Governor Announces His Own Prescribing Restrictions for Acute Pain

On March 29, Governor John Kasich announced new opioid prescribing restrictions for acute pain. This announcement came on the heels of two new pieces of restrictive prescribing legislation, House Bill 167 and Senate Bill 119, introduced for consideration by the Ohio General Assembly at the end of March (see related story “More Opioid Prescribing Restrictions Introduced for Consideration”).

Under the Governor’s plan, scripts for narcotic painkillers for acute pain would be limited to 7 days for adults and 5 days for minors. Those limits could be exceeded if the prescriber provides documented reasoning in the patient’s medical record as to why exceeding the limit is medically necessary. Doctors will be required to provide a specific diagnosis or procedure code on every prescription written for a controlled substance. These limits would apply to acute pain only – not to cancer patients, palliative and hospice care, and medication-assisted treatment for people dealing with addiction.

The Governor indicated that the new restriction will be enacted by the pharmacy, medical, nursing, and dental boards. The governor appoints the members of each of these boards thus explaining why the governor is quoted as saying these rules are a “done deal.” The rules are expected to take effect this summer.

These restrictions are not directly related to the two pieces of legislation introduced earlier in the week.

• 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, OARRS.
• 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 of Ohio, the State of Ohio Board of Pharmacy, the Ohio State Dental Board, and the Ohio Board of Nursing.