Subject: Controlled Medication Policy

Org. name______

POLICY

SUBJECT: CONTROLLED MEDICATION POLICY

Purpose: The Controlled Medication Guideline (see attached) is to formalize an agreement between provider and patient when it is decided that long term use of narcotics or other controlled and habituating medications are to be instituted. These medications are not used unless all other avenues of approach have failed or cannot be employed. The act of negotiating the agreement reminds both provider and patient of the risks of using addicting medication and of the controls to which we must adhere to avoid its abuse.

Procedure: When it is apparent that chronic use of narcotics or other controlled medications are going to be necessary to help a patient with a given medical condition, the following steps are followed:

1.Prior to initiation of agreement, appropriate medication and dosage titration are determined by the provider and it has been documented that

A.) the medication improves both pain and function

B.)the patient has been evaluated for risk of addiction, abuse, & diversion

C.)the patient has been evaluated for comorbid potentially complicating psychological conditions

D.)the patient has been evaluated for comorbid potentially complicating physical condidtions

E.) pain consultaion sought if >120mg/d morphine equivalency appears necessary

2.The guideline is reviewed by the provider with the patient and the medications and dosing schedules are listed along with the name of the single pharmacy with which the patient chooses to deal.

3.The patient and the provider sign and date the agreement. The original is placed in the chart the NCR copy is given to the patient.

4.The fact that a controlled medication guideline is in effect is listed on the problem list of the chart along with the medications and dosing schedules being listed on the problem list and chronic medication flow sheet so that it is easy for a covering provider to follow the program correctly. The clinics use tamper proof prescription pads and a NCR copy of all prescriptions written is kept in the chart to make prescription tampering more clear should it occur.

5.No narcotic or controlled medication refills are done without the chart, including telephone call requests after hours or on weekends.

6.The medication program is reviewed at least every 3-6 months. Urines testing and pill counting for compliance with the agreement will be utilized. If the medical situation changes the medication program is adjusted and a new agreement is instituted. The primary goal is to minimize the use of these medications and to restore patients to the point where they are free of reliance on them.

7.If a patient proves unable to live within the constraints of the program, they are tapered off the medications in question. If they abuse the program or appear to be gaming the program, they are terminated from controlled medication prescriptions, with notice.

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Medical Director Review/Approval