2020-12-15 OMA Agenda - Board of Trustees

What are the practical considerations in prescribing anti-obesity controlled substances (i.e., phentermine), with or without telehealth? Whether DEA controlled medications or not, and whether prescribed via telehealth or clinician office visits, both clinicians and patients should be aware of potential risk and benefits of anti- obesity medications. (6) Additionally, some anti-obesity medications are DEA controlled substances. Phentermine is a DEA schedule IV medication approved in 1959, (7) and often reported to be the most commonly prescribed anti-obesity agent. (8) Phentermine is illustrative of the practicalities of prescribing controlled substances. (Other sympathomimetic amines, such as diethylpropion and phendimetrazine, will not be discussed here). Phentermine may be prescribed alone, or in combination with other anti-obesity agents (e.g., phentermine HCl / topiramate combination agent). (9) Clinicians should prescribe anti-obesity medication treatments in accordance with state and federal laws, and as clinically appropriate for telehealth visit. (Table 1) Phentermine is a sympathomimetic amine that is contraindicated in patients with cardiovascular disease (CVD). (6) The disease of obesity is a major contributor to heart disease. (6) Table 3 lists illustrative cardiovascular diseases and cardiovascular disease (CVD) risk factors to consider in the general management of all patients with obesity. Additionally, according to the prescribing information, phentermine HCl is approved for short-term (12 week) treatment of obesity. (6) From a clinical perspective, the time limitation on indicated use of phentermine may limit potential benefits in patients otherwise at low cardiovascular disease risk having the chronic disease of obesity. (Table 4) From a scientific perspective, the limitation of “short-term”

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