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New Jersey News: Special Exceptions on Narcotic Prescriptions for Chronic Pain Management
Reprinted from the October 2006 New Jersey Board of Pharmacy Newsletter.
A regulation of the New Jersey Board of Medical Examiners permits practitioners to exceed the normal 120 dosage unit or 30-day supply limit (whichever is shorter) when prescribing Schedule II CDS for the management of chronic pain, and thereby for pharmacists to fill and dispense such prescriptions. NJAC 13:35-7.6 allows the normal limits to be exceeded for the chronic management of cancer pain, intractable pain, or terminal illness, so long as the practitioner meets certain criteria. The practitioner is permitted to exceed the 120 dosage unit limit provided that a treatment plan is designed that includes written treatment objectives and criteria for evaluating treatment success. The 30-day limit may be exceeded if an implantable infusion device is used; in which case, the prescription can be written for a 90-day supply of drug so long as the practitioner evaluates and documents the continued need for the medication every 30 days. If chronic pain management in a given patient extends beyond three months, the practitioner must review the treatment plan and patient progress toward meeting treatment objectives, and consider appropriate alternative treatment options.
Importantly, the dispensing pharmacist should understand that he or she bears a corresponding liability. NJAC 8.65-7.5 addresses the information that must be included on all prescriptions for CDS, and states that “[a] corresponding liability rests upon the pharmacist who fills a prescription not prepared in the form prescribed by these rules.” With respect to chronic pain management, if the prescription does not include an indication as described above, the pharmacist should contact the prescriber, confirm the indication, and document the indication on the original prescription.
