What medication are Internal Medicine Doctors NOT allowed to prescibe?

[Gpan]

I was having a discussion with my Pharmacist friends the other day. They said IM Docs cannot prescribe other specialties' types of medications. Is that true?

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[rokshana]

I was having a discussion with my Pharmacist friends the other day. They said IM Docs cannot prescribe other specialties' types of medications. Is that true?

if you have a full DEA license, you can prescribe anything no matter the specialty...whether its appropriate is another story...many times you may have to write a script for a pt that is discharging from the hospital to bridge them until they can see their regular doctor to get the rest of their medicine.

 

[Danbo1957]

A medical board may restrict any doctor from prescribing a certain class of drug. Pharmacists do review every Rx; by law:

http://www.tsbp.state.tx.us/consumer/broch4.htm

 

[rokshana]

A medical board may restrict any doctor from prescribing a certain class of drug. Pharmacists do review every Rx; by law:

http://www.tsbp.state.tx.us/consumer/broch4.htm

ummm...where in your link does it state that?

 

[tco]

The only thing I can think of that they wouldn't be able to prescribe would be Suboxone. It takes a special license to be able to write a script for it, at least in WV.

 

[Raryn]

I was having a discussion with my Pharmacist friends the other day. They said IM Docs cannot prescribe other specialties' types of medications. Is that true?

With only a few exceptions, any licensed physician can prescribe any outpatient medication. Inpatient-wise, hospitals can have their own policies.

(The few exceptions are generally things like Suboxone, where they're extremely tightly regulated and you need special permission to prescribe them, and then only for a limited number of patients. The only others I can think of learning about at some point are some extremely powerful psychiatric medications with horrendous side effect profiles, which you also need special permission to use.)

 

[intmed3]

If your friend is a pharmacist at a hospital that may be true. At the hospital I practice there are chemo must be ordered by oncology, certain antiarrythmics must be ordered by cardiology, etc. I would imagine there are similar things that only surgical subspecialites can order. However, this is hospital policy, not law.

 

[DIce3]

to add to the list: class 1 agents: example, cocaine for ENT

 

[Praziquantel86]

I'm not aware of any state that restricts prescribing of certain classes of medications to certain physician specialties as a blanket law. There are a few medications that require additional education to prescribe per federal law, such as Suboxone, but any physician can take those courses. There are also drugs that have restricted access programs which you have to register for, like isotretinoin or thalidomide, but again, any specialty can enroll. Non-physician healthcare providers, like podiatrists and optometrists, can and do have their prescribing rights limited to their specialty, with definitions varying from state-to-state.

Also, as others have mentioned, hospitals may restrict prescribing by specialty. Many hospitals won't allow non-oncologists to write for chemotherapy, or non-ID to write for certain antibiotics. Those are per policy and vary based on the institution, not law.

 

[Apollyon]

to add to the list: class 1 agents: example, cocaine for ENT

Just this morning, used 11.4% cocaine in the ED. Right on the bottle, schedule C2.

Schedule C1 have no medical use - like heroin and Quaaludes. Medicinal cocaine is not one of them.

 

[Danbo1957]

I'm not aware of any state that restricts prescribing of certain classes of medications to certain physician specialties as a blanket law.

I said any doctor may be restricted from prescribing a certain class of drugs, not a restriction by specialty. But as stated above, IM doctors... nevermind, it was stated above. Pharmacist Rx review does add a lot to patient care.

 

[Bostonredsox]

Just this morning, used 11.4% cocaine in the ED. Right on the bottle, schedule C2.

Schedule C1 have no medical use - like heroin and Quaaludes. Medicinal cocaine is not one of them.

yeah TAC solution has cocaine in it and is a C2 if I remember correct, use it in the ED all the time.

And HOSPITAL Pharmacy committes can restrict drugs. IE at my shop, you cannot write for Tigecil or Merrem without an ID doc approving it, part of the new antibiotic stewardship. My old shop only Nephro and cards could write for Natrecor, if thats even still made. However as far as I am aware the only STATE regulation for prescriptions would be Suboxine and you just have to take a class for that to get the special DEA and then I think its 30 patients year one and 100 per year after that you can prescribe it too.

 

[DIce3]

I had been mistaken for years about cocaine as being class 1 versus 2. Cocaine is class 2 (I guess this shows I have not been doing much ENT these days). I copied this off another site:

Types: Class I (Schedule I Controlled Substance)

High abuse potential
No accepted medical use
Examples
Heroin
Marijuana

Types: Class II (Schedule II Controlled Substance)

High abuse potential
Severe dependence liability
Examples
Morphine
Codeine
Hydromorphone
Cocaine
Amphetamines (e.g. Adderall)
Methylphenidate (e.g. Ritalin, Concerta)
Secobarbital
Oxycodone (Percocet)

I see that marijuana is class 1. I wonder if in a legal marijuana state, marijuana is downgraded to class 2?

 

[Raryn]

I see that marijuana is class 1. I wonder if in a legal marijuana state, marijuana is downgraded to class 2?

Scheduling is a federal issue. Marijuana remains class 1 almost entirely 2/2 political pressures. (Pretty much every group, including many that are entirely opposed to recreational marijuana, supports rescheduling it to class 2 for research purposes if nothing else. But it aint gonna happen)

 

[nancysinatra]

It may be difficult to prescribe Clozaril.

 

[Bostonredsox]

It may be difficult to prescribe Clozaril.

Are there people outside of the psychiatry world who still prescribe clozapine or thorazine???

 

[sprin001]

methadone by tx center only

 

[gutonc]

methadone by tx center only

Depends on the indication.

Chronic pain - anyone can do it
Heroin addiction - Treatment centers only

 

[gutonc]

Are there people outside of the psychiatry world who still prescribe clozapine or thorazine???

I still give thorazine sometimes on the BMT service.

 

[Bostonredsox]

I still give thorazine sometimes on the BMT service.

AH. I stick with B-52's and if not enough, IM geodon.

 

[gutonc]

AH. I stick with B-52's and if not enough, IM geodon.

Not for sedation. It's my 5th or 6th line anti-emetic. Also works for hiccups but seems like kind of a big gun.

 

[2unhigenyx]

Are there people outside of the psychiatry world who still prescribe clozapine or thorazine???

very common on palliative/hospice services. i gave it out like candies...

 

[rokshana]

methadone by tx center only

Depends on the indication.

Chronic pain - anyone can do it
Heroin addiction - Treatment centers only

nope...inpatient if the methadone dose is verified, i don't have any problem writing for it...

and as a taper for heroin...write for methadone taper with no problem.

 

[gutonc]

nope...inpatient if the methadone dose is verified, i don't have any problem writing for it...

Yup. Although since I stopped working Gen Med I haven't had to deal with this.

and as a taper for heroin...write for methadone taper with no problem.

Taper yes, maintenance, no. At least not in my state.

(The wisdom of methadone maintenance in general is a topic for a different thread.)

 

[michaelrack]

Are there people outside of the psychiatry world who still prescribe clozapine or thorazine???

Clozapine is useful for treating psychosis due to parkinson's disease/lewy body dementia, especially in patients who I have failed seroquel (quetiapine). I speculate that there are a few neurologists out there who prescribe clozaril.

 

[michaelrack]

I'm not aware of any state that restricts prescribing of certain classes of medications to certain physician specialties as a blanket law. There are a few medications that require additional education to prescribe per federal law, such as Suboxone, but any physician can take those courses. There are also drugs that have restricted access programs which you have to register for, like isotretinoin or thalidomide, but again, any specialty can enroll..

Xyrem (basically the date rape drug with added salt) is another restricted access drug.