Wednesday, May 26, 2010

DEA Cracks Down On Safe and Efficient Prescribing

A couple weeks ago, after I faxed a prescription refill to a Fred Meyer pharmacy near my office, a pharmacist there telephoned me. She explained that an inspector from the Washington State Board of Pharmacy had instructed the pharmacy to stop accepting  prescriptions for controlled substances with "electronic" signatures, citing DEA regulations. 

I had heard this reference to electronic signatures before and inquired at the Board of Pharmacy where a representative assured me that since I had written the signature on my prescriptions by hand, using a stylus, the Board would not consider it to be electronic. However, when I contacted the inspector, she indicated that since I had not used chemical ink from a pen applied to paper, but instead used a stylus and digital ink on a tablet computer, my signature would now be considered electronic. Never mind that the prescription was sent via fax to the pharmacy, so the pharmacist could not see the original paper or feel for the indentation made by the pen. Presumably the fact that the signature was identical to prior signatures gave it away. (Funny. I would have thought a signature that looked different from a former signature might raise suspicion.)

So at a time when the President encourages eprescribing (where there is no signature at all), at a time when we hear that regulators may permit physicians to order even controlled substances via eprescribing, and at a time when Washington statutes will soon require physicians to use special paper forms for prescriptions (but not when the prescription is faxed), authorities are cracking down on arguably safer and more efficient methods. Now to order a prescription I must print it on paper (wasting trees), sign it with a pen (not one obtained from a pharmaceutical representative of course) with chemical ink, and only then might I scan it with a fax machine to send it electronically to the pharmacy.

But I push back. So I have instituted a policy that I will no longer fax prescriptions to the Fred Meyer pharmacy in question. Rather, after printing and signing the prescription, I will hand it to the patient. Which means the patient must be in the office. If the patient needs to renew between visits they must use a different pharmacy that still accepts "electronic" signatures.

Unfortunately it gets worse: For years I have intentionally omitted my DEA number from prescriptions to prevent patients from using it to forge prescriptions. Instead I provided it by telephone directly to the pharmacist. Now, however, I understand from pharmacists that authorities are cracking down on this practice as well, and have admonished pharmacies not to accept prescriptions for controlled substances unless the DEA number appears thereon.

We can expect to have the DEA to thank for a spike in drug-related crimes and deaths, at least until we can eliminate written or printed prescriptions altogether.

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