Controlled Substance Laws Research Articles

Competitive effects of federal and state opioid restrictions: Evidence from the controlled substance laws

A significant concern in the policy landscape of the U.S. opioid crisis is whether supply-side controls can reduce opioid prescribing without harmful substitution. We consider an unstudied policy: the federal Controlled Substance Act (CSA) restrictions placed in August 2014 on tramadol, the second most popular opioid medication. This was followed seven weeks later by CSA restrictions for hydrocodone combination products, the leading opioids on the market. Using regression discontinuity design (RDD) models, based on the timing of the (up-)scheduling changes, to explore spillover effects, we find that tightening prescribing restrictions on one opioid reduces its use, but increases prescribing of close competitors, leading to no reduction in total opioid prescriptions.This suggests that supply restrictions are not effective in reducing opioid prescribing the presence of close substitutes that remain unrestricted.

Dimension reduction of 911 Good Samaritan Laws: Drawing inferences from policy surveillance

Background911 Good Samaritan Laws (GSLs) extend legal protection to people reporting drug overdoses who may otherwise be in violation of controlled substance laws. Mixed evidence suggests GSLs decrease overdose mortality, but these studies overlook substantial heterogeneity across states. The GSL Inventory exhaustively catalogs features of these laws into four categories: breadth, burden, strength, and exemption. The present study reduces this dataset to reveal patterns in implementation, facilitate future evaluations, and to produce a roadmap for the dimension reduction of further policy surveillance datasets. MethodsWe produced multidimensional scaling plots visualizing the frequency of co-occurring GSL features from the GSL Inventory as well as similarity among state laws. We clustered laws into meaningful groups by shared features; produced a decision tree identifying salient features predicting group membership; scored their relative breadth, burden, strength, and exemption of immunity; and associated groups with state sociopolitical and sociodemographic variables. ResultsIn the feature plot, breadth and strength features segregate from burdens and exemptions. Regions in the state plot differentiate quantity of substances immunized, burden of reporting requirements, and immunity for probationers. State laws may be clustered into five groups distinguished by proximity, salient features, and sociopolitical variables. DiscussionThis study reveals competing attitudes toward harm reduction that underly GSLs across states. These analyses provide a roadmap for the application of dimension reduction methods to policy surveillance datasets, accommodating their binary structure and longitudinal observations. These methods preserve higher-dimensional variance in a form amenable to statistical evaluation.

Have Recent Controlled Substance Laws Affected Disciplinary Actions of Nevada Professional Licensing Boards?

The Nevada Legislature has implemented laws which have increased prescribing mandates for controlled substances, specifically: State Bill (SB) 459 implemented on January 1, 2016 and Assembly Bill (...

Using MyDispense to simulate validation of controlled substance prescriptions in a pharmacy law course

Background and purposeMyDispense is an innovative, web-based program which simulates a community pharmacy. Use of this software may assist students' comprehension of validating controlled substance prescriptions by determining if prescriptions contain errors or omissions. Educational activity and settingFourteen MyDispense practice exercises were created and implemented into a required second-year pharmacy law course. Completion of the MyDispense exercises and performance on the pharmacy law midterm exam were recorded. A questionnaire was administered to students to receive feedback on the exercises. FindingsThere were complete data on all 94 student pharmacists enrolled in the didactic course. Thirty-five students (37%) completed all MyDispense exercises, 15 students (16%) completed some of the exercises, and 44 (47%) did not complete any of the exercises. Linear regression results indicate that students who completed more MyDispense exercises were significantly more likely to score higher on the midterm than those who completed fewer exercises (β = 0.28, p = 0.02). Students reported moderate to high exercise value and a willingness to use the software in preparation for future pharmacy law examinations. SummaryMyDispense provided a platform for students to apply controlled substance laws to the prescription validation process in the community pharmacy setting. Completion of practice exercises in MyDispense was shown to positively impact student performance on a pharmacy law midterm. Students valued the innovative simulation tool and were willing to access the tool again to prepare for future examinations.

Do Current Policies and Practices for Prescribing Opioid Medications Solve Chronic Pain Problems?

Despite the widespread prescribing of opioid medications for the treatment of chronic pain, there is little or no evidence for its efficacy. In fact, the studies show that long-term prescribing of opioid medications leads to significant morbidity and mortality. The Controlled Substance Laws define prescription opioids as dangerous and addicting medications. Despite the classification and scheduling of opioid medication, their prescribing continues to be common and adverse. Most importantly, there are few studies addressing the addicting properties that drive the high rates of prescribing and adverse consequences. It is a myth that most people treated with opioids never become addicted and that addiction does not develop if you are prescribing for pain. [ Psychiatr Ann . 2015;45(10):500–505.]

Current “Legal Highs”

BackgroundA growing number of novel substances have been abused as recreational drugs by young people in the United States (US), Europe, and Australia. Called “legal highs,” these substances range from plant-based to completely synthetic compounds. Spice, Salvia, mephedrone, methylenedioxypyrovalerone (MDPV), and other cathinone derivatives have psychotropic effects and are marketed for recreational use through exploitation of inadequacies in existing controlled substance laws. ObjectivesThis article reviews available literature on the most common “legal highs” as well as discussing the scientific basis for the legal difficulties in controlling trafficking in these novel substances. Conclusions“Legal highs” continue to increase in use in the US, Europe, and Australia. These substances are powerful, can mimic effects of more traditional drugs of abuse, and are intentionally manufactured to circumvent existing controlled substance laws. As controlled substance legislation may be inadequate in the face of the quickly evolving legal highs, physicians are likely to see an increase in the prevalence of legal highs.

Drug Enforcement Administration Liability for False Arrest of Physician

Prescribing opioid analgesic medications brings with it a risk of regulatory oversight. A Florida Physician, Dr. Andrew Nguyen, was arrested in 2000 for allegedly violating controlled substance laws. The allegation was that Dr. Nguyen had not conducted a physical examination of a patient for whom controlled substances were prescribed. The allegation was untrue, and the charges against Dr. Nguyen were dismissed. Dr. Nguyen successfully sued the local law enforcement authorities, but a companion lawsuit against the Drug Enforcement Agency (DEA) was dismissed. The United States Court of Appeals has now reinstated Dr. Nguyen's lawsuit against the DEA. The reinstatement of the lawsuit corrects a moral hazard that produces imbalanced regulatory perspectives on the enforcement of controlled substance laws.

Failure of controlled substance laws in health policy

Failure of controlled substance laws in health policy

Evaluation of State Schedule II Controlled Substance Laws

Background: States have the authority to mandate laws that are more stringent than federal law, which often results in important differences in prescribing and dispensing patterns throughout the country. Objective: To evaluate schedule II controlled substance laws in all 50 states, the District of Columbia, and Puerto Rico to identify important differences. Methods: The current state laws and regulations regarding controlled substances were evaluated using the following criteria: whether prescription expirations dates are mandated, whether partial fills are permitted, whether changes can be made to prescriptions after consulting with a physician, whether maximum days' supplies are mandated, and whether pharmacists can dispense emergency oral prescriptions. Results: Thirty-nine states and Puerto Rico (77%) mandate prescription expiration dates. Partial filling is permitted in all states, the District of Columbia, and Puerto Rico (100%). All 50 states and the District of Columbia (98%) permit pharmacists to make prescription changes after consulting with the physician. Nine states (17%) have mandated maximum days' supplies that a physician may prescribe. All 50 states, the District of Columbia, and Puerto Rico (100%) permit pharmacists to dispense drugs in an emergency situation with verbal prescription. Conclusions: Pharmacists should be aware that differences exist among the states, the District of Columbia, and Puerto Rico regarding Schedule II controlled substance laws. Understanding these differences is fundamental to the profession.

Failure of Enforcement Controlled Substance Laws in Health Policy for Prescribing Opiate Medications: A Painful Assessment of Morbidity and Mortality

Controlled substances can be used for legitimate medical purposes to relieve pain and suffering, and allow management of medical and surgical conditions, whether acute or chronic in duration. However, because these are attractive, addicting drugs, diversion from sources such as physicians and pharmacists can lead to serious health problems. Of importance is that addiction to opiate medications can interfere with treatment of the original pain condition, and can lead to life threatening states because of poor judgment and depressed mood in the users. Consequently, the public has a vested interest in protecting the medical uses of these medications on the one hand, although reducing the morbidity and mortality from their diversion and addictive use. The controlled substance laws contain 3 sources of policy framework that governs the medical use and diversion of controlled substances: (1) international treaties, (2) federal laws and regulations, and (3) state laws and regulations. These laws are aimed at balancing the need to controlling use with adverse consequences against the therapeutic benefits opiate medications provide the public.

Physicians and the Controlled Substance Laws for Opiate Prescription Medications

<p>Physicians are in a unique position to assess and treat people who seek evaluation and treatment for medically related health problems associated with drug and alcohol use and addiction. Well-known medical complications result from drug disorders, including addiction to opiates. Addictions are too numerous to cite but prominently include widespread medical diseases.</p> <h4>ABOUT THE AUTHOR</h4> <p>Dr. Miller is clinical professor, Department of Medicine, Michigan State University, East Lansing, MI.</p> <p>Address reprint requests to: Norman S. Miller, MD, JD, 321 Woodland Pass, Suite 300, East Lansing, MI 48823; or e-mail <a href="mailto:norman.miller@hc.msu.edu">norman.miller@hc.msu.edu</a>.</p>

A survey of physicians' knowledge about pain therapy with strong opioid analgesics

The WHO analgesic ladder, including the use of strong opioid analgesics for the treatment of cancer pain, is widely accepted. However, the use of opioids for the treatment of non-cancer pain is still controversial. This study investigates doctors' medical knowledge about basic aspects of pain management. Additionally, we determined whether the deficiencies in the treatment of patients suffering from pain are based on the rigorous national narcotic control system in Germany. We investigated the juridical and technical knowledge of physicians specializing in pain therapy by a questionnaire. During a postgraduate course the knowledge about pain therapy according to the WHO analgesic ladder and the beliefs concerning the narcotic regulations in Germany were evaluated. The survey participants were asked to rate their attitudes on a 10-point analogue scale (1=disagreement, 10=full agreement). The participants were also asked to indicate occupational criteria such as specialty, clinical practice area, and postgraduate years of practice. Descriptive statistics for the mean values were used. One hundred and forty-three questionnaires were completed. The majority of participants worked at departments of anaesthesiology. Some 51.1% of the participants had no specific multiple-copy prescriptions for opioid analgesics. Only 72% of the physicians knew from which governmental institution they could order multiple-copy prescriptions. In general, more doctors would prescribe opioids by the use of normal forms. The controlled substance laws were seen as an impediment by the majority of participants, without relevant differences as to their years of practice. The regulations were regarded as ineffective protection against illegal use of opioids. Treatment of pain with strong opioid analgesics was seen as beneficial for the patients. The use of strong opioids for long-term treatment was recommended, and psychological addiction was regarded as non-existent. Therapy with strong opioids is accepted practice, but significant deficits of legal and technical knowledge uphold the undertreatment of patients suffering from cancer and non-cancer pain. Patients with a legitimate need for pain relief by strong opioids are the unintended victims of tight narcotic regulations and deficits in medical education. An ease of regulatory conditions is mandatory to reduce the reluctance for prescribing opioids. On the other hand intensified continuous medical education is mandatory to reduce the undertreatment of patients with severe pain conditions.

On Mounting Delicate Bryophytes in Glycerol

Glycerine jelly is an effective substitute microscopic mounting medium for now difficult-to-obtain gum chloral preparations. It does not collapse most thin bryophyte tissues, preserves color responses of cell walls to potassium hydroxide solution, and is made from easily obtained, non-poisonous ingredients. Like other glycerol-based mountants, it evaporates only very slowly and, with luting, is essentially permanent. The study slide is a valuable adjutant to research in bryology. A well labeled permanent or semi-permanent preparation allows repeated examination of morphological traits that allows serial comparisons during revisionary work and serves to reinforce poorly remembered distinctions or illuminate vaguely worded keys during routine identification. For critical species, I find two slides, each with two coverslip-protected mounts, provide space for mounting moss capsules, perichaetia, perigonia, habit (of smaller species), and sections of stem and leaves in a manner that allows subsequent illustration if needed. As anyone who has worked with microscopic mounts knows, taking the time to prepare a slide well saves much time and frustration in the long run. To this end, I have pursued (Zander 1982, 1983, 1993) a better slide medium than gum chloral preparations such as Hoyer's Solution (Anderson 1954), which have severe osmotic effects in many bryophyte species. In addition, chloral hydrate is presently governed under controlled-substance laws in the U.S.A. and good-quality powdered gum arabic is now difficult to obtain. Glycerine jelly has been used for many years as a bryological microslide mountant (Gatenby & Beams 1950; Gray 1954; Murray 1926) but has been superseded in bryological work to a great extent by Hoyer's Solution (Anderson 1954), which is more convenient to work with since it does not need to be heated. Hoyer's Solution and its variants are likewise made with glycerol, and thus last for many years since glycerol has a very low vapor pressure (boiling point 2900C). The high index of refraction of glycerol (much higher than that of cellulose), makes mounted tissue easy to observe un-

Legal bases for the control of analgesic drugs

Governments throughout the world have struggled for decades to ensure the availability of narcotic analgesics for legitimate medical and scientific purposes while controlling the abuse and illegal diversion of such substances. While the international drug-control system has effectively limited illicit trafficking of opioids, concerns remain about its effectiveness in ensuring the availability of these drugs for legitimate purposes. In the United States, federal legislation accommodates the use of controlled substances for medical and scientific purposes more effectively than does state law. Many states' controlled substance laws hinder appropriate opioid prescribing through (a) the use of ill-defined terms, (b) restriction of pain prescriptions to a specific number of dosage units; and/or (c) utilization of multiple-copy prescription programs. A more efficient state approach to monitoring inappropriate schedule II prescribing and dispensing may be through an electronic, computer-based pharmacy point-of-sale system, through which pharmacists can be alerted instantaneously to patients receiving the same drug from multiple pharmacies. In addition, states should consider modifying their approaches to drug abuse by adopting the revised Uniform Controlled Substances Act and/or establishing state pain initiatives.

Representative Sampling of Drug Seizures in Multiple Containers

Abstract Exhibits of illicit drugs in a large number of containers are frequently submitted to crime laboratories. The forensic chemist often needs to select randomly and then examine a number of these containers to provide information regarding the composition of the overall exhibit which is sufficient to support the requirements of the criminal justice system. Although various methods of sampling can be shown to provide samples that will allow statistical inferences to be made with a high degree of confidence, no procedure has been identified that specifically meets the sampling objectives associated with an exhibit of this sort. The authors have addressed this sampling problem by applying the probability theory of the hypergeometric distribution to the sampling of drug exhibits contained in multiple containers. The resulting model will permit strong probability statements to be made regarding the presence of the controlled substance in a predetermined quantity of the exhibit, thereby supporting the prosecution and sentencing of violators of controlled substance laws.