Can I continue renewing controlled substances if a team physician has initiated the prescription or the client has been on it for a long time?
When providing a renewal prescription to a client it is important to perform a clinically appropriate assessment to ensure the prescription of the controlled substance is appropriate for the diagnosis.
What is “Double Doctoring?”
Double doctoring is the deliberate use of more than one licenced provider in order to obtain prescriptions for a greater amount of medications than would be prescribed by a single provider. Typically, patients engage in double doctoring either to obtain large amounts of medications they have become addicted to, such as painkillers, to maintain their addiction; to re-sell medications in order to obtain money for other drugs or another addiction; or to re-use the drugs in another form, for example, crushing stimulant drugs to sell as or mix with street amphetamines.
What types of communication could I receive from the PRP program?
Alert Letter – sent to an RN(NP) when the PRP information indicates possible inappropriate prescribing and/or inappropriate use of PRP medications. No response is required from the RN(NP). This is simply an alert for awareness and education to improve prescribing safety. All PRP medication prescribers on the patient profile for that 30-day period will receive an alert letter.
Explain Letter – Sent to an RN(NP) from the SRNA registrar when PRP information indicates apparent inappropriate prescribing and/or inappropriate use of PRP medications. A response is required from the RN(NP) with 14 days of receipt of the letter. The response will answer specific questions to clarify the clinical situation and care plan implemented by the RN(NP) to ensure safe prescribing. Again, education and awareness are the key objectives of the program.
The SRNA registrar will send letters requiring nurse practitioners to explain their prescribing to a patient in situations such as:
- double doctoring for an extended period of time;
- a pattern of early refills;
- chronic use of benzodiazepines by a patient;
- inappropriate use of PRP drugs as outlined by "The BEERS Criteria";
- prescribing of large quantities of immediate-release opioids repeatedly without the use of sustained release form;
- prescribing of PRP drugs contraindicated for patients on the methadone program for addiction;
- inappropriate chronic use of opioids known to have minimal analgesic effects combined with potential toxic metabolites or a high potential for developing dependency; and,
- reports of illicit use of prescribed PRP drugs by reliable sources.