ALASKA

Alaska State Medical Board
Source: Letter to Alaska Physicians dated June 22, 1993

WALTER J. HICKEL, GOVERNOR

June 22, 1993

Dear Alaskan Physicians:

On October 8, 1992, the Alaska State Medical board heard complaints from patients and physicians that licensees were uncomfortable about prescribing narcotic analgesics. Discomfort arose from a fear that such prescribing might lead to disciplinary action from state or federal regulatory agencies.

Patients with documented diagnoses related stories of enduring pain due to underprescribing by practitioners. The board is sensitive to such issues. It recognized the impropriety of withholding necessary treatment in the form of narcotic analgesics at the expense of patient suffering. The board is providing the attached summary published by the Minnesota Board of Medical Examiners as a guideline for Alaska physicians as it pertains to prescribing practices.

The members of the Alaska State medical Board continue to be aware of uncertainty on the part of physicians regarding the medical board's intervention in the prescriptive use of DEA controlled substances. This memorandum is intended to clarify the responsibility of the Alaska State Medical Board when a complaint is received. Complaints come to board attention by way of patients, family members, friends, nurses, insurance companies, pharmacies, and other physicians.

When a complaint is filed, an investigation is mandatory. In the majority of cases, the complaints can be handled in an expeditious manner in the absence of apparent illegal or negligent medical practice. The case is then closed without further action.

When the DEA contacts the State Medical Board regarding a potential problem, a routine review often closed the case. The DEA performs computerized monitoring which may identify significant over-prescription of a given drug. A routine review of patient records, conducted by the board investigator in cooperation with the involved physician often results in case closure. On occasion, a board member may be requested to participate in the record review and recommendation process. When injudicious prescribing is recognized, the priorities of the State Medical board are those of patient protection, physician education, and rehabilitation.

The DEA publishes a booklet for physicians outlining the Controlled Substances Act. Copies of this publication, JUS-437, may be obtained from the DEA's Seattle Division Office, 220 West Mercer, Suite 301, Seattle Washington 98119; telephone (206) 442-5590. For further concerns or inquiries, contact the Executive Secretary, Caroline Stuart, telephone (907) 561-2878.

Attachment

STATE MEDICAL LICENSING BOARD State of Alaska Division of Occupational Licensing 3601 C Street, Suite 722 Anchorage, Alaska 99503

GUIDELINES FOR PRESCRIBING CONTROLLED SUBSTANCES

1. Perform a work up sufficient to support a diagnosis, including all necessary tests.
2. Document a treatment plan that includes the use of non-addictive modalities, and make referrals to specialists within the profession when indicated.
3. Document by history or clinical trial that non-addictive modalities are not appropriate or are ineffective.
4. Identify drug seeking patients. Review your records. If the patient is new, discuss drug and chemical use and family chemical history with the patient. If drug abuse is suspected, consider obtaining a chemical dependency evaluation or contacting local pharmacies.
5. Obtain informed consent of the patient before using a drug with the potential to cause dependency. Drug companies, the AMA, and other outlets provide printed material in layman's terms that can be used for patient education.
6. Monitor the patient. It is important to follow the patient for the primary condition that necessitates the drug, and for side effects of the drug, as well as the results of the drug. Drug holidays to evaluate for symptom recurrence or withdrawal are important.
7. Control the supply of the drug. Keep detailed records of the type, dose, and amount of the drug prescribed. Monitor, record, and control refills. Require the patient to return to obtain refill authorization at least part of the time. Records of cumulative dosage and average daily dosage are valuable.
8. Maintain contact with the patient's family as an objective source of information on the patient's response and compliance to the therapy.
9. Create an adequate record of care.