self prescribing???

[deleted87716]

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Here's an interesting article on the subject: Should You Treat Yourself, Family, or Friends? . As a general rule, I think this is a slippery slope, and hard to stop once you start. I tend to advise against it.

 

[sdn1977]

Are you kidding? I see the laughing smiley but I can't tell if it's because what you say is untrue or just because it's a bit weird. Can people really get medications "for animal use" without scrips?.

Actually, it is another state by state thing. I'm not sure about vets, but my husband, a dentist, used to order his office medications thru his dental wholesaler. It was better all the way around for us to not have me dispense to him, etc....Dental (and probably medical) wholesalers have the same laws that my drug wholesaler does. They don't have nearly the drugs available, but all state laws still apply. However, only a dentist can order from a dental wholesaler, etc...neither a vet nor a physician could and vice-versa.He no longer has medications (other than anesthetics) in his office (too much risk of burglary) so I'm not sure if the selection is still like it used to be (Tyl #3, pcn, amox, clindamycin, etc...)

 

[3dtp]

Personally, I like to order my antibiotics, anxiolytics and antidepressants from vetmd.com, I keep them on standby in the medicine cabinet for me, my dogs, my cats, my birds, or my husband as needed. I find it useful and cheap this way. Plus, its so easy to prescribe, it says "one tablet for every 10 lbs" none of those annoying dose calculations to work out 😛

I learned this one a long time ago when I was working as a ranch hand. Sheep got caught in the barbed wire, ripped up a leg pretty bad and I was sent into town to get a bunch of sheep antibiotics in the form of Kefzol, USP (vet version). Also got the tetanus antitoxin at the same time. Much cheaper than Rx cephalosporins and other 'cillins. All OTC.

I do not advocate do it yourself stuff, but working with Farmer John, and his vets, I learned a lot about what you can get from the local Farm/Fleet store for horses, piggies and lambies, which also work on your dogs and cats. If you don't mind injecting your kitty and puppies, you can get most of the infant pet vaccines very cheaply, but your cat will hate you when you give her the first vaccine. Maybe better to let the cat hate the vet! Didn't know you could get pet narcs and benzos too,...

 

[rugtrousers]

Here's an interesting article on the subject: Should You Treat Yourself, Family, or Friends? . As a general rule, I think this is a slippery slope, and hard to stop once you start. I tend to advise against it.

Thanks for the link - it's a great article, short and easy to read. It brought up several interesting cases that made me think hard about what I would do if asked to prescribe something in a non-clinical setting. And it mentioned the age-old question of whether to hydrate with IV fluids at home.

How much does a 1-L bag of 1/2NS or NS cost, anyway?

 

[sdn1977]

Thanks for the link - it's a great article, short and easy to read. It brought up several interesting cases that made me think hard about what I would do if asked to prescribe something in a non-clinical setting. And it mentioned the age-old question of whether to hydrate with IV fluids at home.

How much does a 1-L bag of 1/2NS or NS cost, anyway?

Well...that liter bag obtained from a hospital pharmacy or central supply costs the hospital about 30 cents. But...if I have to order it in a retail pharmacy, I have to order a case of 12 - that cost about $25-30, not much at all. But...the real cost of IV fluids is the tubing - to hospitals & pharmacies. The tubing is about $25/set - not much...but you only want 1 & I, as a pharmacy, have to buy a case of 50 without any possibility of using the rest. Then there is whatever cannula you use for venous access. Hospitals get deals because the tubing purchased is tied to the contracts for pumps. If the hospital commits to a certain # of pumps/yr, then they don't pay anything for the pump (which cannot be billed to a patient), but the price is tied to the tubing (which can be billed to the patient). So...the IV fluid itself in inconsequential. As long as you have ready access to the supplies (hospitals, chemo centers, athletic centers, urgent care centers, surgicenters, etc...) you can give a liter of fluid without any problem, otherwise...its really a pain - IMO.

 

[blue2000]

We were told at the start of residency that if we prescribed to family or friends, or "anyone that you are not staffing through an attending" that we would be fired. It's framed as a medico-legal issue, as we have provisional licenses, but I've already found it helpful in situations that I was uncomfortable with. I tend to be a person who believes that prescriptions should be written solely within the confines of the formal physician-patient relationship, so the black and white-ness of my residency's policies align with my personal feelings on the subject. Just something to think about when you're writing prescriptions...what is your program's position?

 

[pillowhead]

Speaking of veterinary medicines---I'd be very hesitant to give prescription meds to your pet unless you KNOW (i.e. your spouse is a vet or your vet told you) it's okay to do so. 1mg per 10lbs or whatever may be true in a human, but dog and cat livers and kidneys metabolize certain substances very differently.

I just found out a couple of weeks ago that human pharmacies will fill veterinary prescriptions. My dog needed clomipramine (a tricyclic--he was abused and neglected for most of his life and we adopted him as an adult and he has some SEVERE separation anxiety issues) and the vet told me to go to CVS since they didn't carry it. The bottle just says, MYLASTNAME, CANINE on it. I think the whole situation of picking up an anti-depressant from a human pharmacy for a dog is just kind of funny (although sad and frustrating, too) because there's all these black box warnings on it about monitoring for suicide. I don't think my dog is planning his own death any time soon.

 

[Mirror Form]

OK, so psych meds are not OK but what about birth control pills/patches/rings? Those are long-term but aren't too harmful.

I'd still be very careful!

For example, what if your friend was already pregnant? You could cause complications and find yourself liable. Or, what if the person you prescribed them for was a smoker, or had a clotting disorder, and got a dvt? Even though she might have gotten the dvt anyway, you'd still be liable and wouldn't be able to defend yourself in court.

 

[3dtp]

We were told at the start of residency that if we prescribed to family or friends, or "anyone that you are not staffing through an attending" that we would be fired. It's framed as a medico-legal issue, as we have provisional licenses, but I've already found it helpful in situations that I was uncomfortable with. I tend to be a person who believes that prescriptions should be written solely within the confines of the formal physician-patient relationship, so the black and white-ness of my residency's policies align with my personal feelings on the subject. Just something to think about when you're writing prescriptions...what is your program's position?

For those us who have unrestricted licenses, this is still a med-mal issue. Your residency insurance does not cover you for stuff you do on your own. Be sure to check your own carrier if you do moonlighting to see what it does, and more importantly does not cover.

 

[hzma]

Guys, I did a search on google and couldn't find out, how do i find out if prescribing to immediate family members is ok in OH?

thanks!

 

[sdn1977]

Guys, I did a search on google and couldn't find out, how do i find out if prescribing to immediate family members is ok in OH?

thanks!

Go into your local pharmacy (or hospital pharmacy if you are a resident & if they fill outpt Rxs - lots don't anymore) and ask the pharmacist if you can prescribe XXX for your wife/husband/child/mother ... etc. For the most part it will depend upon what the drug is. See some of the previous posts for more potential problems...but, we usually try to work it out if we can.

 

[sdn1977]

I should have added...you can probably find the info online since most states have their State Board of Pharmacy laws online now. You'd have to go to the .gov website (here in CA its www.pharmacy.ca.gov) - but I have to warn you....at least in CA, the lawbook for pharmacy is several hundred pages - it would be daunting for most folks to wade through looking for one obscure law. You might find questions about controlled drug prescribing from the federal site: www.dea.usdoj.gov, but if state laws are more restrictive than federal laws, the state law prevails. Personally, I think asking a pharmacist is easier, but I hope this helps.

 

[BatmanMD]

What about phenergan w/codeine. Its listed as class V, so the "good" end of the controlled substances, but it works well when you get sick. Does that raise red flags, when you have to chug like 500mL to get anything good out of it? 😕

 

[Blade28]

If it contains a narcotic, I wouldn't prescribe it for yourself.

 

[toofache32]

If it contains a narcotic, I wouldn't prescribe it for yourself.

This is probaby a moot point because you'll have a helluva time finding a pharmacist to fill it.

 

[BatmanMD]

I did get it filled. Oops. I'll just ask my program director and at least give him a heads up. I got it filled ~ 2-3 weeks ago. No one has asked me about it. I even used my own Rx pad.

 

[8744]

I believe self-prescribing is not allowed in North Carolina, at least with a training (Resident) license.

I know for sure that prescribing for familiy members, friends, or anyone with whom you do not have a formal doctor-patient relationship within the scope of your practice is verboten and strictly so.

In the case of a resident you are only allowed to prescribe for patients who you see in the course of your training duties.

Don't think it's not tempting to write the kids for the anti-biotics that cost a forty dollar urgent care visit and a a couple of wasted hours of the weekend.

On the other hand it's not worth getting fired over.

 

[Annette]

What about phenergan w/codeine. Its listed as class V, so the "good" end of the controlled substances, but it works well when you get sick. Does that raise red flags, when you have to chug like 500mL to get anything good out of it? 😕

I don't know if things have changed, but in the 80's, in Illinois, you could purchase a limited amount of codeine without a prescription.

 

[corpsmanUP]

VIP care is bad care, no matter how you cut it up.

 

[toofache32]

I know for sure that prescribing for familiy members, friends, or anyone with whom you do not have a formal doctor-patient relationship within the scope of your practice is verboten and strictly so....

Why the hassle? I have a state DEA number (outside of my training program for moonlighting purposes) and my friends/family know not to ask me for favors. Occasionally someone will ask for something, but once I tell them that they are asking me to commit malpractice and go to prison they seem to understand.

This is a non-issue for anyone with a backbone. Unless you still let your mommy boss you around.

 

[sdn1977]

As for C-V medications - mostly cough syrups (Tussionex being the big exception), there used to be some states who had this as a pharmacist only behind the counter medication, which did not require an rx (fyi - this is how some want to put Plan B, but different thread...). That was never the case in CA, but I did read about 20 yrs ago. I'm guessing things will be tightening up because of the ease which stuff gets reported to the DEA and the extent of abuse (both by patients & prescribers).

FYI - if you ever want to obtain controlled drug records for a patient & you have a DEA #, you can obtain one by contacting the DEA. Why? - well, if you suspect a pt of Dr shopping for rx's & want to know if you're the only one writing for Vicodin. As pharmacists, we occasionally access the records (not often - mostly the Medical Boards do) when they.. suspect a Dr of providing rxs for money. I'm too lazy to look it up now, but I think it is the main DEA website - deadiversion.gov. Remember - the details of each CII-III you write (& later IV & V) will be immediately transmitted to the DEA in real time as soon as I fill it.

 

[Diane L. Evans]

As a general rule I do not write Rx for myself or my family. I think it is a good practice. I will wirite Rx for nurses or PA's in our clinics provided I can see their charts and examine them. And yes with females if a Rx is class C/D I will get a UPT. (ie in some situations I like the 3 day bid Cipro for uncomplic UTI )

 

[3dtp]

Personally, I like to order my antibiotics, anxiolytics and antidepressants from vetmd.com, I keep them on standby in the medicine cabinet for me, my dogs, my cats, my birds, or my husband as needed. I find it useful and cheap this way. Plus, its so easy to prescribe, it says "one tablet for every 10 lbs" none of those annoying dose calculations to work out 😛

Hmmm....dogs, cats, birdsn husband???

Take it he occasionally lives with the dogs and cats?

 

[mustangsally65]

So do these same rules apply for samples? I know most offices probably won't have controlled substances as samples, but when I go in for my physical every year my doc gives me a big bag of samples. Are samples controlled?

 

[sdn1977]

So do these same rules apply for samples? I know most offices probably won't have controlled substances as samples, but when I go in for my physical every year my doc gives me a big bag of samples. Are samples controlled?

Not sure exactly what rules you are referring to, but samples & how they are distributed & accounted for fall into 2 categories: controlled drugs & non-controlled drugs. The noncontrolled drugs are easiest - these are the Avelox, Protonix, Celebrex, Avapro, etc.....and can be distributed at will by the physician without any consequence. He/she can take them home & use them himself/herself or to a family member - no one watches, no one cares. The controlled stuff is more difficult. In this situation, the prescriber (or office person) actually signs a form documenting what, how many, date, DEA, etc...was given by the salesperson to the prescriber. For noncontrolled drugs, they are signed for also, but the form goes no farther than the drug company. For controlled drugs - the info also goes to the DEA - just the same as when I order 1000 MS 10mg carpujects for my hospital. The prescriber is "supposed" to document who, how many & when the samples were given out in the pts chart & in an "easily retrievable" manner. Does this happen - probably not. But, the reality is very few controlled drug samples are given out because of DEA restrictions - usually when a new one comes out - ie Vicoprofen. You won't get a Tyl #3 sample probably. Hope that answers your question.

 

[mustangsally65]

Yes, thanks! I just wondered if there were any limitations on how samples were distributed.

 

[deleted87716]

The noncontrolled drugs are easiest - these are the Avelox, Protonix, Celebrex, Avapro, etc.....and can be distributed at will by the physician without any consequence. He/she can take them home & use them himself/herself or to a family member - no one watches, no one cares.

Not entirely true. While there's no way to track what happens to samples once a drug rep drops them off at a doctor's office (unless the doctor uses some sort of internal tracking system), doctors may definitely be held accountable for any adverse outcomes resulting from the samples they give out. If doctors distribute samples to family and friends (or anyone with whom they have no formal doctor-patient relationship), they do so at a certain amount of risk (hopefully negligible, but present, nonetheless). Like it or not, this is considered treatment. The same goes for medical advice.

 

[sdn1977]

The noncontrolled drugs are easiest - these are the Avelox, Protonix, Celebrex, Avapro, etc.....and can be distributed at will by the physician without any consequence. He/she can take them home & use them himself/herself or to a family member - no one watches, no one cares./QUOTE]

Not entirely true. While there's no way to track what happens to samples once a drug rep drops them off at a doctor's office (unless the doctor uses some sort of internal tracking system), doctors may definitely be held accountable for any adverse outcomes resulting from the samples they give out. If doctors distribute samples to family and friends (or anyone with whom they have no formal doctor-patient relationship), they do so at a certain amount of risk (hopefully negligible, but present, nonetheless).

oh yes - sorry....I was thinking of the legal sense as related to dispensing restrictions when she asked about "rules". Yes....any distribution of medication, whether it is by a prescriber or pharmacist, a sample, hospital order or rx, is held to the same medico-legal liabilities that go with that. Sorry for the misinformation - yes - you have all the same liabilities, but no one is going to prevent you from giving them out (ie - as in a pharmacist saying no...you can't prescribe Celebrex for your father-in-law because you are a gynecologist).

 

[njbmd]

Hi there,
I never self-prescribe and I never write any prescriptions for anyone that lives in my household. I will phone in two days worth of anti-hypertensive medication to cover a family member over a weekend (if they run out) but I will not write any scripts for antibiotics.

I have seen a 40-year-old nurse die with a necrotic pseudomonal cavitating pneumonia because her "intern friends" kept prescribing antibiotics for her "sinus infections." I will not write scripts for co-workers unless they are specifically under my care.

njbmd 🙂