Controlled substances are medications with a potential for abuse or misuse. Common controlled substances that doctors prescribe include:
- Narcotic pain medications (Demerol, Norco, Tyco, etcetera)
- Stimulant medications (Adderall, Ritalin, Concerta, etcetera)
- Benzodiazepines and similar sedating and anti-anxiety medications (Xanax, Valium, Ativan, Ambien, etcetera)
- Testosterone and some other hormone treatments
Recently California passed a law that went into effect on January 1 of 2017 that requires all physicians in the state to check a database of controlled substance prescriptions from physicians throughout the state before writing any prescription or refill for a controlled substance for one of their patients.
This requirement is in addition to the other databases that we need to check including formulary databases, drug interaction databases, your clinical record, and the electronic prescribing software itself.
If there are questions that come up as a result of checking this database (for example questions about other controlled substances that may have been prescribed) then these questions have to be discussed with the patient before the prescription can be written.
Our experience so far shows that this adds about 10 to 20 minutes to the process of writing a controlled substance refill or new prescription and, that, in a significant percentage of cases, a conversation needs to take place because of information from the databases that requires clarification before the prescription can be written.
For this reason, we will no longer be able to write refills or new prescriptions for controlled substances for our patients outside of a scheduled appointment.
Appointments don’t have to be in person, they can take place by phone or via a tele-psychiatry appointment, but they will have to be scheduled, which means there will be delays in sending in prescriptions for refills or new prescriptions.
The very best solution to this problem will be for all of our patients to make a greater effort to check for needed refills before each appointment.
This is why all of our patients receive reminders for upcoming appointments with links to a short pre-visit questionnaire that is designed to make sure that all issues get dealt with in that session.
The best time for me to write a new prescription or refill an old prescription will clearly be when we see each other for our regular appointment.
Otherwise refills may be delayed by as much as four or five days while we try to find a time to get together during a busy week.
And of course you will have to pay for the additional appointment.