Washington News: Schedule II Controlled Substance Prescriptions

October 1, 2006 3:36 PM Topics: Controlled substances and Prescriptions

Published in the October 2006 Washington State Board of Pharmacy Newsletter

A question we frequently receive: In an emergency, can a pharmacist dispense a Schedule II substance with oral authorization from the prescriber?

The general rule for Schedule II CS is that the pharmacist must have a written prescription prior to dispensing the medication. Federal and state rules permit an exception when the immediate administration of the medication is necessary for proper treatment and no alternative treatment is available; furthermore, it is not possible for the physician to provide a written prescription for the drug at that time. DEA specifies in 21 CFR §1306.11 four requirements for an emergency Schedule II CS prescription.

1. The quantity is limited to the amount adequate to treat the patient during the emergency;
2. The pharmacist shall immediately reduce the oral prescription to writing;
3. The pharmacist must verify the authenticity of the prescriber; and
4. Within seven days after emergency prescription, the prescriber must deliver a signed prescription to the dispenser.

Requirement No. 4 is at odds with the Washington State rule, WAC 246-887-020(6), which states “must deliver a signed prescription to the dispenser within 72 hours.” Until the Board’s rule can be amended, the Board will not enforce the 72 hour limit. The written prescription must be received from the practitioner within seven days.

Another commonly asked question: When may a practitioner fax a Schedule II CS prescription to a pharmacy for dispensing? There are three situations identified by the Uniform Controlled Substances Act RCW 69.50. According to RCW 69.50.308:

1. The prescriber may fax a Schedule II prescription for a patient in a long-term care facility;
2. The prescriber may fax a Schedule II prescription for a patient enrolled in a hospice program certified by Medicare or licensed by the state; and
3. The prescriber may fax an injectable Schedule II prescription to be compounded for patient use by a pharmacy.

The faxed Schedule II prescription shall serve as the original pre¬scription and be kept with other Schedule II prescriptions for two years. Schedule II CS prescriptions may not be refilled.