Xanax Reclassification Affects Alabama NPs!
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On Wednesday, March 15, 2017, the topic of rescheduling Xanax from its current position on the Schedule of Controlled Substances to a level II (CS II) received approval in the Alabama Legislative Council. Other benzodiazepines were moved to CS III. The changes were proposed by the Alabama Board of Medical Examiners (ALBME) and approved by the State Public Health Committee. Other organizations of healthcare professionals in the state were not consulted about the far-reaching implications of this decision.
The planned reclassification for Xanax will make Alabama the only state in the nation requiring the additional documentation and management associated with the prescriptions for CS II. There is no evidence that rescheduling controlled substances result in decrease of use or diversion. Nurse Practitioners who have completed the mandated 12 hours of training in the use of Opioids and Risk, Evaluation, and Management Strategies provided by the ALBME, needed to obtain the Qualified Alabama Controlled Substances Certificate (QACSC) to prescribe CS III-IV, will be forced to apply for additional privileges (via the Limited Purpose Schedule II Permit [LPSP]) in order to prescribe Xanax for their patients in need. This change leads to additional costs and regulatory oversight, along with the wait time required to obtain the new approval, for NPs who formerly had the capability to prescribe the drug. NPs who do not hold QACSC/LPSP will be forced to rely on collaborative physicians to prepare paper prescriptions for the drug, even in patients who have been treated for many years without adverse events.
In addition to unnecessary restrictions for prescribers, patients who have legitimate indications for treatment with Xanax will encounter challenges in obtaining needed medication. In the primary care setting, these patients commonly include older adults and those with mental health disorders, two of our most vulnerable patients groups in Alabama. Serious and potentially fatal withdrawal reactions are associated with abrupt discontinuation of Xanax. The myriad of difficulties many patients encounter in getting to quarterly or biannual visits for reevaluation will be amplified by the need to visit a prescriber’s office monthly to obtain a prescription, and it is inevitable that patients with chronic disorders warranting use of the drug will unexpectedly be without access to it. Patients who find themselves without available medication will experience symptoms including panic attacks, nausea, heart palpitations, seizures, and psychosis.
While NPAA shares the concerns of our colleagues in healthcare regarding the risks of diversion, misuse, and morbidity associated with the use of Xanax, there is no evidence that rescheduling controlled substances such as Xanax results in a decrease in diversion. This decision will have an unfortunate impact for patients across the state of Alabama who already find themselves managing chronic disease with limited access to appropriate healthcare. A change of this significance must all stakeholders who play a role in prescribing, supplying, and managing the drug to better quantify all aspects of risk to public health. We ask that plans to reschedule Xanax as a CS II be delayed until the feasibility of this decision for patients and prescribers can be fully explored by all healthcare stakeholders who play a role in use of Xanax, with special attention to the potentially negative consequences of the decision. Please contact me if you wish to further discuss this issue (256-476-5836).
Susan Alexander, DNP, ANP-BC, ADM-BC