The Medical Licensing Board of Indiana (MLB) recently disciplined physicians who did not properly prescribe weight-reduction medications. The ISMA legal staff reminds you state law prohibits physicians from prescribing any amphetamine, sympathomimetic amine drug or a schedule II controlled substance for weight reduction or control.
Additionally, only a physician may treat a patient for weight reduction or control with a schedule III or IV controlled substance. In those circumstances, it is permissible only if the physician:
- Determines through review of either the physician's records of prior treatment or records of prior treatment from a previous treating physician or weight-loss program that the patient made a reasonable effort to lose weight using a weight-reduction regimen based on caloric restriction, nutritional counseling, behavior modification and exercise – without controlled substances. And the physician must determine the treatment described in those records was ineffective, documenting thoroughly.
- Obtains a thorough history and performs a thorough physical examination of the patient before initiating a treatment plan using a schedule III or schedule IV controlled substance for weight reduction or to control obesity. Again, document thoroughly.
Also under the law, a physician may not begin and shall discontinue using a schedule III or schedule IV controlled substance for weight reduction or obesity control after determining by professional judgment:
- The patient failed to lose weight using a treatment plan involving the controlled substance;
- The controlled substance has offered decreasing contributions toward further weight loss for the patient, unless continuing to take the controlled substance is medically necessary or appropriate as maintenance therapy;
- The patient has a history of or shows a propensity for alcohol or drug abuse, or has consumed or disposed of a controlled substance in a manner not strictly in compliance with a treating physician's direction.
“With these laws, which are not new, the state sent a clear message that controlled substances are supposed to be used as a last resort, and then only as long as they are effective and necessary,” said Julie Reed, ISMA general counsel. “Then and now, the state wants physicians to help patients avoid prescription drug abuse.”
The only way the Indiana Attorney General’s Office and the MLB can see that the physician performed these steps is if they are properly documented.
“Very few sections of the law are this specific,” noted Reed. Therefore, they should be followed closely for compliance.