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Ohio News: Optometrists and Controlled Substances
Published in the August 2008 Ohio State Board of Pharmacy Newsletter
The Ohio State Board of Optometry rule that deals with optometrists’ prescribing of controlled substances for pain was due to go before the Joint Committee on Agency Rule Review (JCARR) on July 14. At the time of this writing, it appeared that there would be no problems with final approval of the rule by JCARR. Ten days after a rule leaves the jurisdiction of JCARR, it may be made effective. Therefore, unless something unexpected happened between the time this article was written and the time it is being read in early August, the rule should be in effect. After the rule is in effect, the optometrists will still have to register with Drug Enforcement Administration (DEA) before they may begin prescribing Schedule III controlled substances for pain. Please make sure the optometrists have a valid DEA number before you fill any controlled substance prescriptions written by them. It is not clear at this time just how many of the optometrists will actually get a DEA number. Many of them currently see no need in their practice settings to issue prescriptions for Schedule III substances. Therefore, pharmacists should not expect all optometrists to have a DEA number.
Those who do register with DEA will be able to prescribe only products containing no more than 60 mg of codeine combined with another product (eg, Tylenol® #4) or products containing no more than 7.5 mg of hydrocodone combined with another product (eg, Vicodin® ES). Please note the limit on the hydrocodone products. Optometrists will not be able to prescribe any product containing 10 mg of hydrocodone. If that happens, the pharmacist should first contact the optometrist and, if that does not resolve the issue, then contact either the Optometry Board or the Board of Pharmacy.
In addition to the limitation on the products, there is also a limitation on the amount of Schedule III products that may be prescribed. According to the proposed rule, optometrists will only be able to prescribe a four-day quantity of Schedule III pain medications one time for a given patient problem. If the pain persists beyond that four-day period, it will be necessary for the optometrist to refer the patient to a physician for additional treatment.
Finally, the rule clearly specifies that the only Schedule III substances that may be prescribed by an optometrist are those that have an indication for the treatment of pain in the Food and Drug Administration (FDA)-approved package insert. That means that pharmacists should not see any prescriptions for cough syrups with codeine or hydrocodone unless they happen to also bear the indication for pain.
Please note that optometrists are in a unique position when compared to other prescribers in Ohio. Optometrists may only write for a few Schedule III controlled substances. They will not be allowed to write for controlled substances in any other schedule (ie, no Schedule II, Schedule IV, or Schedule V products).
