Self-prescribing

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Yes I definitely figured he thought that’s what it was for but I don’t know why you would want to restrict me, even if I was a heroin user, from getting clean needles.
It's because you are so sketch! Rolling up in your MB, with your red soled shoes, well done hair, and looking like a "before" picture of Heather Locklear! You TOTALLY look the part of a wasteoid!

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Yes I definitely figured he thought that’s what it was for but I don’t know why you would want to restrict me, even if I was a heroin user, from getting clean needles.

Restricting needles to discourage heroin use makes about as much sense as restricting birth control to encourage abstinence.
 
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The two are not mutually exclusive. I actually had a good friend who was a pharmacist who apologized about not being able to fill anything for my dog at one point.
Why couldn’t they fill anything for your dog? The mark up for medications at your vet or those specialty vet pharmacies is ridiculous especially for things that are common and cost pennies on the human side.
It's because you are so sketch! Rolling up in your MB, with your red soled shoes, well done hair, and looking like a "before" picture of Heather Locklear! You TOTALLY look the part of a wasteoid!
LOL...

I don’t know about that. Maybe more like Locklear mug shots of late.
 
Why couldn’t they fill anything for your dog? The mark up for medications at your vet or those specialty vet pharmacies is ridiculous especially for things that are common and cost pennies on the human side.
Because I'm not a vet. Our state laws are quite clear. I can prescribe for humans, that's it. Same way they'd turn down the prescription if a vet wrote for their spouse or kid.

For what its worth, your vet can call in meds to a people pharmacy - I will use Publix sometimes for dog meds. But my vet's mark up isn't that bad. Only a few dollars more on average compared to the wholesale price when I had my dispensary.
 
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Because I'm not a vet. Our state laws are quite clear. I can prescribe for humans, that's it. Same way they'd turn down the prescription if a vet wrote for their spouse or kid.

I see I thought you meant in general I didn’t realize you were talking about writing the script yourself.

For what its worth, your vet can call in meds to a people pharmacy - I will use Publix sometimes for dog meds. But my vet's mark up isn't that bad. Only a few dollars more on average compared to the wholesale price when I had my dispensary.

That’s not what the vet forum members say; they say places like one 800 Med’s undercut them by a lot.
 
I see I thought you meant in general I didn’t realize you were talking about writing the script yourself.



That’s not what the vet forum members say; they say places like one 800 Med’s undercut them by a lot.
Well it is still in general. In South Carolina the Code of Laws says stuff like this:

(36) "Practice of Medicine" means:

(b) offering or undertaking to prescribe, order, give, or administer any drug or medicine for the use of any other person;

(c) offering or undertaking to prevent or to diagnose, correct or treat in any manner, or by any means, methods, or devices, disease, illness, pain, wound, fracture, infirmity, defect, or abnormal physical or mental condition of a person, including the management or pregnancy and parturition;

(d) offering or undertaking to perform any surgical operation upon a person;

Conversely, here's what it says about vets:

(13) "Practice of veterinary medicine" means to:

(a) diagnose, prescribe, or administer a drug, medicine, biologic, appliance, or application or treatment of whatever nature for the cure, prevention, or relief of a wound, fracture, or bodily injury or disease of an animal;

(b) perform a surgical operation, including cosmetic surgery, upon an animal;

(c) perform a manual procedure for the diagnosis or treatment for sterility or infertility of an animal, including embryo transplants;

(d) offer, undertake, represent, or hold oneself out as being qualified to diagnose, treat, operate, or prescribe for an animal disease, pain, injury, deformity, or physical condition;

So yeah, if I write a prescription for an animal not only am I breaking the law but so would a pharmacist if they filled it.

As for prices, it does very greatly among vets. There's a buccal form of Precedex for dogs who are freaked out by loud noises (fireworks, bad storms) that we use on our golden. In Columbia it was costing me $50/tube. Here in the upstate I'm paying $30/tube. Its $27 on 1800petmeds.

As for comparable human prices. We used to get Keflex a lot for cellulitis 2/2 allergies. 56 tablets ran us about $10-12. I could get that same amount from my wholesaler for about $7-8.

Now I do know the markup is much higher for heartworm/flea prevention meds - that is quite a bit. I just paid $300 for both, on 1800petmed they're about $150-175.
 
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Well it is still in general. In South Carolina the Code of Laws says stuff like this:

(36) "Practice of Medicine" means:

(b) offering or undertaking to prescribe, order, give, or administer any drug or medicine for the use of any other person;

(c) offering or undertaking to prevent or to diagnose, correct or treat in any manner, or by any means, methods, or devices, disease, illness, pain, wound, fracture, infirmity, defect, or abnormal physical or mental condition of a person, including the management or pregnancy and parturition;

(d) offering or undertaking to perform any surgical operation upon a person;

Conversely, here's what it says about vets:

(13) "Practice of veterinary medicine" means to:

(a) diagnose, prescribe, or administer a drug, medicine, biologic, appliance, or application or treatment of whatever nature for the cure, prevention, or relief of a wound, fracture, or bodily injury or disease of an animal;

(b) perform a surgical operation, including cosmetic surgery, upon an animal;

(c) perform a manual procedure for the diagnosis or treatment for sterility or infertility of an animal, including embryo transplants;

(d) offer, undertake, represent, or hold oneself out as being qualified to diagnose, treat, operate, or prescribe for an animal disease, pain, injury, deformity, or physical condition;

So yeah, if I write a prescription for an animal not only am I breaking the law but so would a pharmacist if they filled it.

As for prices, it does very greatly among vets. There's a buccal form of Precedex for dogs who are freaked out by loud noises (fireworks, bad storms) that we use on our golden. In Columbia it was costing me $50/tube. Here in the upstate I'm paying $30/tube. Its $27 on 1800petmeds.

As for comparable human prices. We used to get Keflex a lot for cellulitis 2/2 allergies. 56 tablets ran us about $10-12. I could get that same amount from my wholesaler for about $7-8.

Now I do know the markup is much higher for heartworm/flea prevention meds - that is quite a bit. I just paid $300 for both, on 1800petmed they're about $150-175.
I appreciate all the information but I think we’re talking about two different things. I thought you said your pharmacist was refusing to fill a prescription For your pet.

I assume the prescription was from your vet not from you and I thought your pharmacist was saying you had to go to the vet nary pharmacy or the vet to fill it. I didn’t think you were writing the prescription.

My whole issue with this was a pharmacist trying to require a prescription for an item that doesn’t require a prescription and then being a jerk about it when I pulled out a prescription pad.
 
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I appreciate all the information but I think we’re talking about two different things. I thought you said your pharmacist was refusing to fill a prescription For your pet.

I assume the prescription was from your vet not from you and I thought your pharmacist was saying you had to go to the vet nary pharmacy or the vet to fill it. I didn’t think you were writing the prescription.

My whole issue with this was a pharmacist trying to require a prescription for an item that doesn’t require a prescription and then being a jerk about it when I pulled out a prescription pad.
Ohhhhhhh. OK yeah I 100% missed that.

I've never had a problem with a retail pharmacy if the vet wrote the script.

Pharmacists can be weird about syringes. Not sure their OTC status here, but I've definitely gotten push back on this before as well.
 
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As a general rule of ethics I only prescribe myself Perc 10's, perc 15's would probably raise some flags
 
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I prescribe for myself very occasionally. Who wants to tell their attending they have a yeast infection, bv, etc? Not me!

I also think it's even more unethical to prescribe something for a patient (resident) that you haven't examined and counseled.
 
I prescribe for myself very occasionally. Who wants to tell their attending they have a yeast infection, bv, etc? Not me!

I also think it's even more unethical to prescribe something for a patient (resident) that you haven't examined and counseled.

... these two statements are quite incongruent.

You don’t think it’s right to do it, but your own rules don’t apply to yourself? Who’s examining and counseling you... yourself?
 
... these two statements are quite incongruent.

You don’t think it’s right to do it, but your own rules don’t apply to yourself? Who’s examining and counseling you... yourself?
You know what your own symptoms are and can easily examine yourself for lots of problems.
 
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... these two statements are quite incongruent.

You don’t think it’s right to do it, but your own rules don’t apply to yourself? Who’s examining and counseling you... yourself?

Huh?
Yes of course. I've mostly treated myself for gyn things and yes I examine myself by doing over the counter UTI tests for example and/or looking at my body in the mirror. I'm assuming you're not a woman? Trust me, we can examine ourselves, especially being a doctor and all.

I also always look up side effects if I'm going to prescribe a med. Obviously I'm not literally talking to myself! I'm pretty sure I counsel myself better than some doctors counsel their own patients :)

If I were to either die or have a severe reaction to a medication I prescribed myself it's not like I'd sue myself. On the other hand if someone had an adverse reaction to something an attending prescribed without examining their resident, absolutely the family could sue for not having the proper documentation regarding an exam and counseling about the med prescribed.

So no, I don't think my statements are incongruent at all.
 
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Do residents have unlimited authority to prescribe? I would not advise any resident to engage in that kind of conduct...
 
Do residents have unlimited authority to prescribe? I would not advise any resident to engage in that kind of conduct...
realize that under a training license, you prescribe under an institutional DEA unless you have your own DEA. You have to have an unrestricted, full state license to get your own DEA. Yes, residents can write for anything, but you are doing so under someone else's DEA.
 
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realize that under a training license, you prescribe under an institutional DEA unless you have your own DEA. You have to have an unrestricted, full state license to get your own DEA. Yes, residents can write for anything, but you are doing so under someone else's DEA.
Not always true, I had a full DEA under a training type license.
 
I'm starting my pgy1 year in July, and out of curiosity, I was wondering what the legalities / ethics is behind prescribing non-controlled substances to oneself. Ie. Flonase, or Claritin. Obviously not any super serious meds, and definitely not Benzos or opioids. Sorry for my ignorance; I know it's probably frowned upon, but prescribing allergy meds for myself seems very benign. I've read some posts here about self-prescribing, but they're circa 2009. I was wondering if laws / consensus has changed since. Thanks!
If it's not controlled, nobody cares. But please don't prescribe yourself and your family anything which is controlled.
 
@bizdr But how does one do that when you don't have a prescription pad.

Not that I would know anything about this <ahem>, but you can call in prescriptions as long as you know your NPI number. In most outpatient clinics, the staff (i.e. the medical assistant, nurse, LPN) actually call in the prescriptions for the physician, once the physician approves the refill request.

(Obligatory note: I am not condoning this kind of behavior, if your family member or yourself needs a prescription then they should see a doctor, everyone should have a physician that they can trust with their health in any case, etc.)
 
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Not that I would know anything about this <ahem>, but you can call in prescriptions as long as you know your NPI number. In most outpatient clinics, the staff (i.e. the medical assistant, nurse, LPN) actually call in the prescriptions for the physician, once the physician approves the refill request.

(Obligatory note: I am not condoning this kind of behavior, if your family member or yourself needs a prescription then they should see a doctor, everyone should have a physician that they can trust with their health in any case, etc.)
The system is pretty lax then. I had my NPI# before I even got my resident physician license. Everyone can go online and see any doc's NPI#.
 
you do still need a DEA...the pharmacist can pull up your DEA with your NPI.
Not if it isn't a controlled substance. There's doctors who don't even have DEA numbers and still work just fine. It's actually against DEA policy to require the number for anything that isn't scheduled.
 
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Not if it isn't a controlled substance. There's doctors who don't even have DEA numbers and still work just fine. It's actually against DEA policy to require the number for anything that isn't scheduled.
Yep. I always use my DEA when phoning stuff in, but that's just because I have that memorized while I don't know my NPI.
 
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Not if it isn't a controlled substance. There's doctors who don't even have DEA numbers and still work just fine. It's actually against DEA policy to require the number for anything that isn't scheduled.

You have a link/reference for that? In no way saying I don't believe you, just haven't come across it before and would be a nice thing to know when invariably it comes up with pharmacy...
 
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Not if it isn't a controlled substance. There's doctors who don't even have DEA numbers and still work just fine. It's actually against DEA policy to require the number for anything that isn't scheduled.
really? did not know this...is this new? When i applied for my DEA, I had to specify what scheduled drugs I wanted to the DEA to cover...Schedule II drugs are the only ones I know that have to have a DEA printed on the script, but still thought you needed an active DEA to prescribe the others.
 
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You have a link/reference for that? In no way saying I don't believe you, just haven't come across it before and would be a nice thing to know when invariably it comes up with pharmacy...
https://www.deadiversion.usdoj.gov/faq/prescriptions.htm#rx-5

To quote:
" DEA strongly opposes the use of a DEA registration number for any purpose other than the one for which it was intended, to provide certification of DEA registration in transactions involving controlled substances. The use of DEA registration numbers as an identification number is not an appropriate use and could lead to a weakening of the registration system. Although DEA has repeatedly made its position known to industries such as insurance providers and pharmacy benefit managers, there is currently no legal basis for DEA to prevent or preclude companies from requiring or requesting a practitioner's DEA registration number.


The Centers for Medicare and Medicaid Services has developed a National Provider Identification (NPI) number unique to each healthcare provider. The Final Rule for establishment of the NPI system was published in the Federal Register (FR 3434, Vol. 69, No. 15) by the Department of Health and Human Services on January 23, 2004. The effective date of this Final Rule was May 23, 2005; all covered entities were to begin using the NPI in standard transactions by May 23, 2007. A contingency extension was provided to covered entities unable to meet the 2007 deadline. Contingency plans were to not extend beyond May 23, 2008."

really? did not know this...is this new? When i applied for my DEA, I had to specify what scheduled drugs I wanted to the DEA to cover...Schedule II drugs are the only ones I know that have to have a DEA printed on the script, but still thought you needed an active DEA to prescribe the others.
Schedule II-V drugs are the ones you checked off. Most drugs are entirely unscheduled. Schedule V is stuff like codeine/lyrica and you do still need a DEA # to prescribe those, but there's no restriction on anything below that.
 
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https://www.deadiversion.usdoj.gov/faq/prescriptions.htm#rx-5

To quote:
" DEA strongly opposes the use of a DEA registration number for any purpose other than the one for which it was intended, to provide certification of DEA registration in transactions involving controlled substances. The use of DEA registration numbers as an identification number is not an appropriate use and could lead to a weakening of the registration system. Although DEA has repeatedly made its position known to industries such as insurance providers and pharmacy benefit managers, there is currently no legal basis for DEA to prevent or preclude companies from requiring or requesting a practitioner's DEA registration number.


The Centers for Medicare and Medicaid Services has developed a National Provider Identification (NPI) number unique to each healthcare provider. The Final Rule for establishment of the NPI system was published in the Federal Register (FR 3434, Vol. 69, No. 15) by the Department of Health and Human Services on January 23, 2004. The effective date of this Final Rule was May 23, 2005; all covered entities were to begin using the NPI in standard transactions by May 23, 2007. A contingency extension was provided to covered entities unable to meet the 2007 deadline. Contingency plans were to not extend beyond May 23, 2008."


Schedule II-V drugs are the ones you checked off. Most drugs are entirely unscheduled. Schedule V is stuff like codeine/lyrica and you do still need a DEA # to prescribe those, but there's no restriction on anything below that.

Codeine is not V. It’s III. Other Narcs are II. Marijuana still I btw.
 
Codeine is not V. It’s III. Other Narcs are II. Marijuana still I btw.
Yes and no.

DEA / Drug Scheduling

Schedule V

Schedule V drugs, substances, or chemicals are defined as drugs with lower potential for abuse than Schedule IV and consist of preparations containing limited quantities of certain narcotics. Schedule V drugs are generally used for antidiarrheal, antitussive, and analgesic purposes. Some examples of Schedule V drugs are:

cough preparations with less than 200 milligrams of codeine or per 100 milliliters (Robitussin AC), Lomotil, Motofen, Lyrica, Parepectolin
 
Yes and no.

DEA / Drug Scheduling

Schedule V

Schedule V drugs, substances, or chemicals are defined as drugs with lower potential for abuse than Schedule IV and consist of preparations containing limited quantities of certain narcotics. Schedule V drugs are generally used for antidiarrheal, antitussive, and analgesic purposes. Some examples of Schedule V drugs are:

cough preparations with less than 200 milligrams of codeine or per 100 milliliters (Robitussin AC), Lomotil, Motofen, Lyrica, Parepectolin

Schedule III

Schedule III drugs, substances, or chemicals are defined as drugs with a moderate to low potential for physical and psychological dependence. Schedule III drugs abuse potential is less than Schedule I and Schedule II drugs but more than Schedule IV. Some examples of Schedule III drugs are:

Products containing less than 90 milligrams of codeine per dosage unit (Tylenol with codeine), ketamine, anabolic steroids, testosterone

Tylenol #3, baby!

Codeine is a little too messy. I think. My favorite destination is cocaine, II.

Edit: I apologize again, codeine straight up is actually II.
So depends on preparation, codeine can be II, III and V.
Just wanted to clarify.
 
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Self-prescribing is all dependent on the legislation in place in the State (and Country) you're living in.

At least in most states of Australia, the general gist about self-prescribing (and prescribing for family) is: It's not illegal but it's highly frowned upon. It's allowed generally but everyone should have their own doctor -- we're all busy but we can all find the time -- my family and I have our own family physician who we go to see; we all patients too at some point.

That said, personally, if It's for something straight forward like Somac then I fill the prescription myself. If it's for the restricted drugs like Endone then I think you're asking for trouble if you're writing scripts for yourself and family/friends; we've all read about colleagues who enter that slippery slope. To be honest, if you're needing drugs like Endone, you should really be going to see a doctor (that's not yourself) for a formal opinion.
 
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