Policy Statement
Providers prescribing schedule II medications for chronic use will have the patient sign a Controlled Substance Use Agreement.
Reason For This Policy
Schedule II medications are frequently prescribed for short and long-term needs. All have potential for abuse. The Controlled Substance Use Agreement is intended as a contract between patient and provider. This agreement governs the use of controlled substances and details responsibilities of both provider and patient/client
Entities Affected By This Policy
Patients, Providers
Who Should Know This Policy
Patients, Providers
Definitions
Schedule II medications are Schedule II drugs, substances, or chemicals are defined as drugs with a high potential for abuse, with use potentially leading to severe psychological or physical dependence. These drugs are also considered dangerous.
Policy
- Indications for a provider to initiate the completion of a Controlled Substance Use Agreement
include:
- More than one request to refill a prescription in a clinical situation
when only a short term need was anticipated.
- Long term use of a controlled substance for relief of a painful condition which can not be expected to improve and when relief from
alternate types of medications has not been satisfactory.
- Patients who have a history of drug abuse such as alcohol, prescription
drugs or street drugs.
- The provider has reason to be concerned from the patient’s history, pattern of visits, or concern expressed by one or more pharmacists
that a patient could be abusing or providing a prescription medication
or medications to others.
- The Controlled Substance Use Agreement is available in the Handouts and the References sections of the electronic record and can be printed for use.
- At the time of initiation of a Controlled Substance Use Agreement, the provider will note that an agreement is in effect on the patient’s Medical Summary page of the electronic record.
4) The completed and signed Agreement will be scanned into the Scanned
Documents section of the patient’s record.
Responsibilities
Providers prescribing controlled substance will do so in accordance with Arizona laws.
Procedures
[The Policy Coordinator will provide a hyperlink to the policy’s procedure documents to insert here. If there are no procedures, insert the statement, “There are no procedures associated with this policy.”]
Related Information
Forms or Tools
[Insert hyperlinks to any forms or tools associated with the policy. If there are no forms or tools insert the statement, “There are no forms or tools associated with this policy.”]
Cross-References
There are no cross-references associated with this policy.
Sources
There are no external sources associated with this policy.
Appendix
None.