Controlled Substances Laws and Regulations Overview for University of Missouri Hospital

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2/23/2012. BNDD. 2. Points to Be Discussed. Doctor prescribed Drug Abuse Impairment of Practitioners and OthersDrug DiversionThe Role of the BNDDControlled Substance Statutes and Regulations . 2/23/2012. BNDD. 3. Themes to Be Discussed. Remedy Writing and DispensingIndividual Practitioners

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Controlled Substances Laws and Regulations Overview for University of Missouri Hospital Presented By: Susan McCann, R.Ph. Overseer Bureau of Narcotics and Dangerous Drugs BNDD

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Topics to Be Discussed Prescription Drug Abuse Impairment of Practitioners and Others Drug Diversion The Role of the BNDD Controlled Substance Statutes and Regulations BNDD

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Topics to Be Discussed Prescription Writing and Dispensing Individual Practitioners – Who can endorse? Long haul Care Facilities Home Health/Hospice Hospital rehearse – orders versus remedies Records Security Protecting Your Practice BNDD

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Prescription Drug Abuse Culture of medication use in our general public 6% of all inclusive community mishandle substances incorporating those with authentic requirement for physician endorsed drugs 1 st time clients of doctor prescribed medications for non-therapeutic utilize 1980s : <0.5 million every year 1998: 1.6 million 2000: >2 million every year BNDD

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Prescription Drug Abuse In 2002, an expected 6.2 million individuals – 2.6% of the populace matured 2 and more established were right now (in a month ago) utilizing doctor prescribed medications non-therapeutically (up from 4 million in 1999) Pain relievers – 2.6 million clients Sedatives/sedatives – 1.3 million clients Stimulants – 4 million clients NIDA Research Report Series – Prescription Drugs: Abuse and Addiction Trends in doctor prescribed medication manhandle BNDD

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Prescription Drug Abuse From The DAWN Report: 2000 - 243 medication manhandle related ED visits per 100,000 populace 2001 – 252 medication manhandle related ED visits per 100,000 populace (638,484) 2001 – 14% of all ED visits were identified with opiate pain relieving misuse (90,232) BNDD

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Impaired Practitioners 10-17% of social insurance experts will manhandle drugs/liquor amid vocation Physical/mental anxieties Recreational utilize Knowledgeable about medications/"safe from hurt" 65-85 % of expert teach is identified with controlled substance/liquor issues BNDD

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Practitioner Impairment Consequences Harm to patients Harm to self Harm to family Harm to vocation Professional train Arrest and criminal indictment BNDD

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Diversion Illegal ownership – ownership aside from as approved by Chapter 195 RSMo Felony DEA Diversion Task Force capturing patients and authorized experts BNDD

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Diversion Occurs from all levels of controlled conveyance Manufacturers Distributors Pharmacies Hospitals Ambulances Physician workplaces, and so on. BNDD

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Diversion Persons capable Pharmacists Physicians Nurses Pharmacy specialists Family individuals Office staff Custodians Patients, and so on. BNDD

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Diversion Methods of redirection Theft Opportunistic Planned get to Break-ins Robberies BNDD

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Diversion Methods of preoccupation Theft Wastage Substitution Theft of patient measurement Theft is regularly joined by record adulteration BNDD

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Drug Diversion Methods of redirection (proceeded with) Record misrepresentation Administration records Wastage records Distribution records Inventory records Receiving records BNDD

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Controlled Substance Schedules CI – CV based upon potential for manhandle CI – no acknowledged therapeutic utilize Research is permitted Analytical labs Dog handlers (law authorization) BNDD

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Controlled Substances Schedules Criteria Potential for mishandle Pharmacological impact Current logical information of substance History of mishandle Scope, span and importance of manhandle Risk to general wellbeing Potential for psychic or physical reliance Whether a prompt antecedent of an ebb and flow controlled substance BNDD

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Controlled Substances Schedules Non-controlled abusable specialists Carisoprodol Nalbuphine Tramadol Advertising – not took into consideration any timetable BNDD

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The Mission of the BNDD The mission of the BNDD is to guarantee and secure the general wellbeing and wellbeing by keeping the redirection and abuse of controlled substance, without denying their fitting and successful utilize. BNDD

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Mission of the BNDD (Cont.) This will be refined through the direction of dissemination and utilization of controlled and hazardous substances, requirement of controlled substance laws and instruction of wellbeing experts, administrative and law authorization offices and people in general. BNDD

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Laws and Regulations State and government controlled substances acts Closed arrangement of enrollment, record keeping and security Similarities/contrasts Not all subjects secured by both BNDD

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Laws and Regulations Other state office controlled substance laws and directions Board of Pharmacy Board of Healing Arts Board of Nursing Department of Health and Senior Services Bureau of Health Facility Regulation - Hospitals Section for Long Term Care Regulation Bureau of Home Health/Hospice Bureau of Emergency Medical Services –Ambulance administrations BNDD

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The Role of the BNDD Registration Education Enforcement Administrative Action BNDD

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BNDD Registration No individual should deliver, plan, appropriate, administer or endorse controlled substances without first getting an enlistment from BNDD. Enlistments issued are legitimate for three (3) years (locum tenens are substantial for one (1) year). Enlistment expense is right now $90.00 ($30.00 for locum tenens). BNDD

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Registration required All honest to goodness controlled substance exercises Agents excepted from enrollment necessity: drug specialists, medical attendants, representatives are not enlisted No enlistment issued if controlled substance conviction: Misdemeanor – 2 years Felony – 7 years BNDD

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Registration prepare Application, "restoration" see Notify BNDD of progress of name, address, or possession 24,143 BNDD registrants as of November 11, 2003 BNDD

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BNDD Registrants The University of Missouri is enrolled as a doctor's facility, not a drug store. The enrollment application is marked by the executive. Singular professionals should likewise have BNDD enrollment to lead CS exercises inside the doctor's facility. BNDD

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Ambulance Service Amb. Surgical Ctr Analytical Lab Correctional Ctr Dentist Drug Distributor Drug Exporter Drug Importer Drug Manufacturer Hospital LTCF E-Kit Narcotic Treatment Optometrist Pharmacy Physician Podiatrist Researcher Veterinarian BNDD Registrants BNDD

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Education and Enforcement Drug Diversion Prevention Record Keeping Requirements Controlled Substance Loss Reporting Security Requirements Primary Practitioner in Clinic Setting Dispensing Procedures Prescription/CS Order Writing Drug Destruction BNDD

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BNDD Inspections BNDD has the expert to review the record keeping and security of any registrant or candidate for enlistment. BNDD participates with different experts in leading reviews and examinations. BNDD assessments of healing centers might be directed together with a state licensure or Medicare study. BNDD

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Administrative Action Process Scope of Practice issues are not inside the expert of the Bureau of Narcotics and Dangerous Drugs. Claims identified with flawed recommending and apportioning examples are alluded to the proper permitting sheets. BNDD will make a move in view of assurance/activity by these organizations. BNDD

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Administrative Action Process Investigations produced by: Findings on routine review Receipt of misfortune report Complaint Referral Licensing board Law requirement Other government office BNDD

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Administrative Action Process Non-Public teach Letter of Concern Letter of Warning Letter of Censure Public train Probation Revocation/Denial BNDD

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Administrative Action Process Criminal referral Federal common fines, detainment Refusal to make or keep records is a wrongdoing Theft, false remedies, and false records are lawful offenses. BNDD

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Practitioner Office Records General Authority to survey by DHSS, Board of Healing Arts, law implementation Readily retrievable Separate, or Electronic or mechanical get to, or Visually identifiable Provide inside three (3) working days Keep two (2) years Keep nearby, aside from as permitted BNDD

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Practitioner Office Records Required data Drug name Form Strength Quantity per compartment Number of holders BNDD

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Practitioner Office Records Required data, proceeded with Date of exchange Name/deliver of individual administered to Name/starting of individual apportioning Any other sort of manner Goal – records are reconcilable BNDD

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Practitioner Office Records Purchasing records Invoices Record of date got BNDD review issues Permission for focal records DEA Official Order Forms Record amount and date got Only individual with POA may sign shape to arrange BNDD

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Practitioner Office Records Returns to provider – unusable, lapsed Disposal records DEA approved – annihilate nearby, DEA frame Reverse wholesaler Hospital drug store or patient care regions Loss reports BNDD

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Practitioner Office Records Transfer records To different doctors, ambulances, and so forth. Utilize Official Order Form (OOF) for CII No "acquire & advance" without exchange record or OOF Distributor enrollment if > 5% add up to measurement units Office use by specialist – can't get with solution BNDD

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Security Physical security Substantially built, safely bolted bureau Limited get to BNDD

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Security Waivers to utilize required For a man with any conviction in regards to controlled substances, if that individual will have any entrance to controlled substances For past disavowal/surrender of a controlled substance enlistment BNDD

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Security Reporting misfortunes Law implementation BNDD Any robbery/noteworthy misfortune Report "upon disclosure" Loss report shape inside 7 d