Physician Beware: Controlled Substances and Regulation No. 2

     The death rate from drug overdose in the United States more than doubled during 1999-2013, from 6.0 per 100,000 population in 1999 to 13.8 in 2013 and is now the leading cause of injury and death in our country.  The increase in drug overdose is attributable primarily to the misuse and abuse of prescription drugs, especially opioid analgesics, sedatives/tranquilizers, and stimulants.  
     The Arkansas State Medical Board (ASMB) may revoke or suspend a physician’s medical license if the holder thereof is found guilty of grossly negligent or ignorant malpractice.  The treatment of pain with dangerous drugs and controlled substances has a legitimate medical purpose when it is done in the usual course of medical practice.  However, the ASMB will deem it malpractice if a physician prescribes excessive amounts of controlled substances to a patient.  
     A physician can avoid the heavy hand of the ASMB by ensuring that his/her prescribing of controlled substances meets a legitimate medical purpose arising out of the usual course of medical practice.  ASMB Regulation No. 2 states that “a physician who prescribes narcotic agents Schedule 2, 3, 4 and 5, excluding Schedule 4 Propoxyphene products and Ultram or Tramadol and including the schedule drugs Talwin, Stadol, and Nubain, on a long term basis (more than six (6) months for a patient with pain not associated with malignant or terminal illness) will be considered to exhibit gross negligence or ignorant malpractice unless he or she has complied with the following:"
The physician maintains accurate records to include the medical history, physical examination, other evaluations and consultations, treatment plan objective, informed consent noted in the patient record, treatment, medications given, agreements with the patient and periodic reviews.
The physician periodically reviews the course of scheduled drug treatment of the patient and any new information about eitology of the pain.  If the patient has not improved, the physician should assess the appropriateness of continued prescription of scheduled medications.
The physician has obtained written informed consent from those patients he or she is concerned may abuse controlled substances and discussed the risks and benefits of the use of controlled substances with the patient, his or her guardian, or authorized representative.
The physician is licensed appropriately in Arkansas, has a valid controlled substance registration and complies with the Federal and State regulations for the issuing of controlled substances and prescriptions.  
Paul Waddell (