Skills- Writing Prescriptions

Controlled Substances

• A controlled substance is a drug or substance whose manufacture, distribution, and possession are regulated by the government.
• A scheduled controlled substance is a drug or substance classified into one of five schedules (I-V) based on its potential for abuse, currently accepted medical use, and safety under medical supervision.

Scheduling of Controlled Substances

• Schedule I: high potential for abuse, no currently accepted medical use, and lack of accepted safety for use under medical supervision.
• Schedule II: high potential for abuse, currently accepted medical use, but with severe restrictions, and abuse may lead to severe psychological or physical dependence.
• Schedule III: moderate to low potential for abuse, currently accepted medical use, and abuse may lead to moderate or low physical dependence and high psychological dependence.
• Schedule IV: low potential for abuse, currently accepted medical use, and abuse may lead to limited physical dependence and psychological dependence.
• Schedule V: low potential for abuse, currently accepted medical use, and abuse may lead to limited physical dependence and psychological dependence.

Examples of Scheduled Controlled Substances

• Products containing less than 90mg of codeine per dosing unit (e.g., Tylenol with codeine) are classified as Schedule III.
• Substances with low potential for abuse relative to substances like alprazolam are classified as Schedule IV.

Prescribing and Dispensing Controlled Substances

• Controlled substances can be sent electronically (with 2-step authentication) if they meet DEA requirements.
• Written Rx signed by the provider must be provided for Schedule II substances (in NC, cannot be faxed or verbal).
• Schedule III-V substances can be given verbally, in writing, or by fax.
• Refills are not allowed for Schedule II substances.
• When sending Rx for controlled substances, the Rx must include the Supervising Physician's name and telephone number (in addition to the prescriber's information).
• The Rx must be documented in the patient's record, including the date, patient's name, medication, dosage, and quantity.

PA and NP Prescribing

• PA's can prescribe Schedule II-V substances in the state of NC.
• PA cannot prescribe controlled substances to patients in a hospital or nursing home setting.
• When sending Rx for controlled substances, PA/NP in pain clinics are required to have supervising physician consultation.

NC STOP Act

• The NC STOP Act does not require e-scripts for Class II and III substances.
• The NC STOP Act includes Mandatory use of NC controlled Substances database.
• To prescribe controlled substances Class II and III, PA/NP in pain clinics are required to have supervising physician consultation.

Prescription Writing

• When prescribing less than 1 milligram, write in micrograms (mcg).
• Spell out the number dispensed to avoid changes to the prescription.
• Refills can be no more than 5 times within 6 months.
• The sig (directions) must include the dosage, frequency, and duration.
• "Sig" is another word for "directions".
• It is generally recommended to avoid abbreviations (especially with medication names) when writing prescriptions.
• Avoid writing "as directed" or "PRN" on a prescription.
• Pregnancy category should be included on the prescription.
• It is OK to use leading zeros (0.5), but not trailing zeros (5.0).