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Thread: Tramadol schedule IV in Ohio

  1. #21
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    wow that list was very interesting.... dammit i knew i shoulda stopped in the pharmacy the last time i was in mexico....but i wouldve been 12 then...and known nothing about tramadol lol. i'm suprised that so many countries require a prescription tho.. for some reason i only thought it was scheduled in some states in the US duh. if i do ever manage to get to mexico again i'd definatly go to the pharmacy and see what would happen tho.


  2. i have searched and searched and find no articles claiming that tramadol is controlled and scheduled in ohio. Wikipedia does list it but wikipedia is quite often wrong. I looked through goverment sites among many others and tramadol is not listed for ohio anywhere aside from wikipedia. Lawriter - ORC - 3719.41 Controlled substance schedules.
    Helpful nwoh, Regis12 Rated helpful

  3. #23
    @LetItBe Tramadol isn't written into State Law yet as controlled but Ohio has adopted an "Ohio Automated Rx Reporting System" (OARRS) which is a prescription monitoring program established in 2006 maintained by the Ohio State Board of Pharmacy. When controlled substances or tramadol are either dispensed or personally furnished to a patient this information must be reported to OARRS on a weekly basis by either a pharmacy or prescriber. In addition The State Medical Board of Ohio rule 4731-11-11 document outline situations for accessing OARRS prior to prescribing or personally furnishing a controlled substance or tramadol to a patient. The state of Ohio has legislation pending concerning scheduling tramadol though and while it isn't technically considered scheduledon paper at this time the Rx procedures and penalties associated with it mimic that of a controlled schedule III/IV.


    According to Rule 4731-11-11, Ohio Administrative Code Standards and Procedures for Accessing OARRS http://www.med.ohio.gov/pdf/rules/4731-11-11%20FAQs.pdf

    FREQUENTLY ASKED QUESTIONS

    Question: What types of drugs are reported to OARRS?

    Answer: Currently controlled substances in schedules II, III, IV, V, and all dangerous drug products containing carisoprodol or tramadol are required to be reported to OARRS. These drugs are referred to as "reported drugs" in Rule 4731-11-11.


    Posted on May 2012..... Per Ohio Automated Rx Reporting System | Ohio Academy of Family Physicians

    Improving Patient Care Through Enhanced Use of OARRS
    Source: The State Medical Board of Ohio Ground Rounds, May 2012

    The State Medical Board of Ohio’s recent newsletter focuses physician attention on the role the Ohio Automated Rx Reporting System (OARRS) can play in improving patient care.

    As physicians, we all share in the responsibility for finding ways to improve patient care. One of the most effective tools for prescription drug safety available today is utilization of an OARRS report. An OARRS report can offer valuable insight into a patient’s use of controlled substances, while also alerting physicians and other health care professionals to possible signs of abuse, addiction, or diversion. House Bill 93 of the 129th General Assembly makes it easy for prescribers to obtain a chronologic history of the patient’s use of controlled substances obtained by prescription. OARRS allows prescribers or their designees to register and receive a password so they can go online and run an OARRS report on their patients. The legislation also directed the State Medical Board of Ohio, the Ohio Board of Nursing, the Ohio State Board of Pharmacy, and the Ohio State Dental Board to develop rules for when physicians and other health care professionals are required to access OARRS. Links to those rules are provided above.

    What is OARRS?
    OARRS is a prescription monitoring program maintained by the Ohio State Board of Pharmacy. When controlled substances or tramadol are either dispensed or personally furnished to a patient this information must be reported to OARRS on a weekly basis by either a pharmacy or prescriber. “Personally furnish” means the distribution of drugs by a prescriber to the prescriber’s patients for use outside the prescriber’s practice setting. This does not include the administration of drugs.

    Once reported to OARRS, the information is uploaded within 24 hours. This information can be accessed by prescribers, their designees, or pharmacists for the purpose of monitoring potential drug interactions and to identify signs of potential drug abuse, addiction, or diversion.

    A prescriber is authorized to request an OARRS report on an individual if: (1) the request is for the purpose of providing medical treatment, and (2) the prescriber has a current prescriber-patient relationship with the individual named in the request.

    What are the benefits of OARRS?
    OARRS prescription history reports are an important component of delivering and coordinating patient-centered care. The reports should be interpreted within the context of a patient’s ongoing medical history. Prescription history reports: (1) assist physicians and other health care professionals in better management of a patient’s prescription regimen; (2) are a screening tool for signs of potential abuse, addiction, and diversion; and (3) highlight patient risk for future addiction or abuse when used in conjunction with a patient’s medical history.

    When are you required to check OARRS?
    The State Medical Board of Ohio rule 4731-11-11 and a frequently asked questions document outline situations for accessing OARRS prior to prescribing or personally furnishing a controlled substance or tramadol to a patient which include: (1) if a patient is exhibiting signs of drug abuse or diversion; (2) when you have a reason to believe the treatment of a patient with controlled substances or tramadol will continue for 12 weeks or more; and (3) at least once a year thereafter for patients receiving treatment with controlled substances or tramadol for 12 weeks or more. If signs of abuse, addiction, diversion, or other patterns of risk appear, prescribers should address these issues with the patient to determine the basis for the suggestive behavior.

    The following are signs of drug abuse, addiction, or diversion that require an OARRS report before prescribing or personally furnishing a controlled substance or tramadol:
    •Selling prescription drugs
    •Forging/altering a prescription
    •Stealing or borrowing reported drugs
    •Drug screens inconsistent with treatment plan
    •Having been arrested, convicted, or received diversion or intervention in lieu of conviction for drug offense while under physician’s care
    •Receiving reported drugs from multiple prescribers without clinical basis
    •Having a family member, friend, law enforcement officer, or health care professional express concern about patient’s use of illegal or reported drugs
    •Increasing the dosage of reported drugs in amounts exceeding the prescribed amount.
    The following are signs of drug abuse, addiction, or diversion that may warrant an OARRS report before prescribing or personally furnishing a controlled substance or tramadol:
    •Known history of chemical abuse or dependency
    •Frequently requesting early refills of reported drugs
    •History of illegal drug use
    •Frequently losing prescriptions for reported drugs
    •Requesting reported drugs by specific name, street name, color, or identifying marks
    •Recurring emergency department visits to obtain reported drugs
    •Appearing impaired or overly sedated during an office visit or exam
    •Sharing reported drugs with another person.
    If there is a basis to suspect abuse, addiction, or diversion physicians and other health care professionals may consider implementing clinical and/or monitoring techniques such as addressing the concerns with the patient, more frequent office visits, utilizing drug screens, seeking authority to speak with family members, considering different treatment options, utilizing pill counts, limiting locations the prescription can be filled, or consultation with an appropriate specialist.


    How do you document an OARRS report?
    The preferred method of documenting the receipt and assessment of an OARRS report is to record the date the report was requested along with any pertinent findings in the patient’s medical record. Your understanding of the clinical significance of the information in the OARRS report is what you want to document. If you choose to maintain an actual copy of the OARRS report in the patient’s medical record it should be in a separate, non-reproducible section of the chart. OARRS reports are confidential. Please note that unauthorized disclosure of an OARRS report may be in violation of the Ohio State Board of Pharmacy laws and/or federal privacy laws such as the Health Insurance Portability and Accountability Act (HIPAA). For more information please contact the Ohio State Board of Pharmacy.

    Who in your office can check OARRS?
    In an effort to improve access to OARRS, physician prescribers are now permitted to have non-licensed staff such as medical assistants or other office personnel register as delegates with the Ohio State Board of Pharmacy for purposes of accessing OARRS. The Ohio State Board of Pharmacy limits the number of non-licensed delegates to three per prescriber.

    What can you do to improve the integrity of OARRS information?
    Prescribers can play an important role in improving the integrity and quality of OARRS data in the way they record information on the prescription. For the OARRS to accurately assign prescription data to a given patient it uses three points of information: patient name, address, and date of birth.



    Here is an article taken from a newspaper about a court case involving Tramadol in Ohio (I'll try and bold some of the key points) Ex-jail officer to take stand - MariettaTimes.com | News, Sports, Jobs, Ohio, Community Information - The Marietta Times

    Testimony continued for nearly four hours Tuesday as prosecutors worked to cement their case against former Washington County Jail supervisor Dean Ketelsen, with Ketelsen expected to take the stand Thursday.

    Washington County Prosecutor Jim Schneider said he has just one witness left to call in the case against Ketelsen, 60, of Lowell, who is accused of taking about 1,400 Tramadol pills from inmates at the Washington County Jail over a two-year period. He faces up to 18 months in jail.

    Nine witnesses took the stand Tuesday, the second day of the trial, with eight of them speaking for the prosecution while one defense witness was called out of order to accommodate the schedule of Dr. Edward Tappel.

    The bulk of Tuesday's testimony was from Washington County Sheriff's Office Chief Deputy Mark Warden, who was one of the officers who interviewed Ketelsen in connection with the missing Tramadol pills.

    "This investigation led us to one person. Unfortunately, it was Dean Ketelsen," Warden said.

    Warden's testimony sparked debate between Schneider and defense attorney Rolf Baumgartel. During the investigation Ketelsen submitted to a polygraph - which he has said he passed - and Baumgartel argued investigators remained focused on Ketelsen despite their own tools indicating he was not guilty.

    Results of a polygraph are inadmissible in court without prior stipulation by the attorneys, and Baumgartel said he was not arguing for the inclusion of the results, but merely the question of why the results were ignored.

    "Still the sheriff's office focused on him, despite evidence," Baumgartel argued.

    Ultimately the question was asked, and Warden denied ignoring any investigative tools to remain focused on Ketelsen.

    Warden was one of two people to conduct interviews with Ketelsen once he became a suspect. Warden had asked John Jenkins and Scott Fitch with the Ohio Bureau of Criminal Investigation (BCI) to conduct the interview, but Fitch was subpoenaed and Warden stepped in.

    The lead investigator on the case, Detective Mark Johnson, the lone prosecution witness yet to testify, did not feel comfortable conducting the interview due to friendship with Ketelsen.

    Questioned why an outside investigator was not brought in to handle the case when many, including Warden, had a friendship with Ketelsen, Warden responded the sheriff's office felt it could handle the case quickly and without bias.

    "I believe we've got very competent investigators that can do the job," Warden said.

    During two separate interviews conducted on Dec. 15, 2010, roughly six weeks after the initial incident that prompted the investigation, Ketelsen was questioned about whether he took the missing pills, as well as his use of Tramadol.

    Ketelsen had been regularly receiving Tramadol from Tappel for treatment of kidney stones, and had received up to as many as 175 on one prescription. The maximum recommended dosage for one month is eight pills per day, or 240 a month.

    "(Kidney stones) is not recurring. It's chronic," said Tappel.

    According to an Ohio Automated Prescription Reporting System, or OARRS, report presented to Zandra Francis, a pharmacist with Kmart in Marietta, Ketelsen received Tramadol during the period of 2009 through 2010.

    Tramadol is considered a non-controlled substance by the state of Ohio, but the Washington County Jail and the OARRS program now consider it controlled.

    "It's a non-controlled substance, but it is recorded in that system (OARRS)," Francis said.


    Of 87 prescriptions filled by Ketelsen, virtually all were prescribed by Tappel. Dr. Robert Grzonka, Dr. Michael Brockett and Dr. Valerie Rigg also prescribed Tramadol for Ketelsen.

    Brockett and Rigg gave those prescriptions while filling in for Tappel in his office, and Tappel said he was aware of Ketelsen's visit to Grzonka.

    Tappel said the amount of pills Ketelsen was receiving was correct for his condition. Ketelsen had to waive his right to doctor-patient privilege for his medical records to be discussed.

    "Can Tramadol be addictive?" Schneider asked.

    "It has the potential," Tappel answered.

    According to the prosecution, Ketelsen filled his prescriptions for Tramadol two days prior to when he should have taken the last pill - the earliest Kmart allows prescriptions to be picked up. That led investigators to believe Ketelsen was consuming pills unaccounted for at the jail, not destroying them as he claimed.

    "Dean had told us it was his policy that Tramadol come to him. He would take it out of the box and shred it," Warden said.

    Two shredders were taken from the Washington County Jail and given to Megan Snyder, a forensic scientist with BCI, who analyzed the machines on Feb. 4 and Feb. 8 of 2011.

    When questioned by defense, Snyder said the first machine had a powdery residue but enough could not be gathered to determine what was destroyed in the shredder. The second machine did not have any residue.

    "Is it fair to say you cannot conclude one way or the other if Tramadol was consumed in that (shredder)?" Baumgartel said.

    "That would be fair to say," Snyder responded.

    Testimony is expected to conclude on Thursday, with the trial set to resume at 9 a.m. A previously scheduled hearing in the courtroom Wednesday is the reason for a day's delay.

    Schneider said he plans to call Johnson to the stand to explain evidence, and then the defense will present its case. Baumgartel has said Ketelsen plans to take the stand in his defense, and he remains confident after two days of testimony.

    "The state has utterly failed to produce any evidence linking Dean to drugs," Baumgartel said.

    "We feel confident that the state has built its entire case on assumptions and presumptions and leaps of faith."




    According to Ohio House Bill 487: Physician and Allied Health Professional Issues
    Bricker & Eckler LLP: Ohio House Bill 487: Physician and Allied Health Professional Issues

    Ohio Revised Code (R.C.) §§4723.481 (advance practice nurses) and 4730.42 (physician assistants) now contain language specifically providing that a collaborating agreement and/or supervisory agreement may not permit the APN/PA’s authority to exceed that of the physician “including the physician’s authority to treat chronic pain with controlled substances and products containing tramadol.”

    R.C. §4731.052 authorizes the Ohio State Medical Board (“OSMB”) to adopt rules and establish standards and procedures related to treatment for chronic pain. In addition, the following requirements have been added to existing provisions related to prescriptions of controlled substances or products containing tramadol for treatment of chronic pain



    Hope this offers some inight and is helpful to some,

    -WISH
    Helpful Regis12 Rated helpful
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    TAKE AS NEEDED FOR PAIN...

  4. #24
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    I think it is a shame that the Federal Government feels the need to take on such a role as regulating substances/medication. I doubt that many of these substance control laws would hold up if ever challenged in front of this Supreme Court (the recent ruling on Health Care is tangentially related to my opinion). The Federal Government's ability to regulate and designate many if not all controlled substances is not based on preventing harm to people - it is based solely on the effects those substances have on interstate commerce (commerce clause). The Federal Government should not be able to use the commerce clause to take on make law regarding matters that do not effect interstate commerce. Posession of drugs for personal consumption does not have a direct effect on interstate commerce. I think one of the reasons that states like Colorado, Washington State and, to a lesser extent California have been able to institute the policys that they have, and the citizens of those states allowed to do what they are doing regarding both medicial and recreational use of marjiuana is in part because the Federal Government realizes it would loose in the Supreme Court. Times are changing and, as Dred Scott v. Sanford and then Brown vs. Board of Education shows us, all laws necessarily leave a lot of room for subjectivity via Judicial interpretation of the law AND the facts of a given case. I think(hope) the Federal Government's days of Drug prohibition are becomming shorter and shorter.
    Last edited by ZackVA; 01-28-2013 at 11:59 PM.

  5. But do the online pharmacies actually report the tramadol to the system? For instance would an Ohio patients pain mgt doctor see the online orders? Or do they fly under the radar?

  6. #26
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    Quote Originally Posted by puggle55 View Post
    But do the online pharmacies actually report the tramadol to the system?
    Of course they don't.

    Probably report about 1/2 of their actual sales too. Probably avoid paying
    most fed taxes.....not to mention state. Last thing they'd be concerned
    with....would be registering some pharm sale[s] to a nat'l registry.
    Helpful puggle55, Cash Rated helpful
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  7. Quote Originally Posted by chestercat View Post
    Of course they don't.

    Probably report about 1/2 of their actual sales too. Probably avoid paying
    most fed taxes.....not to mention state. Last thing they'd be concerned
    with....would be registering some pharm sale[s] to a nat'l registry.
    Thanks!! You have no idea how much you've eased my mind. Perhaps if the doctors would listen more I wouldn't be in this position tho.

  8. #28
    @ChillyCat Agreed! Anybody ordering Tramadol online w/o prescription is doing so undetected from the big brother. Now if you are doing it legit with a prescription by a licensed physician and in turn obtaining your medication from a viable & established pharmacy be it online or otherwise you are certainly subject to that being documented and recorded on some level or other....... by The Man! J/K

    Later,

    -WISH
    TAKE AS NEEDED FOR PAIN...

  9. #29
    So did Ohio offically schedule trams? I know most places are not shipping to Ohio now so I kind of firgured something was going on with the scheduling or something but I can not find any information on this online?

  10. #30
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    Quote Originally Posted by queenofkings View Post
    So did Ohio offically schedule trams? I know most places are not shipping to Ohio now so I kind of firgured something was going on with the scheduling or something but I can not find any information on this online?
    Does not appear to be scheduled yet (the source I referenced is updated as of 3/13/13).
    Lawriter - ORC - 3719.41 Controlled substance schedules.
    Last edited by Cash; 04-25-2013 at 07:35 AM.
    Helpful queenofkings Rated helpful
    Back to the beginning......

  11. #31
    According to the 3/2013 http://www.deadiversion.usdoj.gov/dr...o/tramadol.pdf web site, tramadol has now been scheduled C-IV in Ohio.
    Helpful Cash, queenofkings Rated helpful

  12. Quote Originally Posted by Cash View Post
    Does not appear to be scheduled yet (the source I referenced is updated as of 3/13/13).
    Lawriter - ORC - 3719.41 Controlled substance schedules.
    I can confirm this. These forums saved me back in December. I am more of a reader. But just about no place will ship to Ohio anymore. ones that did last month do not now. I live in Ohio and am down to one place that does but my guess is in May they will stop as well. I am now turning to IOP , No choice now as i have run out of options. I do know that had it not been for the great folks on these forums i would of been sol back in December. I have been on Tramadol for 5 years i have major back problems and rheumatoid arthritis about 7 50mg pills a day. I feel bad for the folks in no ship states , i know how hard and frustrating it is
    Like queenofkings liked this post


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