I was prescribed a medication. The doctor said it was not a controlled substance. Why did he write a prescription? If it's not controlled couldn't I just go to the pharmacist and ask for the medication? It is not a common medication and obviously something you would only get from a pharmacist. I practically don't see getting the medication without going through a doctor.

The only thing I could see is health insurance only covering it if it's prescribed. In that case, could I ask him to prescribe me Tylenol to have my insurance pay for it?

Or is controlled just an extra layer of prescription?

  • Where are you? The way pharmaceuticals are controlled in the UK is very different from France or the USA or South Africa. – Dale M Aug 10 '16 at 2:54
  • @DaleM: True. However, I believe most jurisdictions broadly have the same three classses of medication - OTC, prescription required and controlled. – sleske Aug 10 '16 at 7:11

The concept of "controlled substances" has a special meaning, and stems from the Comprehensive Drug Abuse Prevention and Control Act of 1970, resulting in Chapter 13 of Title 21. Ordinary presecription drugs are the result of an older act, the Federal Food, Drug, and Cosmetic Act, which is also implemented in Title 21. The basic distinction is the difference between "potential for abuse" vs other stuff, and potential for abuse was the historically first desideratum in restricting pharmaceuticals in the old days. There are 5 "schedules" (lists) regarding controlled substances, ranging from the absolutely forbidden Schedule 1 (weed, 1-pentyl-3-[1-(4-methoxynaphthoyl)]indole which probably has a shorter street name) down to Schedule V small doses of opium.

Pharmaceuticals fall into three categories: over-the-counter, prescription, and controlled. Things like ibuprofen over 200 mg is not a "controlled substance" though does require a prescription, as do anti-cholesterol drugs (since they are thought to pose "some risk"). There are also completely unregulated substances, such as green tea, olive oil, vitamin c, which so far are not subject to federal regulation (since they have not been deemed to pose a risk). OTC substances can be bought without special hoops, though they cannot be marketed without passing through hoops. Prescription and controlled require a prescription from a DEA-authorized physician. Ephedrine and pseudephedrine are a recent zombie class of pharmaceutical which do not require prescription, but are subject to purchase quotas.

Controlled substances are subject to much higher levels of scrutiny, to ascertain that the prescription is legitimate and the recipient is the intended recipient; there are also stricter laws about possible justifications for prescribing regular prescription drugs vs. those on one of the 5 schedules. (And the rules are different for the 5 schedules).

It is generally unknown whether doctors can prescribe non-prescription pharmaceuticals, in order to shift the cost to insurance. There is no specific statute prohibiting that, but doctors are also subject to contractual restrictions between themselves and the insurance networks they deal with, so they may have agreed to not engage in such conduct. As far as I can tell, it is not actually illegal for a doctor to write a prescription for OTC Tylenol.

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  • Does a physician need to be DEA authorized to prescribe a non-controlled substance such as high-dose ibuprofen? I though those prescriptions were state regulated. – phoog Aug 10 '16 at 15:57
  • The requirement is indirect, as I understand it, via the requirement to use approved forms, which require the DEA number. There may be states that still allow use of plain paper. – user6726 Aug 10 '16 at 17:06
  • My physician still writes me a prescription for nexium (actually esomeprazole) even though it's OTC in the US now. US Physicians also have to specifically be approved to prescribe controlled substances (like codeine). – mkennedy Aug 10 '16 at 22:40

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