Guidelines for Dispensing Controlled Substances

 As Pharmacists of the Utah Pharmacists Association we are part of a vital healthcare team and serve as gatekeepers to ensure, with the prescribing practitioner, that a prescription for a controlled substance is issued for a legitimate medical purpose by the individual practitioner acting in the usual course of professional practice.

We have seen various questions, recommendations and guidelines from our members regarding controlled substance. The guidelines below have been provided as a guide and recommedation to UPhA from one of our own members. These guidelines come from a retail pharmacy with stores both in and out of Utah. They may not be the best recommendations for you and your pharmacy. They are intended to provide general advice and should not be considered policy and procedure. We do recommend that UPhA members develop their specific practices and policy & procedures for their business and also always recommend seeking the appropriate legal counsel. Federal and local Utah laws regarding the proper dispensing of controlled substances must always be followed.

Recommendations

Pharmacy should complete a checklist on ALL targeted drugs to identify flags that may warrant checking the State Prescription Drug Monitoring Program and/or call to prescriber.

1. If filled, a completed checklist must be attached to the hard copy prescription.

Pharmacists should check their State Prescription Drug Monitoring Program before dispensing Oxycodone, Morphine, Multiples (cocktails of opioid/benzodiazepine/carisoprodol) in the following circumstances (checklist questions):

1. Prescription is written for >120 units
2. Patient is new to the pharmacy
3. Prescriber is different than the prescriber of previous fill
4. Patient requests to pay cash
5. Patient or prescriber address is NOT in geographic proximity
6. Prescriber is acting outside of the scope of practice (e.g. Pediatrician prescribing for adult)

Pharmacists should use clinical judgment on the appropriateness of communicating with prescribers prior to dispensing a controlled substance, but should specifically do so in the following circumstances:

1. Pharmacist suspects a forged, altered or counterfeit prescription. Call the number listed in the computer and do not rely on the printed prescription phone number.
2. Patient repeatedly requests early refills of controlled substances. Specifically early refills of Opioids, Benzodiazepines or Carisoprodol.

Pharmacists should require government-issued identification for ALL patients or authorized individuals picking up a prescription for a controlled substance. 

1. Government photo ID must not be expired or hole punched
2. Photo ID should be documented on the hard copy or captured in the pharmacy dispensing system.

Prescriptions that do not meet the dispensing guidelines should be refused.

1. Refused prescriptions should be copied and filed in a controlled substance rejection log, along with the Controlled Substance Checklist.