Starting December 23, 2018, issues new rule for physicians and physician assistants. Prescribers will need to follow new regulations when prescribing opioids for the treatment of long-term pain. This is pain lasting 12 weeks or more or subacute pain lasting between six and 12 weeks.
The new rules establish the following check points, not limits, to ensure appropriate prescribing and are based on 2016 CDC Guidelines for Chronic Pain Management:
- 50 MED: prescribers are required to re-evaluate the status of the patient’s underlying condition causing pain, assess functioning, look for signs of prescription misuse, consider consultation with a specialist and obtain written informed consent from the patient.
- 80 MED: prescribers need to look for signs of opioid prescription misuse, consult with a specialist, obtain a written pain-management agreement and consider a prescription for naloxone, the lifesaving overdose antidote.
- 120 MED: in order for prescribers to prescribe a dosage that exceeds 120 MED (unless the patient was already on a dosage of 120 MED or more prior to December 23, 2018) there must be a recommendation from a board certified pain medicine physician or board certified hospice and palliative care physician that is based upon a face-to-face visit and examination. There does not need to be a recommendation if the prescribing physician is himself/herself board certified in pain medicine or hospice and palliative care.
The rules do not apply to patients receiving medication for terminal conditions or those within a hospital or in-patient setting where they are closely monitored. They also take into consideration patients who are already being treated for chronic pain by not establishing a maximum dose or duration of treatment. For patients that are already being treated with opioids for chronic pain, medical standards of care still apply, however, these patients will not be required to consult with a pain management specialist unless dosages increase.
The specific requirements can be found in Ohio Administrative Code 4731-11.
4731-11-02 General provisions
4731-11-14 Prescribing for subacute and chronic pain
The old chronic pain rules in Chapter 4371-21 of the Ohio Administrative Code are rescinded as of December 23, 2018.
Opioid Prescriptions for Chronic and Sub-acute Pain (OAC 4731-11) – effective December 23, 2018
Previous Chronic Pain Prescription Rules (OAC 4731-21) – rescinded December 23, 2018