The 9:40 p.m. Telephone Order for Oxycodone

Yes, but only under the narrow emergency-oral-order exception, and only for the emergency quantity.

A Schedule II prescription must ordinarily be a written or electronic original. The federal exception (21 C.F.R. § 1306.11(d)) requires every one of these elements:

• A genuine emergency - here, unmanaged acute dental pain over a weekend before definitive treatment.
• Quantity limited to the emergency period - 12 tablets at 4 per day covers three days, through Monday. Thirty tablets does not fit the exception.
• The pharmacist promptly reduces the oral order to writing.
• The prescriber delivers a written or electronic prescription within 7 days.

Document date/time of the call, the prescriber and DEA number, the emergency nature, quantity dispensed, and the pharmacist's initials. Tell the patient that a follow-up prescription must arrive and that the supply is short by design. The clean PMP supports the decision but does not create the authority; note what you saw. Offer naloxone counseling and document it.

Refuse to treat the fax as the follow-up document, and refuse to dispense 18 more tablets against the original order.

Two independent problems:

1. A faxed CII is not a valid original except in narrow settings (long-term care, hospice, compounded infusion). A fax cannot satisfy the 7-day written-prescription requirement.
2. The follow-up document must match what was dispensed - #12. A prescription for #30 cannot simultaneously legitimize the emergency dispensing and release 18 additional tablets. Doing so converts a 12-tablet emergency authorization into 42 tablets on a telephone call.

Correct sequence: tell the dentist the fax is unacceptable and request the original or an electronic prescription for the 12 tablets already dispensed. If, after examining the patient, the dentist believes more opioid is clinically needed, that is a new prescription based on a new assessment - evaluate it independently (valid prescriber-patient relationship, PMP recheck, quantity and days' supply appropriate for acute dental pain), and it should be written for the additional amount, not stacked on the 12. A short-acting opioid plus NSAID/acetaminophen is the better conversation to have.

Notify DEA and document it; report the dispensing to the PMP; never back-fill.

• If the 7-day window passes without the prescriber's written or electronic prescription, the pharmacist must notify DEA and record the date, method, and person contacted. This is a compliance obligation, not an optional courtesy.
• Do not create, solicit after the fact, or "reconstruct" a prescription to close the file. Falsifying the record converts a technical violation into a serious one.
• The 12 tablets are a dispensing of a controlled dangerous substance and must be reported to the New Jersey PMP under the dispenser-reporting rules, like any other CDS dispensing. Confirm the current reporting interval in the PMP regulations rather than relying on memory.
• NJ places the mandatory PMP query duty on prescribers, not pharmacists. That does not make a query optional in practice: for an emergency CII from a prescriber you do not know, query, document what you saw, and let the record show your reasoning if the pattern later looks unusual.