THE OPIOID ANTAGONISTS ACT BASED ON A PRACTITIONER'S PRESCRIPTION

1.  Q.  Can I dispense Naloxone or other opioid antagonists to an addict pursuant to a prescription? 

A.  Yes.  So long as you have a valid, lawful prescription for it.  WEST VIRGINIA CODE Chapter 16, Article 46 is the "ACCESS TO OPIOID ANTAGONISTS ACT."  The purpose of the Act is to prevent opioid-related overdose deaths.  In §16-46-3(b), the Act provides: 

All licensed health care providers in the course of their professional practice may offer to a person considered by the licensed health care provider to be at risk of experiencing an opiate-related overdose, or to a relative, friend, caregiver or person in a position to assist a person at risk of experiencing an opiate-related overdose, a prescription for an opioid antagonist.

2.  Q.  Q.  Can I dispense Naloxone or other opioid antagonists on a prescription to a relative, friend, caregiver or person in a position to assist a person at risk of experiencing an opiate-related overdose?

A.  Yes, even though there is no traditional prescriber-patient relationship, §16-46-3(b) permits a practitioner to issue a prescription to these people to help prevent fatalities from opioid-related overdoses.

3.  Q.  Can I dispense Naloxone or other opioid antagonists to initial (first) responders?

A.  Yes, you can do this based on a prescription or the a standing order to do so, or you can do it under the pharmacist's protocol.  The Act defines an initial responder as follows: 

"Initial responder" means emergency medical service personnel, as defined in subdivision (g), section three, article four-c of this chapter, including, but not limited to, a member of the West Virginia State Police, a sheriff, a deputy sheriff, a municipal police officer, a volunteer or paid firefighter and any other person acting under color of law who responds to emergencies.

In §16-46-3(a), the Act states:  "All licensed health care providers in the course of their professional practice may offer to initial responders a prescription for opioid antagonists, including a standing order, to be used during the course of their professional duties as initial responders."

While this would normally be seen as a "for stock" transaction, this statute permits a pharmacy to make this sale based on the prescription or standing order, or the pharmacist's protocol. 


FIORICET AND FIORINAL, AND FEDERAL DEA EXEMPTED PRODUCTS

Q.  Does West Virginia honor the DEA’s Exempt Prescription Product list.

 A.  No.  West Virginia has its own controlled substances act and it schedules several things that the DEA exempts.  For example, Fioricet and Fiorinal are treated the same here as controlled drugs, whereas the DEA schedules one but exempts the other.  The Board has fielded several questions recently on state versus federal scheduling of Chlordiazepoxide and Butalbital products.  Federal law has some exemptions for some of these.  However, our state law is tighter. To reiterate and flesh things out:

For Butalbital containing products in Schedule III of state statutes, West Virginia Code § 60A-2-208(c)(3) states that any substance which contains any quantity of a derivative of barbituric acid or any salt of barbituric acid is a CIII, and subsection (6) specifically states “Butalbital (including, but not limited to Fioricet)” is included as a CIII.  So, we treat Fioricet and Fiorinal the same under state law since they both contain butalbital, which comes from barbituric acid.

For products containing Chlordiazepoxide, regardless of federal exemptions, the state statute for Schedule IV at West Virginia Code § 60A-2-210(c)(8) specifically includes Chlordiazepoxide.


PRESCRIPTIONS FROM SUSPENDED/REVOKED PRESCRIBERS

Q:  A prescriber in my area recently had his/her license to practice suspended/revoked.  Can I fill a prescription written by him/her?  What about refills?

A.  The answer in West Virginia is fairly simple.  The law generally requires for a prescription to be valid, it must be written by a properly licensed prescriber, written in the normal or ordinary course of practice, for an actual patient of that prescriber, and be for a legitimate medical reason if necessary.  Thus, so long as the prescriber's license was valid when the prescription was written for his/her patient (with whom there was an actual provider-patient relationship), the prescription was written in the usual course of practice, and it is for a legitimate medical reason, then the prescription may be filled.  The same analysis applies for refills.  For a quick example, Dr. Jones writes a prescription for his patient, Mr. Smith, on April 6, 2010, with three refills.  The next day, on April 7, Dr. Jones surrenders his license and DEA registration.  If Mr. Smith's presents the prescription and the pharmacist believes it was written in the usual course and for a legitimate medical purpose, the prescription and the refills may be honored.  It is recommended that, since the doctor-patient relationship is severed, that the pharmacy direct the patient to get a new prescriber as soon as possible, and that the pharmacy consider limiting the number of refills it will give under the old prescriber.