Writing scripts for DEA scheduled meds

[tacoman2493]

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I'm an intern in medicine. We had clinic on Friday, and I had a new patient (switched over from one of the outgoing senior residents) who had been on Ambien for years. Well I wrote out all her scripts for refills, not realizing that Ambien requires a DEA number.

Late tonight I noticed that I have a voice mail message from the pharmacy stating that they need my DEA number.

I have some kind of temporary DEA number that they give to residents, but I think its only good for in-hospital ordering of pain meds, not outpatient stuff.

WTF should I do? Call my attending and ask for their DEA number? In clinic what usually happens is that if they need a narcotic the attending fills teh script out. Should I ask the attending to call it in?

My next clinic slot is not until next month. We do have an acute care clinic thats resident-run though that I can send her to. Should I send her to the acute care clinic on Monday?

Ambien doesnt come in an OTC form does it? Should I just tell her to use OTC benadryl?

Or should I call the pt tomorrow and say "sorry you'll have to use OTC meds for sleep aids until your next clinic appt in 1 month"??

This brings up a larger point. DEA has 5 schedules, and each schedule has about 40 meds on the list. Do you guys have that entire list memorized? I cant remember all the drugs which require DEA numbers

Do any of you have real DEA numbers that can be used in outpatient pharmacies? How can I get a real one so I can avoid this hassle in the future?

OK so what classes of meds require DEA so I can remember them for next time. Narcotics, sedatives, benzos. What else? What about TCAs or some of hte weird depression drugs? What about gabapentin/pregabalin or high dose NSAIDS like ketorolac?

 

[KidDr]

I'm an intern in medicine. We had clinic on Friday, and I had a new patient (switched over from one of the outgoing senior residents) who had been on Ambien for years. Well I wrote out all her scripts for refills, not realizing that Ambien requires a DEA number.

Late tonight I noticed that I have a voice mail message from the pharmacy stating that they need my DEA number.

I have some kind of temporary DEA number that they give to residents, but I think its only good for in-hospital ordering of pain meds, not outpatient stuff.

WTF should I do? Call my attending and ask for their DEA number? In clinic what usually happens is that if they need a narcotic the attending fills teh script out. Should I ask the attending to call it in?

My next clinic slot is not until next month. We do have an acute care clinic thats resident-run though that I can send her to. Should I send her to the acute care clinic on Monday?

Ambien doesnt come in an OTC form does it? Should I just tell her to use OTC benadryl?

Or should I call the pt tomorrow and say "sorry you'll have to use OTC meds for sleep aids until your next clinic appt in 1 month"??

This brings up a larger point. DEA has 5 schedules, and each schedule has about 40 meds on the list. Do you guys have that entire list memorized? I cant remember all the drugs which require DEA numbers

Do any of you have real DEA numbers that can be used in outpatient pharmacies? How can I get a real one so I can avoid this hassle in the future?

OK so what classes of meds require DEA so I can remember them for next time. Narcotics, sedatives, benzos. What else? What about TCAs or some of hte weird depression drugs? What about gabapentin/pregabalin or high dose NSAIDS like ketorolac?

To answer your 1st question, I'd have your attending call in his/her DEA#. This is the easiest thing to do and the least hassle for the patient. Ambien isn't OTC and if she's used to taking it regularly, she's probably not going to be cool with taking Benadryl for a month (or having to make another clinic visit).

Epocrates will tell you which schedule each med is. So will UptoDate (and probably many other databases). You'll get used to which meds are controlled and which aren't over time. If you're in doubt, just check before you prescribe it.

I think you're stuck with the institutional DEA until you get your license and can apply for a real DEA, but someone correct me if I'm wrong about this.

 

[Samoa]

The institutional DEA is valid for any prescription written on the institution's script paper, even at an outside pharmacy. So you can write that in whenever you write a prescription for a controlled substance.

I got my own DEA about three or four months into internship, so I don't think you need an independent license.

 

[Faebinder]

Institutional DEA also worked for me for scheduled drugs, just like Samoa said. I was in Florida back then.

 

[IndyXRT]

I radiation oncology, we write for narcotics on a daily basis. The institutional DEA always worked at outside pharmacies. I was under the impression that you needed a state licence and CSR before obtaining DEA (those are the steps I went through).

 

[Winged Scapula]

The institutional DEA is valid for any prescription written on the institution's script paper, even at an outside pharmacy. So you can write that in whenever you write a prescription for a controlled substance.

I got my own DEA about three or four months into internship, so I don't think you need an independent license.

Do you have a training license or a full and unrestricted license? Did you get a fee-exempt registration or a state registration? Because I still believe that a FEDERAL DEA registration requires an unrestricted state license to get your own DEA number. Some residencies require that residents get their own DEA but its usually a fee exempt one, to be used with the program address and not for use outside that location. This is not the same as a Federal DEA with your own practice location.

 

[Samoa]

I have a training license, and it's a federal fee exempt DEA. I'm not aware that individual states have the authority to issue DEA numbers. And it certainly works for any situation in which I would use it (i.e. for patients I see as a resident).

I could use the institutional DEA of whatever hospital I was at, and so could the OP (which was my main point). That would certainly be legitimate, but I find it easier to remember just the one number, and it IS unique to me, so it doesn't seem misleading to call it "mine," if that's your objection.

 

[angel80]

Like everyone has mentioned, you can definately write for DEA scheduled meds using an institutional licence. You can even call in some scheduled drugs (I believe it's III and IV) and give your DEA number over the phone. If your clinic patients are the typical patients seen in a resident clinic, be prepared to be writing a LOT of scripts for DEA scheduled medications.

 

[Hernandez]

your institution DEA # will work fine, just don't let the pharmacy give you any crap about the numbers not being correct or it having 3 too many digits. I hate my DEA number, they just switched over to the new letters and I've gotten several calls telling me that my DEA number is incorrect because it doesn't start with a B.

ETA: also Ambien is a schedule IV medication and does not require a DEA #, they'll try to push you to give it for their own uses, but I give them crap and offer them my NPI number and remind them that the DEA has strongly advised against the usage of the DEA for anything other than controlled substance prescriptions. Few things annoy me more than having a pharmacy ask for my DEA # for a script of HCTZ.

 

[Winged Scapula]

I have a training license, and it's a federal fee exempt DEA. I'm not aware that individual states have the authority to issue DEA numbers. And it certainly works for any situation in which I would use it (i.e. for patients I see as a resident).

I could use the institutional DEA of whatever hospital I was at, and so could the OP (which was my main point). That would certainly be legitimate, but I find it easier to remember just the one number, and it IS unique to me, so it doesn't seem misleading to call it "mine," if that's your objection.

I have no objection to you calling it *your* number, using it for patients you see or using the institutional DEA. My objections are purely of the definition variety.

Its just that a training license, fee exempt issued DEA registration is *different* than a federally issued DEA which is permanently assigned and requires a full and unrestricted medical license. Yours cannot be used outside of the context of your residency training; the latter can be. This is discussed on their web site as is the concept of state issued DEA and CDRs.

 

[dragonfly99]

The answer is just use the institutional DEA number of your hospital where you are training whenever you write such a Rx for a controlled substance when you are working in "resident clinic". If you don't know what your institution's DEA number is, find out from the GME office, and write it down somewhere where you can find it and won't lose it!

If you want to moonlight outside of your hospital at some point in your training, then you will need to get your own DEA number and get your state medical license as well. In other words, you shouldn't be out moonlighting at some other hospital and writing scripts for controlled substances using the training DEA number assigned to your residency program's hospital.

 

[Apollyon]

ETA: also Ambien is a schedule IV medication and does not require a DEA #

Yes it does. If a med is federally scheduled, there has to be the DEA number on the Rx.

 

[Hernandez]

Yes it does. If a med is federally scheduled, there has to be the DEA number on the Rx.

I stand corrected, I had misread 21 CFR 1306.21 and failed to read 21 CFR 1306.05.

 

[Sleepygator]

Scheduled drugs are controlled - and require DEA by law

There are five classes...

CI - not able to be prescribed by us - used in research. Examples include LSD, heroin, etc.

CII - not refillable and can not be called in (rare exceptions). Examples include oxycontin, MSO4, Ritalin, Adderall

CIII, CIV, and CV - all able to be called in and refillable five times in six months.

Your institutional dea is good for all controlled substances (CII-CV)

I would not stop Ambien cold turkey due to rebound insomnia. Your patient will not be happy with you. If going to d/c the ambien, taper it off.

 

[Apollyon]

Scheduled drugs are controlled - and require DEA by law

There are five classes...

CI - not able to be prescribed by us - used in research. Examples include LSD, heroin, etc.

Well, actually, it's "no medical use"; research is possible, but highly unlikely to be approved. Other schedule I meds include marijuana (really) and methaqualone (Quaalude).

And, believe it or not, cocaine is schedule II. I've used it in the ED for nosebleeds. However, ENT will tell you that LET is as effective as TAC (Lidocaine, Epinephrine, Tetracaine, and Tetracaine, Adrenaline, and Cocaine).

 

[Apollyon]

http://www.usdoj.gov/dea/pubs/scheduling.html

The whole schedule.

 

[Sleepygator]

There used to be (or maybe still is) cocaine in some eye drops.