Hydrocodone probably will be CII

[rcdavis]

http://www.npr.org/blogs/health/2013/01/25/170255897/to-fight-addiction-fda-advisers-endorse-limits-on-vicodin-and-similar-painkiller

 

Crap.

 

Big problem for me in SC where my DEA. Is III-V

 

Not prob for my C2-5 DEA in NC, however, or is it?

 

THe language seems to be ambiguous ... Does the statement that PAs and NPs would not ge able to prescribe reflect he reporter's ( mistaken) view that MLPs cannot routinely rx schedule 2s... A la my restriction in sc...

Or, will there be language specifically prohibiting MLPs from prescribing hydrocodone, even if they do have schedule authority... Eg, will they be saying that, regardless of state law, NP and PA cannot write for schedule 2?hydrocodone..... I cannot imagine they specifically restrict Vicodin but allow oxycodone...

 

SC PA association has made great strides in the last 25 years, but they have very very limited influence with the state board and less with DHEC, which truly doesn't like PAs prescribing ANYTHING. ( unlike NPs, the PAs have to take a special class and pass an exam before getting schedule 5-3 authority.. NP merely have to apply.)

 

Getting these Rxs countersigned will really crimp by style, and make disposition cumbersome.

 

$hit.

[Guest JMPA]

This artical is a disgusting disgrace, the PA profession needs a voice to stand up against this slander. This article essentially states

that PA/NP ("midlevel") are the cause of prescriptive abuse and need to be denied prescribing privileges. What a crock of #$%^.

http://www.npr.org/blogs/health/2013/01/25/170255897/to-fight-addiction-fda-advisers-endorse-limits-on-vicodin-and-similar-painkiller

 

Crap.

 

Big problem for me in SC where my DEA. Is III-V

 

Not prob for my C2-5 DEA in NC, however, or is it?

 

THe language seems to be ambiguous ... Does the statement that PAs and NPs would not ge able to prescribe reflect he reporter's ( mistaken) view that MLPs cannot routinely rx schedule 2s... A la my restriction in sc...

Or, will there be language specifically prohibiting MLPs from prescribing hydrocodone, even if they do have schedule authority... Eg, will they be saying that, regardless of state law, NP and PA cannot write for schedule 2?hydrocodone..... I cannot imagine they specifically restrict Vicodin but allow oxycodone...

 

SC PA association has made great strides in the last 25 years, but they have very very limited influence with the state board and less with DHEC, which truly doesn't like PAs prescribing ANYTHING. ( unlike NPs, the PAs have to take a special class and pass an exam before getting schedule 5-3 authority.. NP merely have to apply.)

 

Getting these Rxs countersigned will really crimp by style, and make disposition cumbersome.

 

$hit.

[PACProvider]

In my opinion, this move to restrict PAs further should serve as a warning about the vulnerability of PAs practicing medicine in perpetuity without a pathway to independence. In my primary care clinic, most schedule II's are written by PAs and NPs because doctors don't manage chronic pain or see acute care visits. Unfortunately, the hospital and doctors put incredible pressure on PA/NPs to prescribe for everyone regardless of the medical evidence. The PA/NP has the greatest risk exposure to patients engaged in abuse and diversion because he/she sees the most patients demanding sched IIs and can't decide freely when to prescribe. The PA/NPs have the knowledge and training to prescribe appropriately. Unfortunately, they have a gun pointed at their head by the doctors and management of the hospital who want happy customers. I believe that we need a pathway to practice independence. When a PA or group of PAs can band together and open their own shop to practice medicine without physician oversight, most of the drug problems with abuse and diversion will cease.

[fireguy]

From my perspective:

 

We do not write schedule II from the ER. Nobody in my ER does. too laborious with the restrictions on triplicates and record keeping (and in Texas I can't write schedule II anyway).

 

 

The poor pt that comes in with a tib/fib, colles, ribs, etc fracture and ortho follow up in three days... ultram or ibuprofen I guess

moderate 2nd degree burns? ultram or ibuprofen I guess...

 

I usually check the Texas database on narcotics prescriptions before writing, and I only write for 5-15 total anyway.

 

Oh well... at least I don't have pain...

 

 

B

[Guest Paula]

A link to the paper that was written is on Clinician 1. There was a paragraph stating that depending on the state laws, PAs, NPs, and optometrists would not be able to prescribe them if they were reclassified. I took that to mean if you work in a state with schedule II-V, that you will still be able to prescribe. I have II-V privileges in the two states that I hold PA licenses and DEA licenses. I have not worked in one state now for 2 years, but reside in it. I have been thinking of not renewing my DEA for that state when it expires, but now I don't know if I will. I would not want to lose a privilege and then by a loophole,not gain it back if I return to practice in my state of residence. It is so expensive to maintain 2 DEA licenses......I wonder how much more we will have to pay if this all goes through. We need to start acting on this now and contacting AAPA or PAFT to start a protest. Plus our state legislators, etc. Believe me, NP associations will be all over this and will present a unified front so they don't lose privileges. We need to do the same.

 

I will try to post the link. It is a long paper.

[Guest Paula]

Cut and pasted from the document Andrea posted. I think what Dr. Throckmorton is saying is that practitioners who do not have CII privileges NOW depending on their state laws, will not be able to prescribe. I take it that those of us who have privileges based on our state laws will still retain them.

Am I interpreting this right?

4.2. Prescribers and Dispensers

Depending on the State, mid-level practitioners such as physician assistants, nurse practitioners and optometrists are not authorized to prescribe Schedule II substances. Therefore, these practitioners may no longer be able to treat pain with hydrocodone combination products if these products were re-scheduled to Schedule II.

With limited exceptions for emergency oral prescriptions, prescriptions for schedule II substances must be handwritten, and pharmacies must have the original prescriptions in-hand before dispensing. Prescriptions for Schedule III-V may be in a written, electronic, oral (so long as it is promptly reduced to writing), or faxed format. Schedule II prescriptions cannot be refilled; however, a practitioner may issue multiple prescriptions authorizing the patient to receive up to a 90 day supply of a schedule II controlled substance provided that certain requirements are met. Schedule III-V prescriptions can be refilled up to five times within a six month period.

[Guest Paula]

Interesting that optometrists are described as mid-level practitioners.

[jen0508]

From my perspective:

 

We do not write schedule II from the ER. Nobody in my ER does. too laborious with the restrictions on triplicates and record keeping (and in Texas I can't write schedule II anyway).

 

 

The poor pt that comes in with a tib/fib, colles, ribs, etc fracture and ortho follow up in three days... ultram or ibuprofen I guess

moderate 2nd degree burns? ultram or ibuprofen I guess...

 

I usually check the Texas database on narcotics prescriptions before writing, and I only write for 5-15 total anyway.

 

Oh well... at least I don't have pain...

 

 

B

 

ultram or motrin for a fracture? yiiikes

 

I write for vicodin/lortab for legit acute pain. If it is a severe injury I will have my SP to write for Percocet. If really severe, dilaudid.

[Guest Paula]

ultram or motrin for a fracture? yiiikes

 

I write for vicodin/lortab for legit acute pain. If it is a severe injury I will have my SP to write for Percocet. If really severe, dilaudid.

 

He's being sarcastic.

[andersenpa]

Let this be a litmus test on the AAPA and their chapters in sched III+ states.

There should be a response out Monday if they mean business, stating why PAs pose no greater risk to engendering abuse than docs.

[physasst]

Interesting that optometrists are described as mid-level practitioners.

 

Optometrists are midlevel providers, at least in the eyes of Ophthalmologists..

[Contrarian]

Let this be a litmus test on the AAPA and their chapters in sched III+ states.

There should be a response out Monday if they mean business, stating why PAs pose no greater risk to engendering abuse than docs.

 

^^^ Money Bet it WON'T happen...

:sad:

[andersenpa]

^^^ Money Bet it WON'T happen...

:sad:

 

 

 

No in a month there will be an AAPA statement about how eager they are to work with physicians on this new initiative

[burnpac]

Everyone should just step back and take a deep breath. The first step of problem solving is to first understand the problem that you are trying to solve.

 

The likelihood of Hydrocodone becoming Schedule II as well as eliminating Schedule II prescribing for PAs and NPs is probably zero to none. All that has happened is that an advisory group to the FDA has voted on a recommendation. The formal federal regulatory process is a long, drawn out sausage factory that requires hearings, comment periods, etc., and I can guarantee you what comes out at the end will look nothing like the recommendations of this group. On the issue of schedule prescribing, we find ourselves in league with nursing, hospital organizations, medical boards, patient advocacy organizations, physician organizations, pain management advocacy organizations, etc., etc., etc. It would be an unmitigated disaster in our facility if the PAs and NPs couldn't write for Schedule IIs, and there is no way to turn back the clock now without serious compromises to patient safety and access to care. It isn't going to happen, because we and a lot of other players won't let it happen.

 

Just who do you think is responsible over the past 20 years for current DEA policy on PAs and other non-physician prescribers? I guarantee you that the AAPA and all of these organizations who have a dog in this fight will continue, like they always have, to monitor federal regulatory change as it affects PAs and their organizational constituencies, and continuously and effectively lobby the DEA to protect our current scope of practice, and remove barriers to physician / PA team practice, as appropriate.

[burnpac]

The problem that we are trying to solve is a serious one, and that is illegal diversion of prescription narcotics. This advisory group, in an apparent knee-jerk reaction, believes that 1) increasing the control of Hydrocodone, and 2) limiting the professions who can legally prescribe it, will "solve" the problem. Bull____.

 

In California, I can be disciplined by the medical board for failing to adequate treat pain. In my defense, the Department of Justice make available to me (in a HIPPA compliant way) printouts of my patients' recent narcotic prescriptions to determine if there is a pattern consistent with illegal diversion of drugs. If I can document this on the record, I can refuse pain medication and not worry about these complaints. This has made California PAs, physicians and others job's much easier towards becoming part of the solution and not part of the problem.

 

physasst and I were talking today, and this would be a excellent area of research to better understand physician, PA and NP prescribing practices in the US, and to look at the roles of providers in illegal diversion. Judging from my printouts, it is my anecdotal experience that PAs and NPs are NOT the problem when it comes illegal diversion of narcotics, as the provider's names are also listed along with the patient's names. In my community, I see the same physician names over and over again, and I'm not surprised by this.

[Gordon, PA-C]

In my opinion, this move to restrict PAs further should serve as a warning about the vulnerability of PAs practicing medicine in perpetuity without a pathway to independence. In my primary care clinic, most schedule II's are written by PAs and NPs because doctors don't manage chronic pain or see acute care visits. Unfortunately, the hospital and doctors put incredible pressure on PA/NPs to prescribe for everyone regardless of the medical evidence. The PA/NP has the greatest risk exposure to patients engaged in abuse and diversion because he/she sees the most patients demanding sched IIs and can't decide freely when to prescribe. The PA/NPs have the knowledge and training to prescribe appropriately. Unfortunately, they have a gun pointed at their head by the doctors and management of the hospital who want happy customers. I believe that we need a pathway to practice independence. When a PA or group of PAs can band together and open their own shop to practice medicine without physician oversight, most of the drug problems with abuse and diversion will cease.

 

Look man I'm all for PA independence that this is an absolutely absurd statement. You really believe this? While we're at it, lets make another outrageous claim -- making PAs indepdendent will CURE CANCER!

[Guest Paula]

The problem that we are trying to solve is a serious one, and that is illegal diversion of prescription narcotics. This advisory group, in an apparent knee-jerk reaction, believes that 1) increasing the control of Hydrocodone, and 2) limiting the professions who can legally prescribe it, will "solve" the problem. Bull____.

 

In California, I can be disciplined by the medical board for failing to adequate treat pain. In my defense, the Department of Justice make available to me (in a HIPPA compliant way) printouts of my patients' recent narcotic prescriptions to determine if there is a pattern consistent with illegal diversion of drugs. If I can document this on the record, I can refuse pain medication and not worry about these complaints. This has made California PAs, physicians and others job's much easier towards becoming part of the solution and not part of the problem.

 

physasst and I were talking today, and this would be a excellent area of research to better understand physician, PA and NP prescribing practices in the US, and to look at the roles of providers in illegal diversion. Judging from my printouts, it is my anecdotal experience that PAs and NPs are NOT the problem when it comes illegal diversion of narcotics, as the provider's names are also listed along with the patient's names. In my community, I see the same physician names over and over again, and I'm not surprised by this.

 

This would be a good area of research. The paper that is out from the fda advisory board has a chart at the end that shows who is prescribing controlled substances and which ones. Family practice/internal medicine/orthopedic physicians write the most. PA/NPs down a the list a bit and write a lot less. The very end of the paper had numerous cases of drug diversion and most had physicians involved in the criminal activity, along with pharmacists, pharm techs, relatives of such, RNs, LPNs, administrative medical assistants, veterinarians. Not one had a PA listed and there was only one NP identified. THe list was 3-4 pages long.

[Guest Paula]

BTW, can anyone can post the link to the FDA advisory councils paper? It is long, but worth the read.

[physasst]

Yeah, there isn't much published on PA prescribing....

 

Hooker and Cipher wrote a paper in 2005, but it was an overall look at PA prescribing nationally, not a focused paper on narcotic prescriptions and drug diversion...

[burnpac]

Response from the AAPA today.

 

http://www.aapa.org/news_and_publications/pa_pro_now/item.aspx?id=5697

[Guest Paula]

Thanks, AAPA. Where else did this get published other than in the PA Pro Now?

[burnpac]

Thanks, AAPA. Where else did this get published other than in the PA Pro Now?

 

On the front page of aapa.org.

[EMEDPA]

PAFT also wrote a response to the authors of the NY times article and the npr bit who stated incorrectly that all pa's would no longer be able to write for vicodin

[Guest Paula]

On the front page of aapa.org.

 

Yes, I saw that, but did it get published in the newspaper that wrote inaccuracies about PAs, or did NPR put in a correction? PAs can feel good that the AAPA responded and let us know through the AAPA avenues. But, do the public who read the newspapers and listen to NPR know any different?

[Boatswain2PA]

NPR put in a correction? That is about as unlikely as them getting any story correct in the first place.....