Changes on the Horizon for Controlled Substance Prescribing

By:  Erin B. Williams

In May 2012, Governor Haslam signed the Tennessee Prescription Drug Safety Act of 2012 ("Act"). While the Act will significantly impact many aspects of the Controlled Substances Monitoring Database ("CSMD"), some of the most important changes for physicians include (1) the expansion of who may access the CSMD to healthcare practitioner extenders; and (2) the new requirement that physicians check the CSMD prior to prescribing certain controlled substances and then yearly during a course of treatment.

Currently, only a licensed health care practitioner with a DEA number is permitted access to the CSMD, and only for the limited purpose of querying a current patient or a bona fide prospective patient.¹ Effective January 1, 2013, members of a physician's office staff may access the CSMD with certain restrictions. Specifically, the Act now allows "healthcare practitioner extenders" to access the CSMD. A "healthcare practitioner extender" is defined as any registered or licensed healthcare professional and up to two unlicensed persons designated by the prescriber. Each extender must have separate, identifiable authentication for access to the CSMD; however, the licensed prescriber will remain responsible for all acts taken by the designated extenders.

The Act also requires that all prescribers with DEA numbers who prescribe controlled substances for more than 15 calendar days per year register in the CSMD by January 1, 2013.² Then, effective April 1, 2013, all prescribers or designated "healthcare practitioner extenders" must check the CSMD before prescribing any opioid, benzodiazepine, or other designated Schedule II-V controlled substance at the beginning of a new episode of treatment, and then at least annually during an episode of treatment if a controlled substance is prescribed.³ Prescribers are not required to check the CSMD if: (1) the patient is currently receiving hospice care; (2) the medical specialty is exempt; (3) the prescription was for a surgical procedure performed in a licensed facility with no refill; or (4) only a 7-day supply is prescribed with no refill.

Because physicians will generally be required to check the CSMD prior to prescribing a controlled substance, it is best practice to document that a check was performed. However, keep in mind that the information submitted to or obtained from the CMSD is confidential and may not be shared with anyone other than: (1) the patient under certain conditions; (2) other dispensers or prescribers who are or will be involved in the patient's treatment; or (3) any law enforcement personnel to whom a report is made under the doctor shopping laws.⁴ Unauthorized disclosure of information from the CSMD may subject the prescriber to civil and criminal penalties.⁵ Therefore, a print-out of the CSMD query for the patient or other information from the CSMD should not be made part of the patient's medical records. Instead, a notation should be made in the patient's chart that the prescriber checked the CSMD prior to prescribing a controlled substance and that a prescription (or refill) either was or was not issued.

Disclaimer: The information contained herein is strictly informational; it is not to be construed as legal advice.