December 11, 2007

TO:      District Branch Executive Directors
FR:       Nick Meyers, Director of Government Relations
RE:       DEA Schedule II Multiple Prescription Final Rule

In a win for APA members and their patients, the Drug Enforcement Agency (DEA) has issued the final rule covering multiple prescriptions for Schedule II controlled substances that reflect the common-sense policy advocated by APA, several District Branches, and individual APA members.  The final rule will become effective on December 19, 2007.

Members will recall that DEA had initially reversed long-standing policy and concluded that multiple prescriptions given to the same patient on the same day for the same controlled substance(s) on Schedule II constituted a refill order for such medications and was therefore prohibited.  In response to statements of concern from APA and other organizations, as well as from individual psychiatrists and other physicians, DEA proposed in September, 2006 to allow physicians to provide individual patients with “multiple prescriptions, to be filled sequentially, for the same schedule II controlled substance, with such multiple prescriptions having the combined effect of allowing a patient to receive over time up to a 90-day supply” of the controlled substance.

The final rule includes the following important provisions:

·         Refilling a prescription for a Schedule II controlled substance is prohibited.

·         Individual practitioners “may issue” multiple prescriptions authorizing the patient to receive a total of up to a 90-day supply of a Schedule II controlled substance provided that certain conditions are met.  These are:

o   Each separate prescription is issued for a legitimate medical purpose

o   Each prescription (other than the first if intended to be filled immediately) indicating the earliest date on which each prescription may be filled

o   The practitioner determines that multiple prescriptions does not constitute an undue risk of diversion or abuse

o   Multiple prescriptions covered under the rule are permissible under applicable state laws

o   The practitioner complies with all other applicable requirements under the Controlled Substances Act, and the regulations, and additional state requirements

·         Nothing in the regulations should be construed to mandate or encourage practitioners to issue multiple prescriptions or to see their patients only once every 90 days for Schedule II medications.  Instead, practitioners should rely on sound medical judgment and established medical standards in determining whether it is appropriate to issue multiple prescriptions, and how often they should see their patients

·         The final rule is effective on December 19, 2007

It is particularly important for APA members to note that state laws and regulations take precedence.  Members should therefore be certain that the issuance of multiple prescriptions for the purposes described in this memo is consistent with state laws and regulations.  If uncertain, we encourage members to contact their District Branch or State Association, their state medical society, or their state pharmacy board for additional information.

A copy of the DEA final rule is located here.  You will need Adobe reader to open the file.