Norco for said sprained ankle if my wife had an ortho appointment literally the next day? Might get me a talking to, but likely nothing past that assuming it wasn't a pattern. Ongoing script to for my sister's ritalin or 90 norco for your dad's bad back - that's a no-no.
That said, its always a risk and one rarely worth taking - especially with Urgent Cares now open til 10pm most places.
I did not know that resident can self-prescribed... Will a pharmacist really dispense? If you are getting the drug from a drug rep, I can see that. But I am not sure an outside pharmacist (someone who works for Walgreens , CVS, Kroger etc....) would dispense...
You'd be surprised.
A trainee with a permanent license can prescribe just the same as any other physician. A trainee with a temporary license or even no license at all (just an NPI) can still call in scrips and many pharmacists will dispense it if is something reasonable (and of course, never a controlled substance). It's at their discretion at that point.
What?
I got my NPI# before having a training license. Also, an NPI# is something that anyone can google... I don't think calling for prescription is a safe practice unless a DEA# is used because licenses and NPI#s are public domain.
IF you were to ask someone to do it (or more importantly, do it for someone else), please make a rudimentary "medical chart" in a word document on home computer (as I have for all family members, except wife, who is on her own 😉)
Yes. It's super insecure. Theoretically, all you need to call in anything non-scheduled is a name, office phone #, and maybe a license number or NPI, all of which are easily googleable. If you have a DEA #, you can even call in Schedule III-IV controlled substances (which include testosterone, codeine, tramadol, ambien, and most benzos). That said, get caught doing that without a legitimate reason and welcome to prison.
Probably the biggest barrier to fraud is the fact that most people don't know how to talk like a doctor, so if they tried to call something in they'd ask for a pound of morphine or something ridiculous.
Coresident of mine got a call from the pharmacist saying a patient was using her name and a stolen prescription pad to prescribe “four pounds of mophine.”
The pharmacist did not dispense.
The pharmacist did not dispense.
From what I've seen, not only will pharmacist fill the Rx, the pharmacists at the local grocery store are incredibly nice to you once they find out you are a physician, will bump you to the top of the line, fill it while you wait, etc. They will remember you by name next time you come in and be very nice to you -- so be nice back and say hi! MDs come in with scripts for things like ABx all the time. It is not unusual for them.
This is not my experience.
I had a diabetic pet and a pharmacist refused to fill a needle syringe script even though it’s not a controlled substance nor do you even need a script here.
Of course this is Walgreens in Arizona where pharmacists can refuse to dispense drugs they find objectionable.
That's bizarre. I don't know that much about injectable drugs, but somehow I don't think an insulin syringe (maximum 1cc) would be the typical one of choice for that.
And yes, they're available over the counter. Even insulin (human insulin only, N/R) is available without a prescription at Walmart and CVS.
You're not a vet, that's why. I've written stuff for myself before without any issue, but it would 100% get refused if I tried to write the exact same drug for my dog.
That's assuming you tried to write it for your dog in the first place.
I can understand for actual medications but again a script is not required for needles and syringes.
I went to a different Walgreens and the pharmacist had absolutely no problem filling it and even chatting with me pleasantly about the tribulations of having a diabetic pet.
The first guy was just being a jerk
The two are not mutually exclusive. I actually had a good friend who was a pharmacist who apologized about not being able to fill anything for my dog at one point.
At least around here, insulin needles/syringes are the preferred method of shooting heroin/fent. Maybe that's why they didn't want to give them out? Or maybe they just suck. Or both.
Huh. Who'd have thunk it. I looked it up and it's true!
I always assumed 1cc syringes were too small, but I guess I don't actually know what a dose of heroin looks like.
You can buy them on Amazon though, so it still doesn't make any sense at all to restrict the supply. Plus, I'm all for the heroin users getting as many clean needles as they want, better than spreading HIV/hep C/etc (but I do know people who aren't in favor of that for whatever reason).
Yes I definitely figured he thought that’s what it was for but I don’t know why you would want to restrict me, even if I was a heroin user, from getting clean needles.
