The War on Drugs on Pain: Nursing Home Patients Caught in the Crossfire

The National Community of Pharmacists Association (NCPA) submitted a written statement for the United States Special Committee on Aging hearing on March 24, 2010 (Rannazzisi, 2010). The NCPA recommended that the Drug Enforcement Agency (DEA) cease enforcement of its current interpretation of the Controlled Substance Act (CSA). Since the enactment of the CSA 40 years ago, federal law has mandated that a controlled substance may be prescribed or dispensed only by a DEA-registered practitioner. This closed system of distribution was to provide security and accountability for the controlled substance supply.

Since last year, the DEA has tried to crack down on nurses who call a pharmacy requesting controlled substances for patients without having a signed prescription to give to the pharmacy. The DEA has taken action against pharmacies in Ohio, Michigan, Wisconsin, and Virginia (Spoto, 2010). The crackdown affects long-term care facilities (LTCFs) because those institutions typically do not have a DEA-registered practitioner. Hospitals are permitted to have a stock of controlled substances for immediate dispensing. Long-term care facilities have no independent federal or state controlled substance authority and are not eligible to become DEA registrants.

In LTCFs, it was common practice for a nurse to call a pharmacy to order a controlled substance for a patient in pain. Nurses would fax the doctor's order sheet to the pharmacy. The CSA requires prescriptions for controlled substances to have the date it was signed and to contain information about the name and address of the patient, drug name and strength, dosage form, quantity prescribed, directions for use, and name, address, and DEA number of the issuing practitioner (Rannazzisi, 2010). An agent of the practitioner may communicate to a pharmacist, but the practitioner is responsible for ensuring that the prescription conforms to the law and regulations.

The end result was that some patients in LTCFs were unable to receive analgesia in a timely manner. Some LTCFs have locked boxes of controlled substances that could be accessed when needed. Under the new interpretation, the nurse must call the pharmacist with a signed doctor's prescription before the box can be opened. There is the potential for delay if a nurse cannot get in touch with a physician, especially in the evenings or holiday. The NCPA stated that they would be willing to work with the DEA in creating a workable solution for all parties involved. What has happened since this editorial was written?