PURPOSE

IBHHP is committed to the safe, responsible, and evidence-based prescribing of controlled substances. Due to the potential risks associated with these medications, including misuse, dependence, and diversion, the following policy applies to all prescribers within the practice.

Prescribing Standards

Controlled substances will only be prescribed when clinically appropriate and in accordance with federal and state regulations. Providers are expected to use sound clinical judgment and consider non-controlled alternatives when possible.

Evaluation and Documentation

A comprehensive evaluation must be completed prior to initiating any controlled substance. This includes:
• Review of medical and psychiatric history
• Assessment of current symptoms and functional impairment
• Evaluation of risk factors for misuse or diversion
All prescribing decisions must be clearly documented in the patient’s medical record.

Prescription Drug Monitoring Program (PDMP)

Prescribers are required to review the North Carolina Controlled Substances Reporting System (CSRS) prior to initiating controlled substances and periodically thereafter, in accordance with state guidelines.

Controlled Substance Agreements

Patients prescribed controlled substances may be required to sign a Controlled Substance Patient Agreement outlining:
• Medication use expectations
• Refill policies
• Prohibition of sharing or selling medication
• Agreement to use a single pharmacy when possible

Prescription Limits

Controlled substances will be prescribed in no greater than a 30-day supply unless the provider deems it appropriate and necessary. Additional refills or extensions require provider evaluation and approval. Patients are expected to follow up as directed to ensure continuity of care.

Refill Policy for Controlled Substances

Controlled substances are prescribed with the expectation that they will be taken exactly as directed.
• Early refills are not permitted. Requests for early refills will generally be denied.
• Lost, stolen, or damaged medications will not be replaced.
• Running out of medication early due to taking more than prescribed is not a valid reason for an early refill.
• Refill requests must be submitted during normal business hours and within the timeframe established by the practice.
• Providers do not guarantee same-day processing of refill requests.
• Urine drug screens may be required at the provider’s discretion at any time.

Refusal to complete a requested urine drug screen may result in termination from the practice.
Exceptions to this policy are rare and will only be considered at the sole discretion of the provider in extenuating circumstances. Repeated requests for early refills or reports of lost or stolen medication may result in discontinuation of controlled substance prescribing.

Follow-Up Requirements

Patients prescribed controlled substances must be seen regularly for monitoring. Patients must be seen for follow-up visits at least once every three (3) months to receive a refill.

Telehealth Prescribing

Controlled substances may be prescribed via telehealth only when compliant with current federal and state regulations. In-person evaluations may be required when clinically indicated.

Discontinuation of Medication

Providers reserve the right to taper or discontinue controlled substances if:
• There is evidence of misuse, diversion, or noncompliance
• The medication is no longer clinically indicated
• The patient does not adhere to treatment recommendations

Safety and Compliance

Prescribers must comply with all applicable laws, including DEA regulations and North Carolina prescribing requirements.

Patient Acknowledgement

To help ensure your safety and the safe use of controlled medications, we ask that you review and agree to the following:
• I understand that controlled medications are prescribed in limited quantities (typically no more than a 30-day supply or 90 days if deemed appropriate by the provider) and require regular follow-up appointments.
• I understand that I must be seen for follow-up visits at least once every three (3) months to receive a refill.
• I agree to take my medication exactly as prescribed and will not change the dose without speaking to my provider.
• I understand that early refills are not routinely provided, and I am responsible for taking my medication as directed so that it lasts until my next refill.
• I understand that lost, stolen, or damaged medications may not be replaced.
• I agree not to share, sell, or misuse my medication in any way.
• I understand that urine drug screens may be required at the provider’s discretion at any time. Refusal to complete a requested urine drug screen may result in my termination from the practice.
• I agree to use one pharmacy when possible and understand that my provider may review prescription monitoring databases as part of my care.
• I agree to attend scheduled follow-up appointments as directed by my provider.

I understand that failure to follow this agreement may result in changes to my treatment plan, including discontinuation of controlled medications.

By signing below, you are acknowledging that you have received and reviewed a copy of the Controlled Substances Prescribing Policy