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Sens. Joe Manchin (D-WV) and Mark Kirk (R-IL) and Reps. Vern Buchanan (R-FL) and Ed Markey (D-MA) introduced hydrocodone rescheduling legislation on March 20. The Safe Prescribing Act of 2013 (S. 621) would reclassify hydrocodone products such as Vicodin and Lortab from a Schedule III to a Schedule II controlled substance. “Under the new restrictions, a written prescription would be required in order to receive hydrocodone painkillers except in cases of emergency,” according to Manchin’s

FDA's Drug Safety and Risk Management Advisory Committee has voted to recommend rescheduling of hydrocodone from Schedule III (C-III) to Schedule II (C-II). The January 25 vote was 19–10 in favor of the change.

Over-the-counter (OTC) medications are an important component of primary health care. Since Schedule II medications can only be purchased in pharmacies, pharmacists can and should have an important role in the recommendation and proper use of these agents. Accordingly, we have conducted a large national survey of pharmacists' views on OTC medications. The first article in this series described pharmacists' opinions on the scheduling of various nonprescription medications. 1 The second article described pharmacists' opinions on switching of products from Schedule I (prescription only) to OTC Schedule II status.2 In this paper we explore pharmacist-patient contact time. Pharmacists' perceptions of patient expectations for consultation time may serve as an important basis for the development of practical interventions relating to OTC use. Accordingly, we asked pharmacists' opinions on patient expectations regarding this issue for a number of OTC agents.

Aims:The purpose of this study was to investigate disability among patients suffering from schizophrenia and to identify predictors of disability.Methods:101 patients from different types of psychiatric services in Vienna and diagnosed with schizophrenia according to ICD-10 were included. They were investigates by means of 36-Item self-administered version of the WHO Disability Assessment Schedule II (WHO-DAS-II) and the PANSS-scale. Patients’ mothers and fathers were asked to fill in the Family Problem Questionnaire.Results:The mean total score of the WHO-DAS-II was 74.1 (SD 21.9). When using weighted sub-scores the highest disability scores were found for social contacts, participation in society and household (means 2.58, 2.57 and 2.51 respectively). Using logistic regression, overall disability was positively associated with patient's age, overall severity of symptoms (PANSS) and number of previous hospital admissions. Overall disability was not associated with duration of illness and or patient's gender. The subjective burden experienced by patients’ fathers and mothers were increased by reduced social contacts and impaired participation in society, while we could not find an association with other domains of patient's disability (understanding, mobility, self-care, household).Conclusions:This study shows that schizophrenia results in disability in several domains. Family caregivers’ burden was predominantly increased by social consequences of schizophrenia.

To the Editor. —The claims made by Dr Grinspoon and Mr Bakalar 1 have been rebutted by the facts of the scientific and medical record summarized in the Drug Enforcement Administration ruling of 1989, 2 which denied the rescheduling of marijuana from schedule I to schedule II. All of the pharmacological properties of crude marijuana have been attributed to its active ingredient Δ 9 -tetrahydrocannabinol (Δ 9 -THC). Besides Δ 9 -THC, marijuana smoke contains 60 other cannabinoids and 360 chemicals, some quite toxic, like carbon monoxide, acetaldehyde, vinyl chloride, phenol, creosol, naphthalene, and twice as many carcinogens as a tobacco cigarette of the same weight. The American Cancer Society stated in 1989 that results of clinical investigations did not warrant decontrol of marijuana smoking for medical use (especially as an antiemetic), as did the American Medical Association. 3 Δ 9 -Tetrahydrocannabinol was declassified from schedule I to schedule II

To the Editor.— The Council Report, "Medical and Nonmedical Uses of Anabolic-Androgenic Steroids," 1 concludes with recommendations for legislative and legal initiatives to control the prescription and distribution of anabolicandrogenic steroids. In addition to Alabama, California, and Florida, which are mentioned as having scheduled the drugs under their state controlled substance acts, the New York State legislature in December 1989 passed a law that reclassifies anabolic steroids as Schedule II, controlled substances. This law, which went into effect on January 12, 1990, requires that all anabolic and androgenic steroids be subject to the same inventory and ordering controls as Schedule II narcotics, barbiturates, and related compounds. This includes the requirement that the steroids be prescribed on a New York State triplicate prescription form and that they may not be prescribed or administered without first obtaining the informed consent of the patient or a person legally authorized to give consent on

Two schedules of imipramine (IMI) administration were compared, a single intraperitoneal dose (10 mg/kg) (I) and chronic oral dosage (10 mg/kg twice a day for 14 days) (II). During schedule I, IMI reached maximal concentration in brain twice as high as that of its metabolite, desipramine (DMI), but disappeared more rapidly. During schedule II, DMI achieved concentrations twice as high as those of IMI which were maintained in a long-lasting plateau and there were considerable differences in areas of brain concentration curves. During schedule I, depletion of brain noradrenaline (NA) induced by H 77/77 and of 5-hydroxytryptamine (5-HT) by p-chloroamphetamine, were inhibited. During schedule II, after DMI concentration had become high and that of IMI low, only NA depletion but not that of 5-HT, was inhibited. At the same time, fenfluramine-induced hyperthermia was not antagonized although it was inhibited in schedule I. These findings may be relevant to those obtained clinically and may help to shed light on mechanisms of antidepressant action.

The first 100 deaths caused by propoxyphene and recorded by the Chief Medical Examiner of North Carolina were studied. Victims ranged evenly in age from the second to the seventh decade. Over 65% were suicides with a female to male ratio of 2:1. Blood propoxyphene concentrations of 0.2 mg/dl were fatal, representing rapid ingestion of approximately ten capsules. In North Carolina, deaths due to propoxyphene have increased from five in 1969 to 49 in 1975. Raising physician-awareness of propoxyphene's toxicity and placing the drug in Schedule II are two of the author's recommendations for reducing the number of propoxyphene deaths. Language: en

The steps involved in establishing a comprehensive pharmaceutical service in an operating and recovery room complex is described. Objectives of the operating room pharmaceutical satellite were to: (1) improve control of distribution, storage and charging for all drugs, especially Schedule II controlled substances; (2) reduce inventory costs and loss of revenue; (3) improve compliance with the drug formulary; and (4) establish patient-oriented pharmaceutical services. The pharmacy satellite improved inventory control and patient charging, assured continual access to all drugs and appropriate security for controlled substances, and expanded the pharmacy department's clinical, drug information and research activities.

SynopsisOne hundred geriatric psychiatric patients were examined with the Geriatric Mental State Schedule in New York and London, and a correlation procedure involving both clinical and statistical operations was carried out on the psychopathological data thus collected. Twenty-one factors were produced, including three dealing with cognitive impairment. Although it was found that elderly depressives show a profile of psychopathology quite different from that shown by patients with organic disorder, it was also found that patients with an apparently functional disorder may sometimes be diagnosed as an organic disorder, that subjective complaints of intellectual impairment are not good indicators of organic disorders and may be associated with a depressive factor, and that complaints that could be dismissed as attributes of ageing may actually be indicative of a depressive disorder in the elderly. The methodological implications, as well as the limitations of the sample size, are discussed.

A decentralized system for Schedule II controlled substance distribution and accounting that does not rely on proof-of-use sheets is described. Controlled substances are kept in a vault in the central pharmacy; technicians assigned to work in the controlled substances vault are responsible for monitoring, ordering, and storing these medications. The narcotic vault technicians also prepare narcotic boxes that are used by technicians in patient-care areas to transport and issue Schedule Ii substances to nursing units. Twice during each morning and evening shift, technicians in patient-care areas visit each nursing station, replenish the unit's stock of Schedule II medications, and document on a narcotic use form all doses that have been administered since the last technician visit. Nurses leave small cards preprinted with patients' names and room information in the narcotic drawers to alert technicians to administered doses of Schedule II substances; the technicians are responsible for reconciling medications missing from the drawers with doses recorded in patients' medication administration records as being administered. Periodic audits are performed to ensure that actual inventories and the recorded information are correct. The decentralized system for distribution and accounting of Schedule II substances has been successful in increasing the flexibility of inventories on individual nursing units and ensuring maximal pharmacy department control over the dispensation of these medications.

A surface area of 5 m2, a QB of 500 ml/min and a QD of 1000 ml/min reduces the time of hemodialysis to just 6 hours per week. All the patients had been in a conventional dialysis program for at least 2 years. These patients have now been in LSH for a period of between 2 and 3 years. Most patients have no appreciable residual function, they follow a free diet, living a normal life, and weigh between 51 and 88 Kg, ranging in ages from between 26 and 69 years. We use this technique with 3 schedules: Schedule I) 2 hours/3 days/week; Schedule II) 3 hours/2 days/week; Schedule III) 6 hours/1 day/week. In the 3 schedules the clinical and biochemical results have been the same as with conventional dialysis. With this technique the patients have greater freedom and comfort because they avoid 312 hours per year connected to the artificial kidney. The patients in Schedule II also avoid 52 dialysis sessions and 104 trips to the dialysis center per year. And the patients in Schedule III also avoid 104 dialysis sessions and 208 trips to the center per year. Furthermore, the cost savings in Schedule II is $2,500 per year/patient and in Schedule III $8,500 per patient/year.

Prescribing of Schedule II drugs for outpatients before and after enactment of a triplicate prescription law (TPL) was examined at a 1200-bed teaching hospital in Texas. Four pharmacists reviewed all prescriptions for Schedule II drugs during 1981 (before TPL) and 1982 (after TPL). The name of the drug product, quantity, and prescriber's training classification were recorded. Prescribing of non-Schedule II analgesics was also analyzed. Finally, prescribing by 280 resident physicians was examined for six months before and six months after enactment of TPL. The total number of prescriptions received for Schedule II drugs decreased by 60.4% from 1981 to 1982 (total outpatient prescriptions increased by 12.7%). The number of Schedule II prescriptions received from first-year residents decreased by 44.5%, more than for any other category of prescribers. In each year, nine of the ten most frequently prescribed Schedule II medications were analgesics. The numbers of prescriptions for several non-Schedule II analgesics increased in 1982 at a rate greater than that for all outpatient drugs. The medical residents wrote 2958 Schedule II prescriptions in 1981 and 834 in 1982. At this hospital, a TPL discouraged prescribing of Schedule II drugs.

A university-wide pharmacy-based controlled substances distribution system is described. The purchasing and control of controlled substances for the entire university campus is centralized in the hospital pharmacy department. The distribution system uses the concept of restricted versus nonrestricted drugs, where restricted drugs are all Schedule II controlled substances and other drugs needing restrictive control. The restricted or nonrestricted status of a drug is based upon suspected or observed abuse potential. After receipt by the pharmacy, all controlled substances and restricted drugs are stored in a vault. A 24-hour audit-disposition record system is used to control the inpatient distribution of restricted drugs, which are stored in locked cabinets on each nursing unit. In the outpatient pharmacy, a small supply of restricted drugs is stored in a locked cabinet; the inventory is reconciled weekly. Nonrestricted controlled substances, such as phenobarbital and chloral hydrate, are distributed to the inpatient satellite pharmacies and the outpatient pharmacy in the same manner as other prescription drugs. Campus practitioners and researchers order all controlled substances from the pharmacy using the appropriate order forms; each individual is responsible for maintaining a record and control system. A quality assurance program was established to review and improve the quality of service. The centralized pharmacy-based system improved the control, monitoring, and efficiency of controlled substances distribution for the entire university campus.

The prostaglandin F(2alpha) analog (PGFA) alfaprostol was used in 277 cyclic dairy heifers for the purpose of estrous cycle synchronization. A dose of 5 mg was used in all the trials during spring 1979 and 1.5 mg 100 kg body weight were used during winter 1979/80. Animals were treated according to 3 schedules: two doses 11 days apart without prior examination (Schedule I), one dose without prior observation and a second dose 11 days later only for those animals that failed to show estrus after the first treatment (Schedule II) and one dose for animals not showing estrus after a 5-day observation period (Schedule III). Estrus synchronization was achieved with peak estrus activity occurring form 32 to 72 h after treatment in 95% of the responding animals. Of the animals treated according to schedules I, II and III, 93%, 100% and 100% showed synchronized estrus activities respectively. Conception rates in all trials, from insemination at observed heat (Schedules I, II and III) or from fixed time insemination at 48 and 72 h after the first or second treatments in schedules III and I, respectively, compared well with that of untreated contemporary controls with a range of 34.2 to 66.7% for animals in these trials, and an overall conception rate of 49.48% for treated and of 48.30% for control animals. This observation, together with the pregnancy rate at 60 days after breeding (78.30% for all treated animals and 73.50% for all untreated controls), indicates that alfaprostol had no adverse effects on fertility.

An attempt was made to reduce a loud high-pitched respiratory stridor in a 52-year-old male hospitalized for paranoid schizophrenia. Four consecutive schedules of electric shock were employed over a period of 68 days. Each treatment session lasted 15 min per day and consisted of ninety 10-sec intervals. In Schedule I (10 days), the subject was shocked every 10 sec if he emitted four or more stridors. In Schedule II (28 days), the subject was shocked if he emitted three or more stridors during each 10-sec interval. In Schedule III (15 days) shock was delivered immediately after the emission of a stridor, and in schedule IV (15 days) the shock switch was depressed immediately after the subject emitted a stridor but no shock was delivered. While the first schedule yielded a reduction in the subject's stridor, a greater decrease was found during Schedule II, wherein almost complete elimination of the behavior occurred. Schedules III and IV both had deleterious effects, with the former schedule showing the greater increase in the stridor. The differential effects of these aversive schedules are discussed.

Three groups of albino rats were trained under a free-operant avoidance (Sidman) procedure with equal shock-shock and response-shock intervals. After stable performance was achieved, the animals were concurrently exposed to a brief electric shock after each response. The procedures were as follows: Punishment Schedule I: punishment shock was introduced at an intensity approximately one quarter that of avoidance shock; increments of nearly this same size were made as stable performance was achieved at succeeding punishment shock intensities. Punishment Schedule II: punishment shock was introduced at approximately one-half the intensity of avoidance shock; after stable performance, punishment shock was increased to the same intensity as avoidance shock. Punishment Schedule III: punishment shock was introduced and maintained at the same intensity as avoidance shock. Punishment was continued for all groups until one of two suppression criteria was attained. All animals made fewer responses and received more avoidance shocks as a function of increasing punishment shock. Half of the animals under Punishment Schedule I required punishment shock higher than avoidance shock to meet their assigned suppression criterion. A comparison of all procedures showed that suppression was greater when punishment shock was initially at high intensity.

A 200-bed hospital's change in pricing drug products from a cost-plus-fee system to a flat fee per dose based on the medication administration record (MAR) is described. With the flat-fee system, drug charges are not recorded when the drug is dispensed by the pharmacy; data for charging doses are obtained directly from the MAR forms generated by the nursing staff. Charges are 55 cents per oral or suppository dose and $3.00 per injection dose. Drugs administered intravenously, topical drugs, injections costing more than $10.00 per dose, and miscellaneous nondrug items are still charged on a cost-plus-fee basis. Man-hours are saved in the pharmacy department because of the elimination of the pricing function and maintenance of price lists. The need for nursing staff to charge for any doses administered from emergency or Schedule II floor-stock supplies is eliminated. The workload for business office personnel is reduced because the number of individual charges is less than with the cost-plus charging system. The system is accepted by patients and third-party payers and has made a complete unit dose drug distribution system possible at lower cost.

Rhesus monkeys were trained to complete three multiple schedules. The schedules consisted of three components: a fixed interval (component 1), a variable interval (component 2), and a fixed ratio (component 3). During components 1 and 2, pressing lever 1 was always reinforced by food delivery. During component 3, pressing lever 2 resulted in either food delivery or intravenous infusions of saline solution, solutions of cocaine, of d-amphetamine, of phenmetrazine, or fenetylline. In schedule I, animals were presented with all three components independent of key-pressing behavior during components 1 and 2. In schedule II the availability of component 2 was dependent on completion of component 1. Component 3 was made available only on completion of component 2. Noncompletion of components 1 or 2 resulted in timeoutperiods of 15 and 10 min, respectively. Schedule III was identical with schedule II, except that in schedule III the completion of components was indicated only by a change in the lever lights. The influence of self-administered drugs on behavior in all three components was evaluated. Self-administration of psychomotor stimulants impaired the performance of animals and delayed completion of components 1 and 2 of schedules I, II, and III. The effects on behavior were similar with low drug intake in schedule III, moderate intake in schedule II, and high drug intake in schedule I. These effects were strong with self-administration of phenmetrazine, moderate with self-administration of cocaine and d-amphetamine, and weak with self-administration of fenetylline.

Children being treated with methylphenidate or dextroamphetamine for minimal brain dysfunction syndrome and subsequent hyperkinetic impulse disorder may develop annoying side effects. A pilot study substituting caffeine, in the form of two cups of regular coffee a day, suggests that caffeine may be a suitable alternative to Schedule II drugs. The author points out the advantages of treatment with caffeine and suggests some specific aspects for further studies in this area.

Six background characteristics of 79 male physicians found by the New Jersey State Board of Medical Examiners to have indiscriminately prescribed Schedule II medications from 1979 through 1983 were compared with those same characteristics estimated for 10 397 physicians not reported to have indiscriminately prescribed Schedule II medications during 1979. Doctors of osteopathy (D.O.s) had a rate of injudiciously prescribing Schedule II drugs approximately 3.5 times that of medical doctors (M.D.s), and separate analyses, by type of physician, were thus conducted. However, the D.O.s who were members of the American Osteopathic Association (AOA) were approximately 4.25 times less likely to be injudicious prescribers than those who were not AOA members. Age, location, and graduation from a foreign medical school were found to differentiate injudicious M.D. prescribers. The implications of the results for developing continuing medical education programs for physicians are discussed.

To the Editor.— Dr. Karakashian's comments on physician's narcotic prescription blanks (226:1572, 1973) bring to mind a system allowing the institutional control of prescription blanks for schedule II drugs only, implemented at the University of Kentucky hospital. Under the system, to each legally eligible physician wishing to prescribe schedule II drugs is issued (by the pharmacy department) a pad of 25 consecutively numbered prescription blanks. Records are kept on a control card in the pharmacy. The physician writes all prescriptions for schedule II drugs on the assigned blanks. It is the responsibility of the physician to report to the pharmacy any lost blanks. In addition, all of the hospital's routine prescription blanks distributed throughout the hospital bear the following statement, "Caution— This prescription is invalid if used for schedule II controlled drugs." All pharmacies in the central Kentucky area have been informed of this system and have been most cooperative