The General Rules of Emergency Dispensing
Under normal circumstances, a pharmacist may provide an emergency supply of a prescription-only medicine (POM) if a patient needs it urgently and cannot obtain a prescription promptly. This is intended to prevent treatment interruptions, especially for chronic conditions. The pharmacist must use professional judgment to assess urgency, verify the patient's history, and document the supply. This involves checking if the medication is excluded from emergency supply due to its classification and risks.
Requirements for a Valid Emergency Supply
For most standard POMs, an emergency quantity, typically for up to 30 days, can be supplied. The pharmacist must be confident that:
- The medicine is immediately needed to continue treatment.
- A prescription cannot be obtained without delay.
- The patient has previously been prescribed the medication.
- Quantity limits are followed (e.g., 30 days for many POMs, but specific rules for items like oral contraceptives or asthma inhalers).
Categorical Exclusions: The Controlled Drugs
Emergency supply rules are most restrictive for controlled drugs, regulated due to their potential for abuse and dependence. Regulations vary, with higher schedules having stricter controls.
Schedules 1, 2, and 3 Controlled Drugs
Emergency supplies of Schedule 1, 2, and 3 controlled drugs are typically prohibited at a patient's request. Schedule 1 drugs, like LSD, have no recognized medical use. Schedule 2 drugs, such as morphine, require a valid prescription, though emergency oral authorization from a prescriber might be possible in some areas, which is distinct from a patient-requested emergency supply. Schedule 3 drugs, like gabapentin, carry a dependence risk and generally cannot be supplied in an emergency to a patient.
The Epilepsy Exception
An exception is sometimes made for phenobarbitone (phenobarbital sodium), a Schedule 3 drug used for epilepsy, allowing emergency supply due to the risks associated with stopping anti-seizure medication.
Limited Supply for Schedules 4 and 5
Emergency supplies of Schedule 4 and 5 controlled drugs may be permitted under strict conditions and pharmacist evaluation. This might include limited quantities, such as a 5-day supply for certain benzodiazepines (Schedule 4) or specific codeine products (Schedule 5).
Other Excluded Medications
Other categories of medications are also excluded from emergency supply. Unlicensed medicines, often referred to as "specials" prepared for individual patients, require a prescription and cannot be supplied in an emergency. Additionally, regulations may specifically list certain substances, such as mifepristone, as prohibited for emergency supply. Medications that are not essential for immediate health or the continuation of chronic treatment, such as those for erectile dysfunction, are not appropriate for emergency dispensing. Specific non-controlled drugs considered high-risk, such as certain chemotherapy agents, may also face restrictions.
Comparison of Drug Types and Emergency Supply Provisions
| Drug Type | Emergency Supply Status | Typical Quantity Limit (at patient's request) | Primary Rationale for Restriction |
|---|---|---|---|
| Schedule 1 Controlled Drugs | Prohibited | N/A | No accepted medical use, high potential for abuse |
| Schedule 2 Controlled Drugs | Prohibited (patient request) | N/A | High potential for abuse and dependence |
| Schedule 3 Controlled Drugs | Prohibited (patient request) | N/A | High potential for abuse and dependence (e.g., gabapentin, pregabalin) |
| Phenobarbitone (for epilepsy) | Exception Allowed | Varies, often 5 days | Critical for seizure control, risk of withdrawal |
| Schedule 4 & 5 Controlled Drugs | Restricted (Pharmacist discretion) | Often 5 days | Risk of abuse, dependence, potential for misuse |
| Unlicensed Medicines | Prohibited | N/A | Requires specific prescription and manufacturing control |
| Standard Prescription-Only Medicine (POM) | Allowed (Pharmacist discretion) | Often 30 days | Prevents interruption of essential chronic therapy |
The Rationale Behind the Restrictions
Restricting emergency supplies of certain drugs is a crucial safety measure to prevent abuse and diversion, ensure proper diagnosis, avoid dependence, and maintain legal compliance. Procedures for emergency Schedule II dispensing via a prescriber are detailed by bodies like the {Link: Ohio Board of Pharmacy https://www.pharmacy.ohio.gov/emergency}.
Conclusion
Regulations for emergency drug supplies are vital for medication safety. Patients should not expect to receive controlled drugs, unlicensed products, or other high-risk medications without a prescription. While some non-controlled medications allow for emergency supply, highly regulated drugs require a prescriber's authorization. Understanding what drugs cannot be supplied in an emergency helps patients plan and avoid treatment interruptions, while pharmacists fulfill their professional and legal duties.
For state-specific information in the US, resources like the {Link: Texas State Board of Pharmacy https://www.pharmacy.texas.gov/files_pdf/2018_flood_notification.pdf} can be helpful.
