DEA MANDATE: ALL Schedule II–V controlled substance medications for patients going to a long term care facility require a separate, written prescription.

Writing the medication on the discharge order form is not acceptable.

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Long-Term Care Discharges with Controlled Substances

Patients who are discharged from the hospital who have pain are in need of continued medication to control their symptoms. To meet this need, there has been a long-standing practice of writing discharge narcotic medications for patients going to long-term care facilities and hospice, on the discharge order sheet along with all other medications.

In recent months the Drug Enforcement Administration (DEA) has increased its focus on the use of controlled substance medications in long-term care facilities. DEA has stated clearly and in writing that this “widely used system is not in compliance with legal requirements.” Source: 66 Fed Reg. 20834. Specifically, they are doing audits to enforce long-standing rules: 21 Code of Federal Regulations 1306.04-6, 1306.11. As a result, significant fines have been levied against nursing home pharmacy vendors who do not have hard copy or valid faxed prescriptions for Schedule II-V controlled substances. The pharmacy can potentially face administrative or civil fines and penalties for violating the Controlled Substances Act.

As a result of current practices, patients discharged to long-term care facilities or hospice have reached their new location but do not have access to crucial medications. They have been caught in the middle by not having medications to control their pain that have been previously ordered and shown to be effective.

What this means to you is that there must be a WRITTEN PRESCRIPTION for each order for a Schedule II-V controlled substance that is signed by the physician and includes the following:

1. Date issued
2. Full name and address of the patient
3. Drug name, strength, dosage form, quantity prescribed and directions for use
4. The name, address and registration number for the physician
5. The authorized number of refills for Scheduled II-V

While this may be an inconvenience for physicians who discharge patients from the inpatient setting, or who call in medications for patients in long-term care, it is small compared to the importance of maintaining pain control in our patients.

Adrienne Mims, MD MPH
Medical Director, Medicare Quality Improvement

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For more information, review the PowerPoint presentation:
DEA and Controlled Drugs in LTC

For more on the Federal Law and Georgia law for controlled substances visit:
Code of Federal Regulation Title 21, Section 1306

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