While physician organizations were assured that if controlled substance prescriptions were reduced, Ohio’s acute pain guidelines would not become law, but that is, in fact, exactly what is happening. And the mandatory rules are much more stringent than the guidelines were.
Ohio is updating its opiate prescribing policies for treating acute pain by giving them the force of the law. The state began creating its voluntary guidelines in 2012, together with the medical community, even before the U.S. Centers for Disease Control and Prevention (CDC) issued guidelines last March.
After close analysis of the state’s electronic prescribing data, Ohio is taking steps to limit opiate prescribing for acute pain. While we have been provided no information as to how these calculations were made, the state estimates a reduction of opiate doses in Ohio by 109 million per year once these mandatory restrictions are finalized.
- No more than seven days of opiates can be prescribed for adults;
- No more than five days of opiates can be prescribed for minors;
- The total morphine equivalent dose (MED) of a prescription for acute pain cannot exceed an average of 30 MED per day;
- Health care providers can prescribe opiates in excess of the new limits only if they provide a specific reason in the patient’s medical record. Unless such a reason is given, a health care provider is prohibited from prescribing opiates that exceed Ohio’s limits;
- Prescribers will be required to include a diagnosis or procedure code on every controlled substance prescription, which will be entered into Ohio’s prescription monitoring program, the Ohio Automated Rx Reporting System;
- The new limits do not apply to opioids prescribed for cancer, palliative care, end-of-life/hospice care, or medication-assisted treatment for addiction;
- The new limits will be enacted through rules passed by the State Medical Board, Board of Pharmacy, Dental Board and Board of Nursing.
See related articles, “OAFP Submits Comments on Pharmacy Board Rules Implementing Opiate Prescribing Limits for Acute Pain” and “State Medical Board Accepting Comments on Limits to Opioid Prescriptions for Acute Pain.”
The Ohio Academy of Family Physicians is filing comments during the rules making process, but Governor Kasich has described the acute pain prescribing mandates as “a done deal.”