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Important Information

from the State Medical Board of Ohio


Tessie Pollock
Tessie Pollock
Tessie Pollock's Article

New Limits on Prescription Opioids for Acute Pain Bookmark

New Limits on Prescription Opioids for Acute Pain

Effective August 31, 2017, the State of Ohio will have new rules for prescribing opioid analgesics for the treatment of acute pain.  Please be advised, these rules DO NOT apply to the use of opioids for the treatment of chronic pain. Click here to watch the educational video/overview.

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 in the initial prescription for adults.

  2. No more than five days of opioids can be prescribed in the initial prescription for minors, and only after the written consent of the parent or guardian is obtained.

  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.

NOTE: These rules do not apply to veterinarians.

 

Starting December 29, 2017, rule 4729-5-30 will require prescribers to include the first four characters (ex. M16.5) of the diagnosis code (ICD-10) or the full procedure code (Current Dental Terminology - CDT) on opioid prescriptions, which will be entered by the pharmacy into Ohio’s prescription monitoring program, OARRS.  This requirement will take effect for all other controlled substance prescriptions on June 1, 2018.  NOTE: This requirement does not apply to veterinarians.

Starting December 29, 2017, rule 4729-5-30 will also require prescribers to indicate the days’ supply on all controlled substance and gabapentin prescriptions. NOTE: This requirement does not apply to veterinarians.

 

To assist prescriber’s in calculating a patient’s morphine equivalent dose, the State of Ohio Board of Pharmacy has developed a conversion chart that can be accessed here: www.pharmacy.ohio.gov/MEDtable.

For additional information, please review your licensing board’s respective rules and the Board of Pharmacy’s manner of issuance rule:

 

Medical Board - Rules for Physicians and Physician Assistants

4731-11-01 - Definitions (related to controlled substances)
4731-11-02 - General provisions (related to controlled substances)
4731-11-13 - Prescribing of opioid analgesics for acute pain

Dental Board

4715-6-02 - Prescribing opioid analgesics for acute pain

Nursing Board

4723-9-10 - Formulary; standards of prescribing for advanced practice registered nurses designated as clinical nurse specialists, certified nurse-midwives, or certified nurse practitioners.

Pharmacy Board

4729-5-30 - Manner of issuance of a prescription.  (NOTE: This rule will not go into effect until December 29, 2017.  The Board has adopted a resolution regarding the diagnosis/procedure code provisions of this rule: www.pharmacy.ohio.gov/AcuteResolution)

 

Prescribing Opioids for the Treatment of Chronic Pain

As a reminder, Ohio developed guidelines for the treatment of chronic pain using opioids.  These guidelines can be accessed here.

 

For More Information

If you are a prescriber, please contact your respective regulatory board using the information below.

Update for Prescribers Bookmark

The Ohio Board of Pharmacy has recently published a number of guidance documents regarding recent law and rule changes that may impact your prescribing practices.

  • TDDD Requirements for Controlled Substances: All locations that possess controlled substances are required to obtain licensure as a category III terminal distributor of dangerous drugs. Please be advised that this requirement takes effect on April 6, 2017. More information on this provision can be found by visiting: www.pharmacy.ohio.gov/TDDDcs.

  • Office-Based Opioid Treatment: Effective August 4, 2017, all locations that treat more than 30 individuals for opioid dependence or addiction using a controlled substance are required to obtain a license as a terminal distributor of dangerous drugs with an office-based opioid treatment classification. Please be advised that there are some exemptions to this requirement. More information on this provision can be found by visiting: www.pharmacy.ohio.gov/OBOT.

  • Effective April 1, 2017, all prescribers that possess compounded drugs or engage in the compounding of dangerous drugs (i.e. prescription drugs) must obtain a license as a terminal distributor of dangerous drugs (ORC 4729.541). More information on this provision can be found at: www.pharmacy.ohio.gov/prescribercompound.