Drug Diversion and Abuse: "Do Not Fill Until?"

John Burke, commander ofthe Warren County, Ohio,drug task force and retiredcommander of the CincinnatiPolice PharmaceuticalDiversion Squad, is a 39-yearveteran of law enforcement.Cmdr Burke also is the currentpresident of theNational Association of Drug DiversionInvestigators. For information, he can bereached by e-mail at linkEmail('burke','choice.net'), viathe Web site www.rxdiversion.com, or byphone at 513-336-0070.

Effective December 19, 2007, thefinal Drug Enforcement Administration(DEA) ruling in theFederal Register was that prescriberscould write prescriptions for CII controlledsubstances for up to a 90-daysupply. This ruling was a reversal of aNovember 2004 ruling that indicatedthat writing multiple CII prescriptionswas equivalent to refilling that prescription.

This new ruling once again allowsprescribers to write 3 prescriptions fora CII analgesic—1 of the prescriptionsis available for immediate filling, andthe other 2 cannot be filled until 30 and60 days after the date written on theprescription. All prescriptions must bedated on the same day that they arewritten.

This practice was lawful prior toNovember 2004, and I touted it tothousands of physicians as a methodto effectively reduce the amount ofcontrolled substances in a residence.The diversion of a patient's prescriptionmedication within his or her ownhome occurs more often than mostpeople realize. This may be by theft bya friend, neighbor, a person doing workin the home, or even the caregiver.

Prior to November 2004, and nowonce again reinstituted in December2007, this ruling allows prescribers togive a 90-day supply to a patient experiencingchronic pain without having tosubject that patient to coming in to seethe prescriber unless necessary. Ofcourse, the side benefit is that themaximum supply of a CII controlledsubstance in these homes could thenbe a 30-day supply, instead of a 90-daysupply.

The decision that was published inNovember 2004 was heavily criticizedby law enforcement, attorney generals,health professionals, pain patients, atleast 1 board of pharmacy, and yourstruly. Three years later, prescribersonce again have the ability to write inthe manner described above. Prescribersmust be sure they do not violateany state laws or regulations whenfollowing this course of conduct.Pharmacists have a responsibility notto fill these prescriptions earlier thanthe fill date indicated on the prescriptionby the prescriber.

This new ruling is a win?win situationfor prescribers who want to moreeffectively treat their chronic painpatients and patients who will not beunduly inconvenienced in coming tothe prescriber's office every 30 days.Law enforcement also will indirectlybenefit, as reducing the diversion ofthese medications within the homecan be an effective tool.

Countless cases over the years haveinvolved people that were in thepatient's home legitimately. In some ofthese cases, the patient is very wellaware that the medications are beingstolen, but does not want to report it toauthorities for fear of alienating theperson, especially if he or she is thecaregiver, and possibly the only link tothe outside world and their care. Withsome pills being worth up to $100 perpiece, the lure of profit by a person ina chronic-pain patient's residenceshould not be a total surprise. In themost egregious cases I have seen, thecaregiver is taking the drugs and leavingthe patient with a reduced supplyor none at all, incurring incredible painon the patient with no regard orremorse.

My hope is that this ruling will nowput this issue to rest and will not rearits ugly head a few years from now. Inthis case, I applaud the DEA for havingthe fortitude to reverse itself by usingcommon sense and doing what is rightfor all concerned.