DEA/ FDA Regulations Re: Prescribing Methadone

[maggiepen]

11 years ago I underwent 2 crainiotomies to repair 3 cerebral aneurysms--one  of which had burst.  The surgery was successful, but I was left with a TBI and refractory  headaches. (moderate to severe) After many attempts, we discovered that methadone  was the most effective treatment.  I have had three successive doctors since then who've prescribed a regular monthly regime of the drug for me.

The last doctor, a neurologist, just accepted a new academic promotion and position several hundred miles from here.  What are the exact DEA/ FDA/ California State regulations governing  how often a doctor must see the patient to prescribe this medication?  Is it once every 30 days? 90 days?

Is there an exception/ provision for  patients who live far away?  Can "teleconferencing" or something along those lines be used instead of a physical visit?

I am looking for the precise language, if you could possibly guide me to it.  I don't know where to find it

Thank you very much for your help.

maggiepen

[maggiepen]

Oh--another brain injury "issue"  lousy spelling and typing.  Even when it comes to one's own name.  :-)

[maggiepen]

I just wanted to be sure  I was presenting "my case" clearly.  (After my brain injury, I've lost some e but not all confidence in my writing.  Much lower energy levels, poor memory,  etc has changed my writing  sometimes, so I tend to be extra careful about it.)

I have to say, I'm so impressed with this site and the people heree.  I bsically came  "in off the street" and asked a question, and right off was  give so much information that was useful to me.  I know it takes time to research issues like this, and ---believe me--I appreciate it.

I had an appt. with my neurologist yesterday, and I printed all these posts out for her.  She too was impressed.  She has a law student (I think) working on this too: if she finds anything helfpul and I hear about it, I'll pass it along.

I never used online support  groups until about 10 years ago when in desperation I found a brain injury online support site.  It saved my life.  I know what a life-saving and hope-giving role well-run forums--like yours-- can offer.  

maffiepen

[Tuckamore]

Please don't misunderstand me. I never for a moment thought that you were suggesting something not-so-ethical, never.

I was truly just expressing my opinions from how it may be viewed from a medical stand point. I did see your question as you meant to ask it. You're just looking for answer (in good faith) and are in need of a solution. You didn't have to put any more on "paper" or clarify that issue.  

I hope you didn't take my last response in any way that it was not meant to be. My intent was only to be helpful.

I will look forward to any additional information you can discover. We all learn from one another. ... We all try to support one another.... that's what this forum is all about.

My Best to You,
~Tuck

[maggiepen]

I'm rushing against the clock, so I haven't been taking as much time as I usually do writing.  You  raised two issues I've had on my mind, but didn't put down on paper.

I realized teleconferencing  isn't the same as physically seeing a patient.  Taking vitals, etc  And the opportunity for not-so-ethical behavior may be greater in that setting.  I probably should have raised that issue, but I hoped the care with which I wrote my first post would--I hoped!--demonstrated that I was asking in good faith.

The more you tell me, the better I see the big picture and understand the issues.   I am forwarding the information I got here to my doctor, and will keep researching.  If I find answers or relevant language, I promise to let you know.

Again, thank you for all your help.  I am very grateful.

maggiepen

[Tuckamore]

I don't think "teleconferencing" is regarded as "seeing" a patient. This is based on my experience and some knowledge of medical procedures.  

I know that there are some not--so--legal  or not so ethical "practitioners" that will prescribe via internet or teleconferencing.  That may change in time but today physicians want to have the opportunity to examine the patient and "see" them in person.  

I was not able to conquer this issue between the two states that I reside. I have to have TWO physicians. One in my home state and one in the state I reside when I am not in WI.  I must physically "see" them based upon each states laws/guidelines and the specific physicians guidelines.

I am not claiming to be an expert. I am not! This is just my opinion based on my experience and the reading I have done on this subject.

I hope you can come up with a correct answer.

Best of Luck,
~Tuck

[maggiepen]

And thank you for  your continuing efforts to find an answer.  I thought I was a pretty good researcher, but this turned out to be a pretty daunting task!  

I think we're getting closer to an answer.  Those links are very helpful.

It just seems to me in this day and age of doctors seeing patients in more than one city and doctors using teleconferencing  to "see" patients , I'd think there must be some doctors who treat patients  for whom they prescribe Schedule II drugs who've faced this long distance problem--and come up with a workable solution.  I just have to find them so I can ask them!

Again, I really appreciate your time and energy (and good judgment) you've spent helping me on this question.  I'm grateful.

maggiepen

[maggiepen]

I appreciate your research and reply--which I'm adding to my own.  If I find a definite answer, I'll let you know.

maggiepen

[geminigirl1963]

Thank you, Tuck, for pointing out the information regarding hard copy prescriptions is for all Schedule II narcotics - I had meant to mention that in my answer and neglected to.

I'm presuming that the information on the site that I mentioned is not only for methadone, but in particular methadone prescribing in California.  The only reason I'm saying that is because the person who gave the answer on that site is an associate professor of clinical pharmacy IN California.  However, of course, I don't know for sure and very wellI may be very wrong on that.

I wish you the best of luck in finding the answers to your question/s.

[Tuckamore]

I did some searching on the prescription Laws in CA and found this: "It is important to note that the management of patients with controlled substances requires monthly, quarterly, or semiannual visits as required by the standard of care. "  This comes under the heading of Periodic Review.

I found it on a site called, "State Opioid Prescribing Policy: California" I read the entire law and could not locate a specific references to Methadone. This law covers Schedule II Opiates.... which we know is what Methadone is considered.  Here's the link:
http://www.medscape.com/resource/opioid/opioid-california

I cannot find anything else on Methadone specifically in CA unless it applies to the drug rehabilitation use of Methadone. There are several sites.

Here is a link to the actual written law for physicians, etc that write opiate prescriptions in CA: http://www.mbc.ca.gov/laws/laws.html

I hope this helps. Please let us know.

Wishing you the Best,
~Tuck

[Tuckamore]

The information Geminigirl provided is accurate to my knowledge.

However this is true for every Schedule II controlled substance .... which includes Oxycodone. Oxycontin, Methadone, MS Contin and so forth. In my home-state (WI) my prescribing physician (PCP) requires that I see him every 3-4 months. In FL where I spend 6-7 months a year I must be seen every month by my PMP. I believe the state (FL)  requires a monthly visit.  

So if that is your question the answers are above from both Geminigirl and myself. The tricky part of your question is Methadone treated the same as all Schedule II controlled substances in every state. According to what I have read on this forum it isn't.

However I will try to find an answer for you regarding CA law. If you find it first please let us know.  

Peace,
~Tuck

[geminigirl1963]

I just found this information and hope it's helpful.  From what it says, it sounds like, while your doctor CAN make the decision to only see you in person every 60-90 days (or however long in between visits they deem necessary for treatment of your pain/condition), the prescription for methadone can only be written for a 30 day supply at a time. In other words, since the methadone requires a hard copy prescription, you would still need to go to the office to pick up that prescription every 30 days whether you actually see the doctor at that time or not.

http://www.caring.com/questions/doctor-appointment-for-methadone

[maggiepen]

I appreciate your reply even though you didn't know the answer.  I did ask my Pharmacist (who is very conscientious, smart, and helpful), but he didn't really have a precise answer.  Anecdotal answers won't help me.

This is difficult.  I'd look it up myself, but I don't know the name of the document I should use.

I tend to believe that in this day and age,, provisions may have been made to use the computer instead of in person appointments.  But that's just my feeling.

If I find out, would you like to know?

maggipie  

[Tuckamore]

Hi Maggipie,

Sorry, I don't have the answer to your question. I think your local Pharmacist would have this information. If not they will probably get it for you. They are the true experts in medication and prescribing law and best of all their service is free.

I hope you are able to find the answers.

Good Luck,
~Tuck