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New limits on prescription opioids for acute pain

Source: State Medical Board of Ohio

Effective Thursday, August 31, the State of Ohio will have new rules for prescribing opioid analgesics for the treatment of acute pain. Acute pain is defined in the rule as pain that normally fades with healing, is related to tissue damage, significantly alters a patient’s typical function and is expected to be time limited.

Please be advised, these rules DO NOT apply to the use of opioids for the treatment of chronic pain. Chronic pain is defined as pain that has persisted after reasonable medical efforts have been made to relieve the pain or cure its cause and that has continued, either continuously or episodically, for longer that three continuous months.

In general, the rules limit the prescribing of opioid analgesics for acute pain, as follows:
  1. No more than seven days of opioids can be prescribed in the initial prescription for adults.
  2. No more than five days of opioids can be prescribed in the initial prescription for minors, and only after the written consent of the parent or guardian is obtained.
  3. Physicians and other licensed health care prescribers may prescribe opioids in excess of the day supply limits only if they provide a specific reason in the patient’s medical record.
  4. Except as provided for in the rules, the total morphine equivalent dose (MED) of a prescription for acute pain cannot exceed an average of 30 MED per day.
  5. The new limits do not apply to opioids prescribed for cancer, palliative care, end-of-life/hospice care, or medication-assisted treatment for addiction.

Starting Friday, December 29, 2017, rule 4729-5-30 will require prescribers to include the first four characters (ex. M16.5) of the diagnosis code (ICD-10) or the full procedure code (Current Dental Terminology – CDT) on opioid prescriptions, which will be entered by the pharmacy into Ohio’s prescription monitoring program, the Ohio Automated Rx Reporting System (OARRS). This requirement will take effect for all other controlled substance prescriptions on Friday, June 1, 2018.

Note: Following months of contentious opposition, the Ohio State Medical Association, on behalf of all physicians, and the Ohio Hospital Association reached a compromise with the Kasich administration that they would not continue to object to the ICD-10 requirement as long as a 9-month delay in the requirement for non-opioid controlled substance prescriptions was instituted.

Starting Friday, December 29, 2017, rule 4729-5-30 will also require prescribers to indicate the days’ supply on all controlled substance and gabapentin prescriptions.

To assist prescribers in calculating a patient’s MED, the State of Ohio Board of Pharmacy (SOBP) has developed a conversion chart that can be accessed on its website.

For additional information, please review your licensing board’s respective rules and the SOBP’s manner of issuance rule:

Medical Board – Rules for Physicians and Physician Assistants
  • 4731-11-01 – Definitions (related to controlled substances)
  • 4731-11-02 – General provisions (related to controlled substances)
  • 4731-11-13 – Prescribing of opioid analgesics for acute pain
Pharmacy Board
  • 4729-5-30 – Manner of issuance of a prescription. (NOTE: This rule goes into effect Friday, December 29, 2017. The SOBP has adopted a resolution regarding the diagnosis/procedure code provisions of this rule).

Prescribing Opioids for the Treatment of Chronic Pain
As a reminder, Ohio developed guidelines for the treatment of chronic pain using opioids in October 2013.

Contact the State Medical Board of Ohio for more information.

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