Controlled substance drugs are not available over the counter and require a proper reason after diagnosis to be administered by a DEA registered physician. Without a prescription, these drugs cannot be purchased from any pharmacy store. The reason these drugs are called controlled substance drugs is they can cause mental or physical dependency and therefore they are regulated by law or the Drug Enforcement Administration (DEA). 

 

What are controlled substances?

 

Often patients suffer from unbearable pain and need something that supports and relieves the pain that they are going through. Animal euthanasia is a common practice that helps animals to meet their end more peacefully and painlessly. Controlled substance drugs have made their contribution significant when it comes to medically treating such situations. 

There is a risk involved when a prescriber prescribes controlled substances to patients. When patients claim pain, it is difficult to distinguish if the claim is legitimate or not. Signs and symptoms need to be carefully studied to ensure that the chronic pain that the patient is suggesting is for real and not being misused to procure prescription drugs for diversion and abuse. FDA has approved opioid analgesics for severe to moderate pain. They are commonly used on cancer patients, neurologic, and euthanasia. The 1990 opioid epidemic has led to stringent measures on opioid analgesics drugs and other controlled substances. The inability of health professionals to detect between genuine and severe patients led to this disorder. This exceptional overuse and overdoes of opioid analgesics compelled the DEA to bind controlled substance drugs with stringent regulations. 

Patients have different pain thresholds that stem from various levels of endurance. It involves behavioral, cultural, emotional, and psychological disorders. Before an opioid drug is prescribed for a long or short-term treatment a complete patient assessment needs to be established. A treatment plan has to be formulated to prevent divergence, disorder, and pseudo-addiction. 

Opioid use disorder is unclear to many physicians who still confuse opioid dependency with opioid use disorder and consider them equal. Physicians also lack training in controlled substance handling and this leads to more risks and diversion possibilities. Providers therefore should go through training in controlled substance management and also have a thorough knowledge before prescribing the drug.

 

Controlled Substances Act and Scheduling

 

Those handling controlled substance drugs need to fully understand how they should handle controlled substance drugs. The Controlled Substances Act and Scheduling, CSA controlled substances, is a regulating law that controls how drugs should be used, produced, and sold in the United States. The act is applicable for both controlled substances drugs and noncontrolled substance drugs. The classifying of the substance is done by Drug Enforcement Agency (DEA) and the Food and Drug Administration (FDA).

 

CSA Controlled Substances Drug scheduling

 

Each drug is assigned a rating system by the DEA to determine the addiction potential of the drug. Drugs that fall under schedule I Controlled Substances have no medical purpose with a chance of high abuse potential. The most well known are Heroin

Hallucinogens, Marijuana (may not fall under schedule I in many states), and Ecstasy.

The schedule II controlled substances include drugs like Cocaine (an Anesthetic component), Methamphetamine, Methadone, Morphine, Dilaudid, Demerol, Oxycodone, Hydrocodone, Fentanyl, Adderall, Ritalin, Dexedrine, etc.

Schedule III Controlled Substances drugs include moderate to low potential for abuse and are accepted medically as they have a low psychological dependency. Drugs like Anabolic steroids and testosterone fall in this section of drugs. Codeine, Buprenorphine, and ketamine fall under this category. 

Schedule IV drugs also have a low abuse potential and DEA has approved of their medical use. 

The Schedule V controlled substance drug has the lowest abuse potential according to DEA.

 

How is the drug abused and misused?

 

Controlled substances drugs are scheduled under various categories according to their level of abusive potential. When we talk about drug abuse it should mean that they are illicitly procured like stealing through an illegal prescription. However, when we mention misuse it would mean that the drug is a prescription medicine and the patient has got addicted to its use. Though no longer required the patient continues to use the drug in an incorrect dosage and procures the drug through an incorrect route.

 

How has pill shopping been stopped?

 

This practice of drug misuse has led to pill shopping where through a single prescription a patient does pill shopping from numerous pharmacies procuring the drug in small portions and gathering a cumulative sum. Sometimes, the patient also manages to procure multiple prescriptions. However federal laws and DEA have imposed stricter policies and made tracking of prescriptions possible that has curbed the liberty of pill shopping from ill intending patients.

 

Controlled substance Drug diversion

 

Controlled substances are also sold in the streets and this happens when patients sell the drugs that they have procured from their fake prescriptions. This drug diversion is a source of illegal earning. Some patients use this means to take care of their daily life without realizing the implications of their actions. Challenges faced by law enforcement agencies in trying to control drug diversion through prescriptions are at times surmounting.

 

The top 4 ways in which prescriptions containing controlled substance drugs are procured

 

 It has been found that friends or relatives are responsible by 55%, Prescribers almost 20% have been found to prescribe and allow misuse of controlled substance drugs, 10% users buy controlled substance drugs from friends and 5% steal from friends and relatives. 

The misuse of controlled substances drug leads to rampant morbidity and mortality. The U.S. Department of Health and Human Services, National Survey on Drug Use and Health, found that the abuse of prescription medicine was over 10 million, and more than 40,000 people died of opioid overdose in 2020.

 

What are the most common reasons for opioid prescription?

 

Pain is the most common reason when mu-opioid binding the central nervous system sends signals to the brain and the receptors in the GI tract and the respiratory system. Along with pain, it is also effective in controlling diarrhea, and cough.

 

How can physicians control through safe assessment to prevent misuse?

 

Proper training in prescribing pain medication is important. If physicians are trained properly with complete knowledge of the CSA controlled substances, they will follow the standers of safe prescription. The training entails a thorough review of the complaint, with a full understanding of the history of the ailment, asking the patient, or procuring online a list of the past medication and its dosage that is prescribed to the patient. Carefully reviewing the pain rating scale, thoroughly examining the family history to ensure that no member is into alcohol or drug addiction. No one is suffering from mental depression. Understanding the family culture and how the family is placed socially, the education, employment, living standards, medical status, and if the family is involved in any legal issues if any member of the family has shown opioid risk assessment all these factors are considered. Before prescribing a head-to-toe medical examination must be done and after the urine and drug test result is obtained and the physician is satisfied with all the results without the slightest hint of doubt from any of the above, a controlled substance drug is prescribed. 

Providers with a DEA registration of prescribing controlled substance drugs can prescribe these drugs. However, physicians should hold this as a last resort. If general medicine helps in alleviating pain then that should be used. Before the treatment starts, the physicians should inform the patient of the implication of using the controlled substance drug through informed consent. The consequences of overdose like respiratory distress, drug dependency, and also death. In women, it can cause a withdrawal symptom. The benefits are it will effectively relieve pain.

The patient and provider must also enter into an agreement that offers an informed list of responsibilities that both the patient and the provider must follow when using controlled substances for a specific reason. In the case of non-compliance in the treatment, the consequences can be severe. 

According to the DEA compliance, the first prescription should be in the form of a trial. The pills should be counted and recorded on the prescription. The refills should be handled in the way suggested by the DEA. The controlled substance should be bought from a single provider and the provider and patient must exit from the treatment plan once the treatment is concluded.

 

Conclusion

 

While most physicians are busy looking after and managing their treatment plans it is not always possible for them to keep track of each patient individually and demands team effort. However, in your care center, not every worker can be fully committed to your cause and drug diversion or prescription misuse is most likely to happen internally. How can you ensure that the controlled substance drugs prescribed by you to one patient are not being transferred to another from an internal staff for some cheap income? If such is the case then you will not be far from DEA’s audit and scrutiny and might end up with a closed dispensary. Before things get out of hand contact the DEA experts to help you cleanse and structure your internal framework and work model to ensure that no misuse of prescription is taking place from one of your staff members. Titan Group is highly experienced as they have worked with the DEA and the Federal Government to stop controlled substance drug abuse and misuse. They will help you streamline and organize your healthcare center. Visit https://titangroupdea.com/ To protect yourself, your profession, and help your patients.  

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