Ohio’s New Limits on Prescription Opioids for Acute Pain

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Consistent with the guidelines for chronic pain, Ohio’s guidelines for acute pain are both rational and flexible, providing safety, promoting responsible use without tying the hand of physicians when addressing patients and circumstances which fall outside expectations.

Updated 2/22/2019

NOTE: This guidance is intended to provide a general overview of the limits on prescription opioids for acute pain. For specific questions regarding the limits, please contact the appropriate prescriber regulatory board.

The State of Ohio has rules for prescribing opioid analgesics for the treatment of acute pain. Please be advised, the limits in the rules DO NOT apply to the use of opioids for the treatment of chronic pain. Ohio also implemented rules for the treatment of chronic pain using opioids. More information can be accessed at here.

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 for adults.
  2. No more than five days of opioids can be prescribed for minors and only after the written consent of the parent or guardian is obtained in accordance with section 3719.061 of the Revised Code. A guidance document (that includes exemptions to the consent requirements) can be accessed here.
  3. Health care providers 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.
  6. The rules apply to the first opioid analgesic prescription for the treatment of an episode of acute pain.
  7. The rules do not apply to inpatient prescriptions as defined in rule 4729-17-01 of the Administrative Code.

NOTE: These rules do not apply to veterinarians.

All prescribers are required to include the first four alphanumeric characters (ex. M16.5) of the diagnosis code (ICD-10) or the full procedure code (Current Dental Terminology – CDT) on all controlled substance prescriptions, which will then be entered by the pharmacy into Ohio’s prescription monitoring program, OARRS.

NOTE: This requirement does not apply to veterinarians.