Special authorization from the DEA is necessary to be considered a narcotic treatment program. Physicians who wish to run a narcotic treatment program must: Be separately registered with the DEA as a narcotic treatment program; Comply with all DEA regulations regarding drug addiction treatment; Be licensed by the Massachusetts DPH as a substance abuse treatment program; and Obtain a DEA waiver to treat opioid addiction outside a treatment program, if the physician wants to prescribe in the office setting. Section 2: Drug Schedules In Massachusetts, all prescription medications are “controlled substances.” This section describes each of the six schedules, and lists examples of the drugs in each Schedule. Section 3: Prescriptions This section sets out the requirements for issuing prescriptions, including verbal, faxed, and electronic prescriptions. It discusses the elements of a written prescription. Section 4: Dispensing This section sets out the requirements for dispensing controlled substances. Section 5: The Prescription Monitoring Program. The Prescription Monitoring Program (PMP) is a repository for a patient’s prescription history for Schedule II-V prescriptions. The PMP is administered by the Department of Public Health. All Massachusetts pharmacies and out-of-state pharmacies delivering to people in Massachusetts provide prescription data to the PMP. Section 6: The Medical Marijuana Law Effective January 1, 2013, Massachusetts voters passed a Medical Marijuana law through the initiative petition process. The law allows physicians to advise a qualifying patient about the risks and benefits of the medical use of marijuana. The physician may provide a qualifying patient with written certification that the medical use of marijuana may benefit that particular
limitations on prescriptions, and when referral or physician consultation is required. When appropriate, the guidelines should address the treatment of common medical conditions and should include protocols for managing emergencies. The guidelines must include a mechanism and time frame for the supervising physician to review the APRN’s prescriptive practice. In addition, there must be specific protocols for the initiation of intravenous therapies and Schedule II drugs. While the regulations permit the physician and the APRN to set the frequency of review of the APRN’s prescriptive practice, the physician must review the initial prescription of Schedule II drugs within 96 hours of the prescription. APRNs who are authorized to prescribe Schedule II drugs may prescribe a extended release medication that is not in an abuse deterrent form. Certain APRNs may be authorized to issue written certification for marijuana for medical use. Such prescribing practices shall be completed in accordance with applicable regulations and written guidelines mutually developed and agreed-upon with the APRN and the supervising physician. Physicians who supervise a CRNA’s prescribing practice must be aware that such practice is limited to the immediate perioperative period, which is defined as the time period beginning on the day prior to surgery and ending upon the patient’s discharge from care. The Board urges physicians to remember that they are responsible for the prescriptive activities of the APRNs whom they supervise. Physicians should provide supervision as necessary, taking into account the education, training and experience of the APRN, as well as the nature and scope of their practice. The Board expects that physicians will only enter into supervision agreements with advanced practice registered nurses for whom they are able to provide supervision, practice review, and ongoing direction for the advanced practice registered nurse’s prescriptive practice.