A risk manager recently sought advice regarding providers self-prescribing medications.
In our response, we address federal and state law, ethical considerations, and licensing requirements. Under federal law, physicians in the United States are not prohibited from self-prescribing medications. State laws governing physicians, however, vary greatly, and some may prohibit physicians from prescribing, dispensing, or administering certain medications to themselves or family members. Depending on their jurisdiction, physicians may also be disciplined for writing prescriptions outside the course of his or her medical practice, which could include self-prescriptions. For example:
In addition, according to an article in Medical Economics, some states may have other laws and regulations that may indirectly affect whether a physician can self-prescribe, particularly since most physicians who self-prescribe do not document having done so in the medical record. For example:
- Almost all states have one or more laws requiring a prescriber or dispenser to ensure that prescriptions are based on patient examination. Often, self-written prescriptions are not based on a proper, documented evaluation.
- Some states have rules dictating when a physical exam is needed, and some states have special standards for controlled substances.
- Where there are exceptions to physical exams, such as cases where telemedicine might be permissible, almost all states still have requirements for a physician-patient relationship and a documented patient evaluation.
In addition to state law, every physician must comply with Drug Enforcement Administration (DEA) requirements for the prescribing of controlled substances, which specifically dictate the necessary conditions under which such drugs can be prescribed.
Even if self-prescribing is not prohibited under state law, there are ethical questions that should be considered before doing so. The American Medical Association's (AMA) Code of Medical Ethics states, "Physicians generally should not treat themselves or members of their immediate families. Professional objectivity may be compromised when an immediate family member or the physician is the patient." In addition, AMA states that physicians may be inclined to treat problems that are beyond their expertise or training when treating themselves or family members. However, the code does acknowledge that certain situations may warrant self-treatment, such as in an emergency situation or isolated settings where there is no other qualified physician available.
Physicians should also check their licensing requirements for any specific rules related to self-prescribing.
Below are some additional resources that may provide further guidance on this subject.
The recommendations contained in Ask HRC do not constitute legal advice. Facilities should consult legal counsel for specific guidance and develop clinical guidance in consultation with their clinical staff.