PRACTICE MANAGEMENT
A necessary pain E-prescribing controlled substances is worth it
BY KARA NUZBACK Getting certified to prescribe controlled substances electronically is not easy, but it’s worth the trouble, says pain medicine specialist Cheryl White, MD. Like many physicians, Dr. White wrote controlled substance
prescriptions from her prescription pad for her patients at Bra- zos Pain Consultants in Sugar Land. But in March, a pharma- cist notified her he caught a patient trying to obtain a con- trolled substance using her name and credentials. When the pharmacist noticed the phone number and address provided by the patient did not match Dr. White’s Texas Department of Public Safety (DPS) profile, he called Dr. White to confirm the prescription and faxed her a copy of the paper document. Dr. White says the prescrip- tion was fake; someone had manufactured a prescription pad using her name and credentials, including her medical license number, her Drug Enforcement Administration (DEA) certifica- tion number, and her DPS identi- fication number, coupled with a fake address and a phone num- ber she later discovered linked to a prepaid, disposable phone. In October 2013, DPS official-
prescription pad and uses them to obtain drugs illegally. Even if a pharmacist tries to confirm the prescription, the number provided on the forged document often connects him or her with the perpetrator, who poses as the physician in question and gives the pharmacist permission to fill the prescription. “So simple it’s elegant,” Dr. White said. “These people are hi- jacking my credentials, manufacturing prescription pads, and going to town. The way we currently write paper prescriptions is tantamount to leaving blank checks all over town.” As of May, Dr. White says about 75 people across Texas have
“I have faith that e-prescribing will
ly began allowing physicians to electronically prescribe schedule II controlled substances, such as Adderall, Ritalin, morphine, methadone, Oxycontin, Roxicet, and Percocet. The practice of electronic prescription of controlled substances (EPCS) for schedule II drugs became more commonplace in March, after DPS completed a small pilot program to test the accu- racy of reporting schedule II drugs to the Texas Prescription Program.
Sending prescription requests to a pharmacy through an
electronic vendor helps reduce the risk of prescription fraud. But doctors who are using EPCS have encountered some chal- lenges, including pharmacies not certified to accept the elec- tronic requests. Prescription fraud is a type of medical identity theft in which the perpetrator lifts a physician’s credentials from a
eventually become the standard of care.”
filled prescriptions illegally using her name. Worst of all, Dr. White says, she can’t make it stop. If she applied for new DEA and DPS numbers, the time it would take to obtain them would interrupt patient care. According to the DEA Office of Diversion Control, a new DEA application can take four to six weeks to process. “I have cancer patients and cannot potentially suspend their treatment for several weeks,” she said.
Although Dr. White works to help her patients manage pain, her predicament is not unique to her specialty. She says any physician who prescribes a con- trolled substance, such as an
obstetrician-gynecologist prescribing hydrocodone after a ce- sarean section, is at risk. The solution, she says, is for doctors to embrace EPCS. “If I’m going to prescribe controlled substances, I’d rather do it through a clearinghouse,” Dr. White said.
A growing problem Dr. White says she reported her case of prescription fraud to local police and sheriff’s departments, DEA, the Texas Leg- islature, and DPS. She has also informed the Texas Medical Board (TMB) and the Texas State Board of Pharmacy about her predicament to avoid being blamed for violating the law. “I’ve had a hell of a time getting law enforcement to give
July 2014 TEXAS MEDICINE 55
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