New Law Governing Prescribing of Controlled Substances in Florida July 1

There is an ongoing epidemic of addiction to prescription pain medications in our country. The death toll from opioid drug overdoses on a daily basis is now higher than loss of life through motor vehicle accidents and violence.

This spring the Florida Legislature passed Hb21, a new law that is meant to keep oral pain medications off the streets. Hb21 requires that when you are prescribed a controlled substance, the prescriber must first access the states Prescription Drug Monitoring Program website (Known as E-FORCSE) and review the recipient’s history of receiving prescribed controlled substances in the state of Florida. It is designed to make sure that drug seeking patients are not able to doctor or clinic hop to obtain narcotics.

Dispensers of the controlled substance such as pharmacies and pain clinics with dispensaries will be required to list the prescription on E-FORCSE within 24 hours. There are fines and penalties by the state for physicians and dentists failing to comply with access to E-FORCSE before writing the script. It is expected the Florida Board of Medicine will add penalties, license suspensions and revocations for noncompliance as well.

The law defines “acute pain” from an injury, medical procedure or dental procedure. Practitioners may prescribe three days of controlled substances for pain relief with no refills after accessing E-FORCSE. If they believe the procedure or injury are so severe that it requires more than a three day supply, they must write “Acute Pain Exception” on the prescription and they may request a 7 day supply with no refills. The prescriber will be required to document in the medical record why controlled substances are being prescribed and why there is an exception

The law additionally requires dispensers to complete a state mandated two hour course on safe prescribing of controlled substances. The course must be given by a recognized and accredited statewide professional association for a fee. The course will need to be retaken every two years before your license comes up for renewal. This course is separate and distinct from the course required to prescribe medical marijuana.

Our office has been registered with and has used E-FORSCE for several years now. It is helpful in tracking a patient’s ability to obtain controlled substance medications. It clearly adds additional time and labor to a doctor’s visit to comply with the new state regulations. Once again the Legislature has chosen to treat every patient as an addict and every dispenser as a criminal.

There is talk that in the near future we may be required to prescribe controlled pain substances electronically as opposed to the current requirement that a patient present a legible hand written or typed script. We have been told by our computer software maintenance vendors that there will be a significant charge to set up this service along with a monthly maintenance fee.

The law goes into far more detail than this synopsis permits me to go into. I suspect that, as we move forward, pharmaceutical chains may find it cost prohibitive to stock controlled substances and designate only certain locations as prescribing centers. This is what happened when the Legislature passed a 2011 law to deal with chronic pain and eliminate the “pill mills.”

If you have any questions or concerns feel free to call or email me and we will review your individual situation.

Computerized Prescribing and Pain Medications

As part of the government initiative to modernize health information recording and exchange , doctors and health care providers are encouraged (with financial incentives) to prescribe medications using the computer.  This “e-RX” system allows you to send prescriptions to the patients’ designated pharmacy right from your computer screen with a few clicks and turns of your computer mouse controls. The only medications you are not permitted to prescribe are narcotics, controlled substances and pain medications with narcotic contents.

At the same time this initiative is occurring, there is a massive crackdown in the State of Florida on prescribing medications for pain. Sloppy legislation in Tallahassee by the State Legislature led to the opening and growth of “pill mills.”   Drug addicts and suppliers from all over the country routinely travelled to Florida to obtain massive quantities of prescription medications from these fraudulent facilities staffed by criminal physicians. The medications ended up on the streets causing numerous drug and alcohol related deaths around the country.

The “sloppy” Florida State Legislature then attempted to rectify the problem by passing new rules and regulations that closed the “pill mills” with the help of the police and drug enforcement authorities but has frightened the legitimate physician population into not being willing to prescribe for legitimate chronic pain. Their actions included updating physicians’ online profile with the state licensing agency to declare whether you write narcotic scripts for chronic pain or not.  If you reply “yes” you are apparently placed on a list of “chronic pain” prescribing doctors that the public can access as well as the criminal elements looking for doctors to write scripts for cash.

At the same time legislation now requires doctors to take specific courses to prescribe some of the newer pain delivery products necessitating the physician to leave their practice to train on the use of the new medications. The result is that legitimate neurologists and anesthesiologists are shying away from seeing chronic pain patients less than 65 years of age even if they have been referred and have legitimate needs for pain medications.

This brings me back to computerized prescription ordering. If you are trying to track narcotic prescriptions, why prevent the doctors from using the computer to prescribe controlled substances?   What is easier to track and trace, a computerized order or a hand written prescription?   It would seem that computerized record keeping through electronic order entry would be the preferred method of tracking narcotic prescriptions.