Guns and Controlled Substances

My elderly cognitively impaired patient fell at home hitting her face, jaw and left side on the corner of a cabinet. Her entire face was bloodied, and black and blue, with the bridge of her nose the only pink normal skin remaining. Her left flank was a deep purple covering four broken ribs and blood in the pleural space. Her hands and fingers were purple bilaterally. The ER sent her home without pain medication so her son called me for help.

First, I went to her medication list on my computer and researched several options for drug/drug interactions. This took a few minutes. Then I was required to access EFORSCE, the state of Florida narcotic dispensing documentation website. Failure to do so in advance of prescribing a narcotic controlled substance is a $10,000 fine and possible loss of my DEA prescribing license. I am no longer permitted by Florida law to phone in the prescription to the patient’s pharmacy. I now have to access their chart online in my cloud-based electronic health record.

I type in the medication, dosage, number of pills and instructions for taking the medication – plus refills. I have to indicate if the prescription is for “acute pain” which allows for a three-day supply or for chronic pain. I then have to look up their pharmacy’s online electronic number, enter it and hit send (I can store that number in the system for future use).

A new screen appears asking me to log in to “Mobile Pass”. I enter a User ID and Password and then a number appears on an app loaded to my smartphone. I have 30 seconds to enter that six-digit number and hit send. The process takes 5-7 minutes per prescription. No one on my office staff is permitted to do this for me.

The last controlled substance pain prescription I sent in resulted in a message that the system was not recognizing my credentials. I repeated the process and was successful the second time.

The prescription process occurred on the same day as the tragic school murders in Uvalde, Texas. I was so frustrated at the carnage, and so frustrated by my own ineptness in using the technology drafted by Florida’s State Legislature to prescribe needed medication for an injured patient, that I decided to see how long it would take me to purchase an automatic pistol with magazines of ammunition allowing me to fire multiple rounds per minute. I used Google to look it up and filled it all out in under two minutes. If I decided to use curbside service, I could pick up my weapon and ammunition in less time than it took me to prescribe Percocet for an injured victim. I don’t think our Founding Father’s meant for it to happen this way when they wrote the Second Amendment.

Controlled Substances and Schedule Drugs

The right to prescribe narcotics and controlled substances is regulated by the Federal Government. Physicians, dentists and health care providers apply for licensing with the Drug Enforcement Agency and request the right to prescribe medication from the different “schedules.” State legislatures and state medical boards regulate this further. Most people are unaware which medications and drugs are in which schedules or categories.

Schedule I – For the most part, these are substances which have no current accepted medical usage and are easily abused.

Examples are: Heroin, LSD, Ecstasy (methylenedioxymethamphetamine), Quaaludes          (methaqualone) and peyote.

Schedule II – These are substances with high potential for abuse with a risk of physical and psychological dependence.

Examples are: Vicodin, cocaine, methamphetamine, methadone, hydromorphone (dilaudid), meperidine (Demerol), oxycodone (OxyContin), fentanyl, Dexedrine, Adderall, Ritalin

Schedule III – these are drugs with moderate to low potential for physical and psychological dependence.

Examples are: Products with < 90 milligrams of codeine per dosage unit such as Tylenol with codeine, ketamine, anabolic steroids and testosterone.

Schedule IV – These are drugs with a lesser risk for abuse and dependence.

Examples are: – Xanax, Soma, Darvon, Darvocet, Valium, Ativan, Talwin, and AmbienTramadol.

Schedule V drugs have lower potential for abuse than Schedule IV drugs and contain limited amounts of narcotics. This would include antidiarrheal medications, antitussives, and mild analgesics. Cough medications with less than 200 milligrams of codeine per 100 milliliters such as Robitussin AC, Lomotil, Lyrica and Parapectolin.

All the medications on these schedules must be reported to E-Forcse, the Prescription Drug Monitoring Program, within 24 hours of dispensing by pharmacies. They all require the prescribing doctor to check E-FORSCE before prescribing.