Legal Q & A: Can R.Ph.s fill self-prescribed Rxs or Rxs for family members?

First and foremost, it must be emphasized that the rules governing this type of situation vary among the states. Therefore, it is imperative that a pharmacist knows and adheres to the particular state's rules. For example, one state may consider a script invalid and therefore subject the pharmacist to discipline if filled, while the same script in another state may be acceptable and valid.

Most of the concern relates to prescriptions written for controlled substances, since they create an enormous potential for abuse and/or dependence. Likewise, prescribing controlled substances to family members is frequently associated with problems of self-medication and dependency by the prescriber and/or the family member. Therefore, restrictions on a physician's ability to prescribe such prescriptions would logically result in a decrease of this abuse potential and is justified. However, some states are more restrictive than others.

Other states' rules aren't as explicitly prohibitive. For example, New Hampshire simply states that it is "not appropriate" for physicians to prescribe controlled substances for themselves or to family members, except in emergencies. Montana takes a particularly interesting stance – although there is not a rule specifically prohibiting the self-prescribing of drugs or prescribing to family members, the state does inquire into such prescribing habits by exploring factors such as if the treatment is well-reasoned and well-documented, whether there's a potential dependency problem, and whether the prescriber maintained objectivity in the process. That state strongly encourages its physicians to carefully consider the legal and medical disadvantages of such prescribing. Similarly, Kentucky doesn't have any rules specifically prohibiting such prescribing, but it recommends avoiding doing so to prevent any appearance of impropriety.

Some states consider self-prescribing and prescribing to family members as unprofessional conduct, usually due to factors such as the lack of a valid doctor/patient relationship, poor medical history, and the lack of a proper physical exam.

It's clear that some states will not tolerate such conduct. For example, South Carolina requires a valid doctor/patient relationship before a controlled substance can be prescribed. Due to the loss of objectivity in making the proper medical decisions, a practitioner cannot usually acquire the required relationship with him/herself nor with a family member. Also, prescribing controlled substances for family members is considered outside the scope of good medical practice, except for a true emergency where the health and safety of an individual may be at great risk Likewise, Arizona considers prescribing controlled substances to family members as unprofessional conduct. Similarly, Tennessee states that a physician cannot have a bona fide doctor/patient relationship with him/herself. Florida law even states that when a pharmacist knows or has reason to believe that a purported prescription is not based on a valid doctor/patient relationship and the script is dispensed, the pharmacist is subject to discipline.