Controlled Drug Policy

Our office has an established policy regarding the use of controlled drugs. These drugs include those categorized by the Drug Enforcement Agency (DEA) as category 2, 3, and 4. These medications are so categorized because of their potential for addiction and/or abuse. Because of this they are closely regulated and monitored by the authorities. Misuse of them by either patient or prescriber results in serious penalties under the law.

The majority of controlled drugs fall into three main groups:

  • Opioid pain medications

  • Benzodiazepine anxiety medications

  • Stimulant medications

There are other medications under these main categories, and there are other less common categories (which are omitted for the sake of brevity). Our policy applies to all medications which are in these controlled classes.

Our policy on these medications is based on the following:

  1. Controlled drugs can be useful in helping people if used with caution.

  2. When misused, controlled drugs cause harm that far exceeds their usefulness.

  3. Controlled drug abuse is common, and these drugs are commonly trafficked illegally.

The dangers of controlled drugs include:

  • Dependency - where a person develops a tolerance to the drug over time, requiring progressively higher doses to get the same effect, and where abrupt stopping of the drug causes significant withdrawal symptoms.

  • Addiction - where a person uses the drug compulsively and uncontrollably.

  • Impaired mental status - can cause falls in elderly, dangerous behavior, and impaired driving.

  • Overdose - many of these drugs are dangerous or even fatal if taken in excess or in combination with other drugs/alcohol.

  • Long term consequences - Long term use of these medications are associated with a variety of problems. Recent data, for example, point to an increased risk of alzheimer’s  in people taking long-term anxiety medications.

  • Legal consequences - Selling, sharing, or illegally possessing these drugs is considered a felony offense.

Our policy, therefore, is as follows:

  1. Opioid pain medications

    1. These medications should be, with rare exception, taken on a short term/temporary basis.

    2. Long-term use of these medications should be done with great caution and high supervision. Regular efforts should be made to decrease chronic dosage whenever possible.

    3. Every effort should be made to minimize their use on a regular basis, working to find alternative treatments or finding the source of the pain which creates the need.

  2. Benzodiazepine anxiety medications

    1. These medications are meant to be taken, whenever possible, on either a short-term basis, or an intermittent as needed basis. They are not meant, in general, for daily use.

    2. Long-term use of these medications should be done with great caution and high supervision. Regular efforts should be made to decrease chronic dosage whenever possible.

    3. As with opioids, those requiring regular use of these medications should be encouraged to find other treatments, such as daily anti-anxiety medications and/or psychotherapy to decrease the need for such medications.

  3. Stimulant medications

    1. These medications can be taken on a daily basis, but should only be taken when their benefits outweigh the negative.  

    2. Regular breaks in taking these medications is encouraged.

All of these medications, because of their legal classification, have the following additional rules. Failing to follow these rules will result (in most circumstances) in discharge from the practice.

  1. Patients should never share medication with family members or friends.

  2. All patients taking these medications for more than short-term will be required to sign the “Controlled Drug Agreement” for our practice.

  3. Patients should not get medications of this class from other doctors unless it is clearly communicated to us and the other doctor that this has been done.

  4. Patients should not use illegal drugs while taking these medications.

  5. We will not refill these medications early for any reason (even medications lost or stolen are not refilled early).

  6. Refill of these medications will only occur after a person has filled out and submitted the “Controlled Medication Refill Request” form, online or on paper.

  7. All Category 2 drugs require patients to pick up the handwritten prescription in person. All of these prescriptions can only be written as “Do Not Refill.” We will only give these prescriptions to patients during regular office hours.

  8. Category 3 and 4 medications can be called in, but refills will only be called in during regular office hours.

  9. Should suspicion arise about the following of these rules, we reserve the right to do drug testing to see:

    1. If the drug is being taken as described

    2. If other drugs are being taken (including illegal) without our knowledge.

  10. We also will, should suspicion arise, check the state controlled drug registry, which records all filled prescriptions of these medications by patients.

Our goal is to maximize the length and quality of life of the lives of our patients. These rules are in place so that we can accomplish that without putting ourselves or our patients at risk. While we don’t want to withhold treatment that will help our patients, patients must understand that these medications cause significant harm to many in our society, and so should only be taken with great caution.

Urine Drug Testing Policy

Applies to all patients taking controlled drugs on a regular basis,

Additionally, we will require regular urine drug testing. The testing will be done as follows:

  1. Urine drug testing will look for two abnormalities:

    1. Drugs not on patient list show up in the urine test (including illegal drugs).

    2. Drugs on the patient list do not show up in the urine.

  2. Patients at “low risk” will be required to get testing done every 6 months. 
    “Low risk” patients are those who:

    1. Have been with the practice more than a year without significant incident.

    2. Have never had abnormal urine drug screening.

  3. Patients who are “high risk” will be required to get tested every 3 months.

  4. Children on stimulant medications will be tested once during the school year.

  5. New patients will be tested prior to getting their first prescriptions.

  6. The in-office urine test costs $10 (which must be paid prior to getting prescription filled).

  7. A positive in-office test requires a confirmation test be sent to the laboratory. 
    There are two ways to pay for this test:

    1. Pay $60 up-front (the cash price for the test).

    2. Apply to insurance and accept billing from the lab (insurance is billed $137)

  8. Patients with unexplained abnormal tests will (at our discretion) either be:

    1. Required to undergo random urine testing over the next year

    2. Dismissed from the practice.

    3. Kept in the practice, but not prescribed any more controlled drugs.

Why are we drug testing?

The main reason we are doing this is to comply with state requirements for the prescription of these medications. We don’t want to get in trouble with the state. The second reason is to assure us that our patients are using the medications safely and responsibly.  

How will this work?

We will notify our patients when the test is due. They must get tested prior to that medication being refilled. If patients don’t get tested, they don’t get their refill.

Important advice

  • Don’t wait until last minute before getting refills if testing is due.

  • Be honest. If you’ve not taken your medication, or if you’ve used an illegal drug, TELL US.

  • Understand that we will do our best to be reasonable with this policy.