Fast Fact and Concept #94: Writing Discharge / Outpatient Opioid Prescriptions

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Title: Fast Fact and Concept #94: Writing Discharge / Outpatient Opioid Prescriptions

Author(s): Colleen Dunwoody ; Bob Arnold

Assuring continuity in pain relief in the outpatient setting or following hospital discharge is an important aspect of patient care. Patients suffer when prescriptions are written incorrectly. Please consider the following:

REGULATIONS Different states have different rules concerning controlled substances: amount of drug that may be dispensed, number of refills, fax orders and telephone prescriptions, and requirements for special prescription forms or blanks. Review your state regulations. See website below for state-by-state listing.

LEGIBILITY The DEA # and name must be legible. Print your name after your signature or otherwise indicate the spelling of your name on a personalized prescription.

FREQUENCY Consider if the frequency you are prescribing is the recommended frequency. Third party payers may not pay for medications prescribed to be taken more frequently than recommended in the literature. For example, Duragesic patches q48h and Oxycontin q8h may not be paid by insurers without a specific reason; Oxycontin and MS Contin may, and should, not be dispensed when the frequency is PRN or less than 8 hours.

STRENGTH There are more than two dozen combination opioids available; it is good practice to always write the correct strength for combination opioids (e.g. oxycodone/acetaminophen 5 mg/325 mg). Be sure the check the available pill/tablet doses when prescribing long acting opioids.

ACETOMINOPHEN Consider whether the 4000 mg/day maximum can be exceeded when writing the frequency. Most pharmacists will not dispense doses likely to exceed this recommended maximum daily dose.

TAMPERING Write the number after the numeric ?10? (ten) to prevent someone altering the prescription (e.g. changing 10 to 40 by changing a 1 to a 4).

SUBSTITUTIONS / CORRECTIONS The pharmacist will not substitute or correct an improperly written prescription, nor will a prescription for an opioid be filled when written on a prescription printed with "not for controlled substances". Thus if you write for 80 mg of MS Contin, the pharmacist will not fill it since the medicine is not available as a 80mg tablet.

COMMUNICATION When prescribing opioids that are infrequently used or in high doses, communicate with the pharmacist before the patient is discharged or leaves your office to assure availability. Pharmacists prefer communication from physicians and nurses in advance so medications can be stocked.


Pain and Policy Studies Group http://www.medsch.wisc.edu/painpolicy

Copyright/Referencing Information: Users are free to download and distribute Fast Facts for educational purposes only. Citation for referencing. Dunwoody C and Arnold R. Fast Facts and Concepts #94 Writing discharge/outpatient opioid scripts. July 2003. End-of-Life Physician Education Resource Center www.eperc.mcw.edu.

Disclaimer: Fast Facts provide educational information, this information is not medical advice. Health care providers should exercise their own independent clinical judgment. Some Fast Fact information cites the use of a product in dosage, for an indication, or in a manner other than that recommended in the product labeling. Accordingly, the official prescribing information should be consulted before any such product is used.

Creation Date: 7/2003

Format: Handouts

Purpose: Instructional Aid, Self-Study Guide, Teaching

Training: Fellows, 3rd/4th Year Medical Students, PGY1 (Interns), PGY2-6, Physicians in Practice
Specialty: Anesthesiology, Emergency Medicine, Family Medicine, General Internal Medicine, Geriatrics, Hematology/Oncology, Neurology, OB/GYN, Ophthalmology, Pulmonary/Critical Care, Pediatrics, Psychiatry, Surgery
Non-Physician: Nurses

ACGME Competencies: Patient Care, Practice-based Learning and Improvement, System-based Practice

Keyword(s): Addiction, Chronic non-malignant pain, Controlled substance regulations, Pain, Pain assessment, Pain treatment

The Fast Facts series is distributed for educational use only and does not constitute medical advice. For the most current version of Fast Facts visit the EPERC web site at www.eperc.mcw.edu. This mirror version is provided subject to copyright restrictions for educational use within the Inter-Instutional Collaborating Network on End-of-Life Care (IICN).