Regulation of Medicine

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Georgia’s Controlled Substances CME Requirement and PDMP Registration

Executive Summary 

Physicians must follow several requirements when prescribing a controlled substance in Georgia for the treatment of pain or chronic pain. In limited circumstances, such as with a terminal illness, requirements for prescribing controlled substances may be reduced.   

Recommended Actions 
  • Obtain medical history, prior related diagnostic records, physical examination and informed consent when initially prescribing a controlled substance.  
  • As a Georgia physician who prescribes controlled substances, complete three hours of CME courses designed to specifically address controlled substance prescribing. 
  • Utilize the PDMP to make treatment decisions, address potential misuse and abuse of controlled substances and report potential violations.  

When initially prescribing a controlled substance, the physician must: 

  • Obtain a medical history. 
  • Conduct a physical examination (in a documented emergency can prescribe an amount to cover less than 72 hours without the physical exam). 
  • Obtain informed consent. 
  • Make a diligent effort to obtain prior diagnostic and pain treatment records related to the condition for which the controlled substances are being prescribed and document such efforts (not applicable if the condition is terminal). 

When prescribing Schedule II or III controlled substances for 90 consecutive days or more for a non-terminal condition and for patients who are not in a nursing home or hospice, the physician must: 

  • Have a written treatment agreement with the patient. 
  • Require the patient to have a clinical visit at least every three months to evaluate response to treatment, compliance with therapeutic regimen and any new condition that may have developed and be masked by controlled substances. 
  • Perform drug screens at least four times per year. 

The requirements for a clinical visit and drug screen every three months can be reduced to only once per year if the physician determines there is a substantial hardship and documents the hardship in the record or the morphine equivalent daily dose is 30mg or less. 

Georgia PDMP 

All prescribers with a DEA number must register with the PDMP. All Georgia physicians who prescribe controlled substances must complete (at least once) three hours of CME courses designed to specifically address controlled substance prescribing. As of July 1, 2018, prescribers: 

  • Must check the PDMP the first time an opioid or benzodiazepine is prescribed and at least once every 90 days thereafter. 
  • May delegate authority to check the PDMP to two staff members per shift or rotation provided that the staff members are properly licensed or they submit to the annual registration process. 
  • Note inquiries to the PDMP in the medical record along with the date and time and the name of the individual doing the search. 
  • For opioid prescriptions, give the patient written and/or verbal information on the addictive risks of using opioids and options available for the safe disposal of unused drugs. 
  • May use information obtained from the PDMP for treatment decisions, to communicate concerns about potential misuse, abuse or underutilization with other prescribers and dispensers involved in the patient’s healthcare or to report potential violations to the Department of Public Health. 

These rules do NOT apply when: 

  • The prescription is for no more than a three day (72 hour) supply of a covered substance and no more than 26 pills.  
  • The patient is in a hospital or healthcare facility, including a nursing home, an intermediate care home, a personal care home or a hospice program that provides patient care and the prescriptions are administered and used by a patient on the premises of the facility.  
  • The patient has had outpatient surgery at a hospital or ambulatory surgical center and the prescription is for no more than a 10-day supply and no more than 40 pills.  
  • The patient is terminally ill or under the supervised care of an outpatient hospice program.  
  • The patient is receiving treatment for cancer. 

Download a PDF version of this checklist here. 

Lessons Learned  
  • Consider creating a brochure or information packet for patients regarding the addictive risks of using opioids and options available for the safe disposal of unused drugs. 
  • Ensure that staff members accessing the PDMP are properly licensed or submit to the annual registration process. 
  • Consider implementing a checklist for physicians to follow each time they prescribe a controlled substance.  
Potential Damages 

Providers who inappropriately prescribe controlled substances or do not follow necessary guidelines for prescribing controlled substances risk investigations and sanctions brought by the DEA as well as state authorities. Penalties for violating guidelines for prescribing controlled substances include jail time, fines and revoking a physician’s license to prescribe. Not only are these actions brought relatively frequently, but defending against such claims and damages can be costly.  

Quiz 

Answers are provided below 

True or false?  

Question 1: When prescribing a Schedule II or III controlled substance for 90 consecutive days or more, a physician must receive a patient’s written treatment agreement, while requiring clinic visits every three months and drug tests at least four times a year. 

Question 2: Georgia providers may utilize patient information obtained from the PDMP. 

Question 3: Providers must always follow Georgia PDMP when prescribing controlled substances. 

Answers  

Question 1: True: Unless a patient is terminally ill or in a nursing home or hospice, the prescribing physician must have a written treatment agreement with the patient and require drug tests four times a year and a clinical visit every three months to evaluate their response to and compliance with their treatment. The requirements for a clinical visit and drug screen can be reduced to only once per year if there is a substantial hardship and the physician documents the hardship in the record, or the morphine equivalent daily dose is 30mg or less. 

Question 2: True. Providers may use information from the PDMP for the following reasons: treatment decisions; to communicate concerns about potential misuse, abuse or underutilization with other prescribers and dispensers involved in the patient’s healthcare; and to report potential violations to the Department of Public Health. 

Question 3: False. There are limited circumstances in which physicians do not need to follow the controlled substance requirements, including when the patient is terminally ill, receiving cancer treatment or in a hospital or healthcare facility, or the prescription is for no more than a 10-day, 40-pill supply after outpatient surgery.  

12/22

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Disclaimer

The information provided in this resource does not constitute legal, medical or any other professional advice, nor does it establish a standard of care. This resource has been created as an aid to you in your practice. The ultimate decision on how to use the information provided rests solely with you, the PolicyOwner.