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The Coordinator's Column: A Prescription for Compliance
Posted on: 8/1/2013
Brian S. Zachariah, MD Chief Medical Coordinator Division of Professional Regulation, IDFPR

I've written before in this column and elsewhere about circumstances where compliance with the Medical Practice Act and other relevant statutes is easy, but failure to abide by the law can have significant negative consequences for us as physicians.

Recently, a new issue has emerged. More than a dozen cases alleging violation of Paragraph 570/309 of the Illinois Controlled Substances Act (720 ILCS 570/309) have crossed my desk. This paragraph allows physicians to issue lawful oral prescriptions for Schedule II controlled substances "in the case of an emergency, epidemic or a sudden or unforeseen accident or calamity . . . ." In my experience this usually takes the form of a phoned-in prescription for a Schedule II narcotic pain medication for an established patient (either your own or one of your partner's) who has run out of their regular chronic pain medication or otherwise needs the medication to tide them over until they can be seen in the office.

Importantly, this same paragraph also requires that this emergency (oral) prescription be followed within seven days by a written prescription. The Act specifies a few more details as well. For example, the written prescription must say on its face "Authorization for Emergency Dispensing" and must include both written and numerical notations of the quantity prescribed. If delivered by mail rather than directly to the pharmacy, the written prescription must be postmarked within the seven-day period.

Unfortunately, in the majority of cases, physicians did not respond to multiple reminders and "educational letters" from the involved pharmacies, and the required written prescriptions were forwarded only after the Department got involved – weeks or even months after the required seven-day time frame. In several cases, the physician has never sent the required written prescription.

Thus far, the Department has begun investigations and may take disciplinary action against more than a dozen Illinois physicians for allegedly violating this provision, particularly those who did not respond to several reminders at all or only did so after a significant delay.

Physicians should also be aware that there is a parallel federal requirement [Title 21, CFR §1306.11 (d), (4)]. So failing to follow one's emergency Schedule II prescription with a written authorization within seven days exposes one to not only potential state discipline, but to adverse action by the U.S. Drug Enforcement Administration as well.

In my continued quest to keep your chart off my desk, please remember to submit your written prescriptions for Schedule II emergency prescriptions in a timely fashion.

Brian S. Zachariah, MD, is a contributor to Illinois Medicine EXPRESS. He is the current Chief Medical Coordinator, Division of Professional Regulation, at the Illinois Department of Professional and Financial Regulation.

Disclaimer:Views and opinions expressed in the "Coordinator’s Column" are those of its author and are not necessarily endorsed by ISMS. This column does not necessarily reflect official policy of ISMS, but is intended to raise issues of importance to its members. Comments and questions regarding the content of this column may be directed to the author at brian.zachariah@illinois.gov.

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