Illinois Trends in Prescribing and Enforcement: When May Doctors Prescribe the Diet Drug Phentermine?

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Diet drugs have long been a staple of the weight loss industry. In the United States, weight-loss products and services have continued to show formidable staying power, a market segment valued at over $66 billion in 2017. Perhaps the one product with the longest history of use for dieting purposes is the weight loss drug phentermine. Approved in 1959, phentermine is a stimulant used to suppress the appetite. According to the Mayo Clinic, phentermine should only be used by people who are clinically obese.

The widespread use of this diet drug led to controversy and consequences in recent years, both for those who use it as well as those who prescribe it. According to Illinois law, phentermine is a Schedule IV drug, categorizing it among controlled substances that have a potential for abuse (720 ILCS 570/210 e.3). But until recently, and unlike opioids or other, more deadly controlled substances, improper phentermine use has largely flown under the radar of regulators.

That trend appears to be changing, as more serious attempts to regulate phentermine distribution and punish misuse are on the rise. One of the most significant cases that brought phentermine back into the spotlight was the 2016 indictment of a Chicago doctor and weight loss center owner for illegally dispensing weight-loss drugs. According to court filings, Michael Jennings, the owner of Results Weight Loss Center, was purportedly posing as a doctor and using physician William Mikaitis’s federal registration number to order and dispense phendimetrazine and phentermine in exchange for cash payments. The indictment accused the two of making at least $790,000 in illegal proceeds over two years.

The following year, the Illinois Senate amended Section 5 of the Illinois Controlled Substances Act (ICSA) to add stronger reporting requirements for prescribers with an Illinois controlled substance license. The new regulations, outlined in Public Act 100-0564, require all prescribers to enroll in the Illinois Prescription Monitoring Program (PMP), which is in turn overseen by the Illinois Department of Human Services (IDHS). The PMP itself has long been used to collect data from retail pharmacies dispensing in Illinois. What the new change does is place a larger share of the responsibility for regulating controlled substances on prescribers.

The consequences for failing to adhere to the new regulations can be severe. The Illinois Department of Financial and Professional Regulation (IDFPR) warned prescribers that anyone found non-compliant may be subject to disciplinary action. In February 2019, the new regulations made headlines when Dr. Samuel Figueroa, the operator of the Dutch Hollow Medical Spa, had his medical license placed on probation because of claims he improperly prescribed phentermine. The doctor’s hospital privileges were also revoked, pending an investigation. According to the IDFPR web site, Figueroa “failed to properly prescribe and document his treatment management protocols utilizing Phentermine.”

Such cases raise the question of what will constitute a proper use of a drug like phentermine, and when doctors can safely prescribe it. The popularity of the drug itself may in some cases hinder a prescriber’s ability to ethically prescribe phentermine. According to a New York Times report, physicians often profit from selling the pill to their patients. What is more, individuals seeking the drug will trade tips on social media sites, including the names of doctors who prescribe the drug with few questions asked. It is also one of the least expensive diet drugs currently on the market. Together, these factors put pressure on prescribers and may encourage them to give phentermine to people who should not otherwise be taking it.

According to the available literature on the drug, phentermine is intended for individuals who are clinically obese and for whom other methods of weight loss have failed. The proper use of this drug can have positive results, but it does come with certain risks. According to the Mayo Clinic, the risk for addiction is relatively low, but because phentermine is a stimulant, it can cause side effects like elevated heart rate, tingling in the hand and feet, sleeplessness, nervousness, and several others. Those with a history of heart disease, high blood pressure, or an overactive thyroid gland should not take phentermine or drugs like it, as it will likely make these conditions worse.

With restrictions and potential risks like these, the State of Illinois has made it clear that it is up to the prescriber to ensure that their patients can safely take a weight loss drug and to monitor its use closely. While drug-seeking or pharmacy-shopping behaviors by consumers are expressly forbidden by the Illinois Controlled Substances Act (720 ILCS 570/314.5), consumers are not the only individuals the state will hold accountable when improper use or distribution is discovered.

Jordan Matyas

Jordan Matyas

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Jordan Matyas is a lawyer, lobbyist, and Founder of 1818 Legal, an Illinois professional licensing defense law firm he created in 2014. With more than 18 years of experience practicing law, he represents clients in a wide range of legal matters, including professional license defense, administrative law, land use and zoning, and state, local, and municipal law.

Jordan received his Juris Doctor from the University of Illinois — Chicago School of Law and is a member of the Illinois Bar Association.