Hydrocodone Reclassification Starts October 6

A new rule from the Drug Enforcement Administration (DEA) taking effect Oct. 6 reclassifies hydrocodone combination products as Schedule II controlled substances, prohibiting refills and establishing other restrictions that will require major changes to prescribing practices.

Following are the six key points you need to know so you can take appropriate action over the next few weeks:

1. Refills aren’t allowed for prescriptions that are written beginning Oct. 6. Be prepared to issue new hard-copy or electronic prescriptions for patients. Note that eScripts can only be used if state law permits and the prescriber is certified to ePrescribe Schedule II substances. Pharmacies also must be certified to accept eScripts for controlled substances.

2. Prescriptions issued before Oct. 6 won’t necessarily qualify for refills; plan to issue new ones. Although the DEA rule allows refills of prescriptions issued before Oct. 6 until April 8, 2015, other factors could prevent patients from getting those refills.

Several states have published notices that they will treat hydrocodone combination product prescriptions issued before Oct. 6 in the same way they will handle prescriptions issued after the rule’s implementation date. In addition, any state laws that are more stringent than the DEA rule will govern refills. Meanwhile, some pharmacy quality and safety processes may not allow refills for prescriptions issued before Oct. 6, and some health insurers will not pay for those refills.

3. Prescriptions can’t be called in or faxed. Make sure to plan ahead for any patients who may need refills. The new rule prohibits pharmacies from filling prescriptions delivered over the phone or via fax, so you’ll need to issue written scripts.

The only exception to this rule is emergency treatment, which would allow physicians to call in a limited quantity of the medication to cover the emergency period only. Pharmacies are required to report prescribers to the DEA if they make such a request and do not give the pharmacy a written prescription within seven days.

4. Allied health professionals might not be able to write prescriptions for these drugs going forward. Check your state’s restrictions around Schedule II substances to confirm whether any non-physician members of your team who have prescriptive authority will be able to continue issuing prescriptions for hydrocodone combination products. You may need to modify your collaborative practice agreements accordingly.

5. Multiple prescriptions may be issued at one time under certain circumstances. The new rule does allow a patient to receive prescriptions that would total a 90-day supply, if the prescriber has determined it is appropriate to see the patient only once every 90 days. Each prescription must include written instructions that specify the earliest date it may be filled.

In addition to sound medical judgment and established medical standards, make sure to base your practice’s policy on issuing multiple prescriptions on relevant federal and state laws.

6. Patients should be notified of the new requirements and processes. Make sure your patients understand that their new prescriptions will not be refilled and are aware of the procedures they will need to follow going forward.

Remember to Register for the “All Candidates Forum” Tomorrow, Tuesday, Sept 16th

If you are interested in who is running for State House Representative for Districts 52 – 55, State Senator in District 18, or Congress in Districts 7 and 12, please join us at the “All Candidates Forum” scheduled for Tuesday, September 16, at the Ann Arbor City Club, 1830 Washtenaw Avenue. Doors open at 6 p.m. and a strolling dinner will be available. Candidates take the stage at 7 p.m. A Q & A session from the audience will take place thereafter.

If interested, please contact the Washtenaw County Medical Society office at 734-668-6241.

Scheduled to attend:
State Representative – District 52
John Hochstetler
Gretchen Driskell

State Representative – District 53

Jeff Irwin

State Representative – District 54

David Rutledge
Ed Moore

State Representative – District 55

Adam Zemke

Congress – 12th District
Terry Bowman
Debbie Dingell

State Senator – District 18

Rebekah Warren
Terry Linden

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Influenza A/H3 Diagnosed in Washtenaw Adult

On September 12, a lab-confirmed case of influenza A/H3 was reported to Washtenaw County Public Health (WCPH). The case occurred in a young woman who is a college student in Ann Arbor and had classic influenza symptoms starting September 8. She was not hospitalized and is currently recovering.

The nasal swab was PCR positive at University of Michigan Microbiology Lab for influenza A/H3 and is being forwarded to the MDCH Bureau of Laboratories for confirmation. This is the first case of influenza diagnosed in a Washtenaw resident since late May.

Influenza Testing:

Early in the flu season, it is important for clinicians to order confirmatory lab testing on suspect influenza cases, especially given the current enterovirus situation. Rapid flu tests are not reliable when low levels of influenza are circulating. Influenza PCR and culture isolates are an essential part of public health surveillance.

MDCH College Flu Vaccination Challenge toolkit: http://www.michigan.gov/mdch/0,4612,7-132-2942_4911_4914-315201–,00.html

Michigan Monitoring for Cases of Enterovirus, None Yet Confirmed

The Michigan Department of Community Health (MDCH) is receiving reports indicating an increase in severe respiratory illness in children ages 5-17 across the state. MDCH is working with local health departments and hospitals to investigate these cases. At this time, Michigan has no confirmed cases of Enterovirus D68 (EV-D68) associated with the national outbreak, but MDCH is forwarding samples to the Centers for Disease Control and Prevention (CDC) for testing.

The majority of those affected nationally had a previous medical history of asthma or prior wheezing. Symptoms of EV-D68 infection can include wheezing, difficulty breathing, fever and racing heart rate. Most people infected with enteroviruses have no symptoms or only mild symptoms, but some infections can be serious requiring hospitalization.

Young residents with asthma are encouraged to be vigilant in taking their asthma controlling medications and using general hygiene precautions. Additional information about human EV-D68 can be found in the CDC Morbidity and Mortality Weekly Report: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6038a1.htm

Hearings on Senate Bill 2 Held

The House Health Policy Committee met yesterday to accept testimony on Senate Bill 2. Testimony lasted for the full hour and a half of allotted time for the hearing. Rose Ramirez, MD, testified on behalf of Michigan State Medical Society (MSMS).

MSMS was joined by physicians from the Michigan Academy of Family Physicians, the Michigan Osteopathic Association, and the Michigan Radiological Society who also testified in opposition to Senate Bill 2. Collectively, the voice of organized medicine was clear that Senate Bill 2 is not a solution that should be pursued by the legislature.

The testimony of the advocates for advanced practice nurses focused mainly on arguments surrounding access that were not substantiated and claims that their education is sufficient to justify the passage of Senate Bill 2.

The agendas for the House Health Policy are full until after the election, so it is unlikely any formal action on Senate Bill 2 will occur prior to the end of the year.

MLive’s article on yesterday’s hearings can be found here:


Rhoda Powsner Memorial Service Scheduled for October 11, 2014

A memorial service for Rhoda Powsner will be at the Ann Arbor City Club, 1830 Washtenaw Ave., Ann Arbor, on Saturday, October 11 from 2 PM to 5 PM

CDC Staffer Exposed to Ebola Amid Growing Concerns for Health Workers

The Ebola virus threat to health workers and international responders in West Africa saw no letup today, with news of the US Centers for Disease Control and Prevention (CDC) returning one of its deployed staff members after contact with a patient and Canada pulling a lab team after infections were detected at their hotel.

CDC Director Tom Frieden, MD, MPH, is in West Africa this week getting a first-hand look at the steep challenges the affected countries and international health responders face. In Monrovia, Liberia, he told CNN that the outbreak is worse than he feared. He said each day the outbreak continues increases the threat of exporting the disease to other countries.

“The sooner the world comes together to help Liberia and West Africans, the safer it will be,” Frieden told CNN.

CDC Staffer Had Low-risk Exposure

In a statement on Wednesday, the CDC said it brought an employee back on a charter jet following low-risk contact with an international health worker who recently tested positive for Ebola virus disease (EVD). The CDC staff member worked within 3 feet of and in the same room with the infected health worker for a prolonged period when the international worker was symptomatic and capable of spreading the virus to others.

The CDC said its staffer practiced good personal infection control. The individual is not sick, does not have any disease symptoms, and does not pose a threat to others. Also, the CDC said the staff member is rotating back to the United States, as scheduled, from the assignment in West Africa.

The agency said it is handling the case based on its interim guidance for monitoring and moving people who have been exposed to the Ebola virus, which stipulates that contacts can travel long distances only by private means during a 21-day interval after last contact.

The restriction addresses the possibility that a person could start having symptoms during travel and ensures that individuals would have quick access to care if they had symptoms. The CDC also recommends that travelers who have visited Sierra Leone, Guinea, or Liberia monitor their health for 21 days and seek medical care if they start experiencing EVD symptoms during that time.

Once the CDC staffer returns to the United States, he or she will not be on home restriction and could return to duties at the CDC during the 21-day symptom monitoring period, the group said.

Canada Pulls Lab Team from Sierra Leone Field Unit

In a related development, the Public Health Agency of Canada (PHAC) said that it has recalled a three-member mobile lab team that worked a field unit with a World Health Organization (WHO) employee who was recently infected with EVD, according to a Canadian Press report. The PHAC also said people at a hotel complex where the Canadian lab team was staying were diagnosed with EVD.

The PHAC said the Canadian lab workers are not sick but will be in voluntary isolation during their flight home and after they return to Canada.

The WHO said it was pulling its staff from a unit in Sierra Leone’s Kailahun district after one of its deployed workers, a Senegalese epidemiologist, was sickened by EVD. It also announced that it would send another team to the area to review how the worker was infected. The field site is located in a part of West Africa that has been called one of the outbreak’s most intense hot spots.

Christy Feig, WHO director of communications, told the Canadian Press that the unit where the epidemiologist and the Canadian lab team were working did not treat patients but rather supported operations at a nearby treatment center run by Doctors Without Borders.


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