Source: State Medical Board of Ohio
Starting Sunday, December 23, Ohio prescribers will need to follow new regulations when prescribing opioids for the treatment of long-term pain (lasting 12 weeks or more) and subacute pain (lasting between six and 12 weeks). The specific requirements can be found in Ohio Administrative Code 4731-11.
According to the State Medical Board of Ohio (SMBO), the new rules will not take away medication for those in need, but instead strengthen communication between physicians and patients by establishing check points for additional assessment.
Following is an overview of the new regulations so physicians and other prescribers may incorporate them into practice without disruption to patients’ care:
Physicians are required to engage in conversations with patients before starting on long-term medication treatment to ensure opioids are improving function and the patient is offered non-opioid treatments when appropriate:
- Prior to treating or continuing to treat subacute or chronic pain with an opioid, the physician needs to first consider and document non-medication and non-opioid treatment.
- If medication is appropriate, the physician should prescribe it for the least amount of days and strength to adequately address the pain.
- Prescribers should complete and document in the patient’s record: history and appropriate physical exam, review of diagnostic tests, check on the patient’s history in OARRS, functional pain assessment, and a treatment plan. If the patient has signs or symptoms of substance misuse or substance use disorder, the diagnostic tests must include a urine drug screening.
According to the Centers for Disease Control and Prevention, a dose of 50 MED or more per day doubles the risk of opioid overdose death. At 90 MED or more, the risk of overdose increases ten times. The new rules establish the following check points to ensure appropriate prescribing:
- At 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, obtain written informed consent from the patient, and consider offering the patient a prescription for naloxone, the life saving overdose antidote.
- At 80 MED, prescribers need to look for signs of prescription misuse, consult with a specialist, obtain a written pain-management agreement and offer a prescription for naloxone.
- At 120 MED, prescriptions will need to be written by, or in collaboration with, a pain-medicine specialist, board-certified hospice physician or health care professional, or board-certified palliative care physician or health care professional.
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.