Transcript Prescribing in Washington

Drug Distribution in Washington
Richard D. Morrison, Pharmacist
Chief Investigator
Washington State Board of Pharmacy
Objectives
Describe who may prescribe drugs in WA
Describe drug classifications
Describe drug regulation process
Discuss Board of Pharmacy inspection process
Discuss the importance of outdated drug
disposal
Prescribing Authority
Must be authorized under State Law
Governed by:
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Legend Drug Act
Food Drug and Cosmetic Act
Uniform Controlled Substances Act
Profession’s Practice Act
Rules adopted under above laws
Drug Classifications
Over the Counter (OTC)
Prescription Drugs (Legend drugs)
– Caution Federal law prohibits dispensing except on the
prescription of a physician
– Prescription only
Controlled Substances
– Classified in five Schedules according to potential for abuse
– Schedules I, II, III, IV, IV, V
Controlled Substances Schedules
I Heroin, marihuana, LSD, illegal substances
II Morphine, oxycodone (Percodan, Percocet, OxyContin),
codeine, cocaine, meperidine (Demerol), Ritalin,
amphetamines, secobarbital, pentobarbital
III Codeine combinations (Tylenol w/ codeine),
hydrocodone combinations (Vicodin, Lortabs), Marinol
IV Phenobarbital, benzodiazepines (Librium, Valium),
propoxyphene (Darvon), Talwin
V Codeine cough syrups, antidiarrheals
Who Regulates Drugs
FDA
– Initial approval
– Manufacture/distribution
DEA
– Controlled Substances
– Mfr/dist/storage/disposal
States
– Board of Pharmacy
– Boards - Professionals
Prescribing Authority
Profession
Physician (MD)
Physician (DO)
Dentist (DMD/DDS)
ARNP
Restriction
None
None
Dental practice only
Legend & Schedule V;
Schedule II-IV if joint
practice agreements with
MD/DO
Prescribing Authority
Profession
CRNA
Physician Assistant
Physician Assistant
Certified (PA-C)
Restriction
Legend & Schedule II-V
for anesthesia per order
and per facility protocols
As approved by the
Medical Commission
As above
Prescribing Authority
Profession
Optometrist (OD)
Naturopath (ND)
Veterinarian (DVM)
Restriction
Topical eye Rx only for
diagnosis or treatment
(DX or TX on Rx). NO
controlled substances
Limited list of drugs NO
controlled substances
Animal treatment only
Prescribing Authority
Profession
Pharmacist (RPh)
Podiatric Physician
(DPM)
Restriction
Initiate or modify Rx
therapy under protocol
with authorized prescriber
Foot treatment only
General Limitations on Prescribing
 No self-prescribing of controlled substances
 Okay, but not advisable to prescribe for family
members
 Medications must be for therapeutic purpose
 There must be valid doctor-patient relationship
 Medications must be within scope of practice
Drug Administration Authority
Profession
Licensed Midwife
Restriction
Administer medications prescribed by a physician
and may use certain other drugs on own (e.g.,
postpartum oxytocin, vitamin K, Rho immune
globulin, local anesthetics, lactated ringers solution,
heparin locks, Magnesium Sulfate per protocol, and
epinephrine for allergic reactions)
Drug Administration Authority
Profession
RN
LPN
Respiratory Care
Physical Therapist
Dental Hygienist
EMT
School employee
Restriction
Prescribed drugs
Prescribed drugs
Prescribed respiratory drugs
Prescribed topical drugs
Local anesthetics/topical fluoride
Prescribed drugs/Epinephrine
Per Rx order, school policy
Prescribing Limitations
Members of the following professions may not
prescribe, administer, or dispense drugs:
Acupuncturist
Chiropractor
Dispensing Optician
Ocularist
Massage Practitioner
Pharmacy Technician
Counselor
Dietitian/Nutritionist
Lay Midwife
Occupational Therapist
Psychologist
How many people have
prescribing authority?
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MD
DO
DDS
DPM
DVM
ARNP
ND
PA
OD
18,879
688
5,237
263
2,113
2,000
466
1,422
1,134
Where are drugs used/stored?
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Pharmacies (1200)
Drug Wholesalers (80)
Hospitals (110)
Outpatient Surgery Centers (50)
Practitioner Offices/Clinics (10,000)
Nursing Homes (400)
Adult Family Homes/Boarding Homes (500)
What is the scope of the drug
disposal issue?
Thousands of sites
Thousands of people
Lack of knowledge
about proper disposal
Lack of information
Board of Pharmacy - Inspections
Inspection of pharmacies, drug wholesalers,
drug manufacturers, outpatient surgery centers,
researchers, humane societies, etc.
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About every 18 months
Appropriate professional practices
Proper records
Proper storage
Proper control of Controlled Substances
Outdated Drugs
Board of Pharmacy - Investigations
Investigation Process
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Investigate drug law violations by any licensee
Pharmacy – dispensing without prescription
Theft of controlled substances
Diversion for personal use
Other health professionals
Diversion of drugs for sale or personal use
Forgeries, theft, substitution, records fraud, etc.
Importance of proper & prompt
disposal of outdated drugs
Outdates are set aside to deal with later
No one pays much attention to them
They are subject to theft and abuse
The registrant is still responsible
It takes longer to investigate losses
Summary
Described who may prescribe drugs in WA
Described drug classifications
Described drug regulation process
Discussed Board of Pharmacy inspection and
investigation process
 Discussed the importance of disposal of
outdated drugs
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