Methadone law in Calfornia

February 1, 2016 11:56 AM

I have a very specific question about the legality of prescribing methadone in a specific context in the State of California. Regular old googling isn't resolving this.

I understand that methadone for opiate replacement (rather than for the treatment of pain) is restricted on a national level. My question is this: I've been told that in California, there is a specific statute which allows a clinician (not one working for a methadone clinic or specifically certified to prescribe opiate replacement methadone) to prescribe a three-day supply of methadone to a patient who is being discharged from an acute-care hospitalization.

The intent (I assume) is to "bridge" the person the couple days it may take to get to a methadone clinic after hospitalization, for example, if they are discharged on a Friday, or if the local methadone clinic doesn't admit new patients on certain days of the week.

Can you help me find the specific law that stipulates this, if such a law exists?

Thanks

posted by latkes to Law & Government (9 answers total)

Response by poster: Alternately, perhaps you can point me to a specific hospital policy that stipulates that they do this. Perhaps this will help me understand how a hospital can justify this practice.
posted by latkes at 11:57 AM on February 1, 2016

It's probably referring to a Federal law rather than a California-specific one-- Title 21 CFR 1306.07

Essentially, in order to prescribe narcotics for "detoxification or maintenance treatment" providers have to be registered as an opiate treatment program. BUT there is an exception allowing providers to give up to 3 days of treatment to bridge patients to referral for treatment--not just for hospitals, you could do this for an outpatient.
posted by The Elusive Architeuthis at 12:27 PM on February 1, 2016

Response by poster: OK, great, this is exactly what I was looking for!

I am a bit confused on the wording though. Anyone know? Can we hand a patient 3 days worth of methadone, or only one day, when she's walking out the door of the hospital? This wording makes it sound like she'd have to come back once a day for three days to dose, but in practice, neighboring hospitals seem to hand people three days worth of methadone.

"...Not more than one day's medication may be administered to the person or for the person's use at one time. Such emergency treatment may be carried out for not more than three days and may not be renewed or extended."
posted by latkes at 12:43 PM on February 1, 2016

I would interpret it as allowing a single dose at a time. Elsewhere in the regulation the ability to dispense take home doses is detailed. Someone in TX for fewer than 90 days is only allowed a single take home dose when clinics are closed. (I regulate methadone clinics in another jurisdiction from CA.)
posted by OmieWise at 2:03 PM on February 1, 2016 [2 favorites]

I think the way you're actually supposed to do this is to give the patient 3 prescriptions, each for a single dose, with "Do not fill before..." on it. i.e., if it's January 1 and you're giving 3 days' worth, you're supposed to give them 3 prescriptions, each for 1 day's worth of methadone, all dated January 1, but on the 2nd and 3rd you write "do not fill until Jan 2" and "Do not fill until Jan 3".

It's tremendously cumbersome and the patient has to go back to the pharmacy every day (and let's not even get into the fact that a lot of pharmacies don't stock methadone) and also a pain in the neck for the discharging provider who has to write 3 prescriptions. I'm certainly not an expert on this though, (and I'm not a methadone prescriber although I do office based opioid treatment) so there may be some nuances or loopholes I'm not aware of to make it easier for hospitals to provide methadone on discharge.
posted by The Elusive Architeuthis at 2:44 PM on February 1, 2016 [1 favorite]

Just fo information's sake, the CFR is the Code to f Federal Regulations. It's the rule written by Executive agencies to implement Federal statute, which is passed by Congress. It has a lot of the force of law, but it's not really law.
posted by OmieWise at 3:22 PM on February 1, 2016 [2 favorites]

Response by poster: Thank you both. A policy level MD just explained this too me too, and thanks to your comments I was able to talk with her with some level of understanding. This was helpful.
posted by latkes at 3:56 PM on February 1, 2016

This is covered in the FAQ for providers on SAMSHA's website. You are only supposed to administer one day's dose at a time without a waiver. I'm fairly sure the three-day rule applies to any narcotic maintenance therapy. You should check out the CFR reference in the FAQ to be sure.
posted by wierdo at 5:41 PM on February 1, 2016 [1 favorite]

The 3 day rule applies to methadone, SAAM, and buprenorphine, but buprenorphine is covered by a separate section of the code and can be filled for up to a month at a time as long as the prescriber has a DEA waiver to do office based opiate therapy.
posted by The Elusive Architeuthis at 8:09 PM on February 1, 2016 [1 favorite]