The Internet provides an incredible array of informative sites regarding the prescription of controlled substances. Let’s say, for example, that I’m a physician with offices in New York and New Jersey. I’m licensed in both states and go back and forth across the border depending on my clinic schedule. I have a DEA registration for prescribing controlled substances, but only in New York. Can I still prescribe such medication in New Jersey? As it turns out, I can’t. Rather I have to pay an additional $130/year for an additional DEA registration in the second state. This answer can be found at www.deadiversion.usdoj.gov.

As I write this, it’s the middle of the winter and I was recently unable to reach a rural clinic where I treat patients with buprenorphine. The clinic was concerned; patients would be running out of medication before I was next scheduled to be there. Perhaps I should have left a post-dated or undated prescription at the clinic. Unfortunately, that’s not legal, our friendly website informs us. Perhaps I could have, the last time I was there, left a prescription with that day’s date but with instructions to the pharmacist saying, “Do not fill until x/x/05.” Here’s where the web fails us; in fact, that’s not legal either anymore. Ever since the middle of November 2004, an interim policy has been in effect saying that physicians can’t do that. This hasn’t made it to the DEA website, but it has made it to the Federal Register. Knowing that, I can find the relevant details by searching the web for it. I quickly found it at www.painfoundation.org/policy/dearesponse.pdf

This brings up an important issue given what we know about ignorance of the law. The web is loaded with information, some of it timely, some outdated, and some not yet updated. The DEA site has not been brought up to date as of this writing with the DEA’s own policies as written up in the Federal Register.

That doesn’t mean it should be ignored, but rather that readers searching for truth should recognize that a web search is the starting point. Our clinic’s next step in my absence was to call the nearby hospital to ask if one of the physicians there would write a prescription for buprenorphine. We know that unless one of those docs is specifically authorized to prescribe buprenorphine, this is not a legitimate alternative. Looking at the DEA’s website, however, specifically at www.deadiversion.usdoj.gov/drugreg/faq.htm, reveals that “buprenorphine products are currently under development for use...[but] have not been approved for marketing.” It has been about two years since that statement went out of date, yet there it is at the government’s information website for consumers and physicians alike about controlled substances.

Each state has separate policies, codes, administrative rules, and regulations that apply to the prescribing of controlled substances. Some of them are online, some aren’t. Some are up-to-date, some aren’t. A physician is required to follow the more stringent of the applicable policies. That is, hypothetically, if the federal government says that you can prescribe a controlled substance for one month plus one refill but the state says you are limited to prescribing for one month, then the latter law applies. What happens, however, if you are practicing in New Jersey and treating a patient from New York? Does the applicable law change if your patient calls you from New York while you’re at your office in New Jersey? I tried finding discussion of situations of this nature within the regulations online. It’s quite difficult even to find discussion of medical practice across state lines in these types of situations, but if you then add in the federal and state statutes that apply to controlled substance prescribing, you end up with a virtual spider's web of regulation and no clear answer.

Stuart Gitlow, MD, is a member-at-large of the American Society of Addiction Medicine's Board of Directors. This column represents his personal opinion and does not imply any position or policy taken by ASAM.

This article is published in Counselor,The Magazine for Addiction Professionals, April 2005, v.6, n.2, pp.69-70

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