Tag Archives: Hydrocodone Containing Product

Emergency Situations: Prescribing Schedule II Controlled Substances

Remote Pharmacy Solutions

Emergency is defined by the Secretary of Health and Human Services as “situations in which the prescribing practitioner determines that:

(1) Immediate administration of a controlled substance is necessary, for proper treatment of the intended ultimate user;

(2) That no appropriate alternative treatment is available, including administration of a drug which is not a controlled substance under Schedule II of the Act; and

(3) It is not reasonably possible for the prescribing practitioner to provide a written prescription to be presented to the person dispensing the substance, prior to dispensing” (21 CFR 290.10).

  • In emergency situations, a prescription for a Schedule II controlled substance may be telephoned to the pharmacy and the prescriber must follow up with a written prescription sent to the pharmacy within 7 (States may require that the prescription be sent to the pharmacist in a shorter time frame.)
  • Here are some additional requirements to heed when orally transmitting prescriptions in emergency situations: “In an emergency, the prescriber may give an oral prescription for a Schedule II drug if the pharmacist makes a reasonable effort to identify the prescriber and the amount is limited to what is necessary to treat the patient during the emergency. The prescriber must cause to be delivered an original prescription to the dispensing pharmacist within 7 The prescriber must write ‘Authorization for Emergency Dispensing’ on the prescription. The prescriber must document how the situation met the criteria for emergency treatment” (21 CFR 290.10).

Faxing Prescriptions for Schedule II Controlled Substances

  • Prescriptions may be faxed under certain conditions. Here are the conditions, as stated in federal regulations: “A pharmacist may dispense directly a controlled substance listed in Schedule II, which is a prescription drug as determined under the Federal Food, Drug, and Cosmetic Act, only pursuant to a written prescription signed by the practitioner, except as provided in paragraph (d) of this section. A prescription for a Schedule II controlled substance may be transmitted by the practitioner or the practitioner’s agent to a pharmacy via facsimile equipment, provided that the original written, signed prescription is presented to the pharmacist for review prior to the actual dispensing of the controlled substance.
  • Therefore, Schedule II prescriptions can be faxed to a pharmacist, but the copy is just an alert to the pharmacist that the patient is en route with an original prescription.

Do not hesitate to contact me at ____ (insert your telephone number) should you have questions or would like more information about this matter.


Joe Blog,


XXYYZZ Pharmacy


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Reclassification of Hydrocodone Combination Products (HCP)

Remote Pharmacy SolutionsOn August 22nd, 2014, the FDA announced the up-scheduling of hydrocodone combination products (HCP). Effective October 6th 2014, all HCP will be classified as Schedule II controlled substances which require additional safeguards with regards to prescribing, procurement, recordkeeping, inventory and storage.

Regardless of your opinion on this issue, pharmacists must be prepared to be compliant on October 6th. This article provides a quick reference tool to help pharmacists prepare for the process by outlining steps that needs to be taken prior to October 6th.

Pharmacies must have valid state and federal (DEA) registrations to purchase and dispense Schedule II products.

Storage: take stock of the maximum quantity of HCP you normally carry in your pharmacy. Can your current stock of HCP be relocated to your schedule II vault or safe? If the answer is no then you might need to purchase or source additional vault space.

Recordkeeping: one way to prepare for this change is to close out all HCP records from your Schedule 3-5 register on September 30th, 2014. The closed records should be transferred to your Schedule 2 register on that same day meaning that you would be keeping the right records on HCP by October 6th.

Inventory: be sure to take a physical inventory count of all your HCP by September 30th, 2014. The DEA requires an exact physical count of Schedule II controlled substances and an estimated count or measure of the contents of a schedule III, IV, or V controlled substance (unless the container holds more than 1,000 tablets or capsules in which case an exact count of the contents must be made). The Controlled Substances Act also requires that all inventory records be maintained at the registered location in a readily retrievable manner for at least two years for copying and inspection. In addition, the inventory records of schedule II controlled substances must be kept separate from all other controlled substances.

Procurement: Pharmacists and agents authorized to order Schedule II controlled substances will have to use paper DEA 222 or its electronic equivalent, Controlled Substance Ordering System (CSOS), to place their orders for HCP from October 6th, 2014.

Prescribing: This aspect of controlled substances management will be impacted the most as the changes will be significant. As pharmacists, we can be proactive and take certain actions in advance to minimize the impact of this change on our patients particularly those with chronic pain.

Write to all your patients who have had HCP filled at your pharmacy in the last 90 days informing them of the change and advising those without prescription refills to make arrangements with their physicians’ offices as soon as possible. The DEA will allow patients’ with existing legitimate prescription refills issued before October 6th, 2014 to be refilled until April 8th, 2015. Click here for a sample patient letter 

Write to physicians in your local area informing them of this change and how it will affect their usual course of practice. Click here for a sample physician letter

Further information about entire rescheduling process can be found at this link Hydrocodone Combination Products – Fact Sheet



On August 22, 2014, the DEA published a final rule rescheduling hydrocodone combination products (HCPs) to schedule II of the Controlled Substances Act. The final rule is available at www.regulations.gov and www.DEAdiversion.usdoj.gov
This Fact Sheet contains a general summary of the effects of the rescheduling on the general public.

This Fact Sheet contains a general summary of the effects of the rescheduling on the general public.

Frequently Asked Questions

  1. What are HCPs?

HCPs are pharmaceutical drugs containing hydrocodone in certain combinations with other drugs. Common names include: Vicodin®, Lortab®, Hycodan®, Tussionex®, and several generics.

  1. What does this final rule do?

HCPs will be controlled as schedule II substances effective October 6, 2014. DEA registrants (e.g., distributors, physicians, and pharmacies) will be required to adhere to more stringent security and recordkeeping requirements with respect to HCPs.

  1. I have a current prescription for HCPs that authorizes refills. Can I still have it refilled?

Yes. Any legitimate prescriptions for HCPs that are issued before October 6, 2014 that authorize refills may be dispensed by a pharmacy if such dispensing occurs before April 8, 2015.

  1. Can my physician issue a prescription for an HCP with refills after October 6, 2014?

No; a prescription for a schedule II controlled substance may not be refilled. However your physician may issue multiple prescriptions authorizing you to receive a total of up to a 90-day supply provided certain regulatory requirements are met.

  1. Will I now have to see my physician every month?

Not necessarily – the DEA does not regulate the practice of medicine. Your physician must determine on his/her own, based on sound medical judgment, and in accordance with established medical standards, how often to see you.

  1. Will I have to show my ID at the pharmacy when I pick up my prescription?

There is no federal requirement for you to show ID; however, you may be required to do so by your pharmacy or applicable state law.

Hydrocodone Combination Products:

  • What are hydrocodone combination products (HCPs)?
  • HCPs are pharmaceutical drugs containing specified doses of hydrocodone in combination with other drugs in specified amounts. These products are approved for marketing for the treatment of pain and cough suppression.
  • All pharmaceutical drug products containing hydrocodone approved for marketing in the United States by the U.S. Food and Drug Administration are HCPs, except ZohydroTM ER which is a single-entity hydrocodone product and as such is already a schedule II controlled substance.
  • There are several hundred brand name and generic hydrocodone products marketed with the most frequently prescribed combination being hydrocodone and acetaminophen (e.g., Vicodin®, Lortab®). Currently marketed cough suppressants containing HCPs include Hycodan®, Mycodone®, Tussionex®, Pennkinetic®, Tussigon®, and several generics.
  • HCPs have been controlled in schedule III since enactment of the Controlled Substances Act in 1971.
  • HCPs are the most frequently prescribed opioid in the United States: nearly 137 million prescriptions for HCPs were dispensed in 2013.


  • What is the purpose of this rescheduling action?
  • Effective October 6, 2014, HCPs will be controlled as schedule II substances under the Controlled Substances Act (CSA).
  • For prescribers, the change primarily means that they may not authorize refills for any HCP prescriptions. However they may issue multiple prescriptions authorizing a patient to receive a total of up to a 90-day supply of HCPs, in accordance with 21 CFR 1306.12.
  • The DEA is allowing legitimate HCP prescriptions issued before October 6, 2014 that authorizes refills to be refilled until April 8, 2015.
  • For pharmacies, the primary changes are that they must utilize a DEA Form 222 in order to obtain HCPs from a distributor, and they must keep HCP records separate or readily retrievable.
  • For distributors, the primary change is that they must physically store HCPs in a vault that meets specific requirements.
  • Manufacturers are relatively unaffected by the rescheduling action, except manufacturers that repackage or relabel HCPs will be required to obtain a quota in order to repackage or relabel HCPs.
  • DEA is allowing HCPs to be repackaged and relabeled without the requirement of a quota until December 8, 2014.


  • Why did the DEA reschedule HCPs into schedule II of the CSA?
  • Schedule II controlled substances are substances that have a currently accepted medical use in the United States, but also have a high potential for abuse, and the abuse of which may lead to severe psychological or physical dependence. After considering the analysis and rescheduling recommendation of Department of Health and Human Services (HHS) and reviewing available data, the DEA found that HCPs meet the statutory definition of a schedule II controlled substance.
  • Various drug abuse indicators for HCPs indicate that HCPs are widely diverted and abused at rates largely similar to that of oxycodone products (schedule II). The data indicate that HCPs have an abuse potential similar to schedule II opioid analgesics such as oxycodone and their abuse is associated with severe psychological or physical dependence.
  • Abuse of HCPs is also associated with large numbers of individuals being admitted to addiction treatment centers. Individuals are taking these drugs in sufficient quantities to create a hazard to their health, and abuse of HCPs is associated with large numbers of deaths.
  • Summarized timeline
  • DEA received the petition in 1999.
  • On July 28, 2004, DEA forwarded the petition and related materials to Department of Health and Human Services (HHS) for a scientific and medical evaluation and scheduling recommendation
  • On March 6, 2008, Department of Health and Human Services (HHS) forwarded to the DEA a scientific and medical evaluation and recommended that HCPs continue to be subject to control under schedule III of the CSA.
  • On February 13, 2009, the DEA submitted the reanalyzed data to Department of Health and Human Services (HHS) and requested a reevaluation and scheduling recommendation.
  • As mandated by the Food and Drug Administration Safety and Renovation Act of 2012, on   January 24-25, 2013, the FDA held an Advisory Committee meeting. The Committee voted in favor of rescheduling HCPs from schedule III to schedule II.
  • On December 16, 2013, Department of Health and Human Services (HHS) forwarded to the DEA its scientific and medical evaluation and recommendation that HCPs be controlled in schedule II.
  • On February 27, 2014, DEA published the Notice of Proposed Rule Making, Economic Impact Analysis, and the DEA and Department of Health and Human Services (HHS) 8-factor analyses.
  • On August 22, 2014, DEA published the final rule.