Health care providers who prescribe opioids may soon find their states have added regulations regarding how they prescribe them. In response to the ongoing opioid epidemic, more states are adopting regulations for prescribing pain medications, although the majority of states have not. Pennsylvania is among the states to adopt opioid laws. Going into effect as of January 2017, they include prescribing limits in emergency rooms, patient education requirements and continuing education requirements. North Carolina is the most recent state to adopt such a bill, An Act Strengthening Opioid Misuse Prevention, which went into effect in June 2017.

So far, only around 10 states have extensive programs, rules, and regulations addressing opioids, controlled substance prescribing, or pain management. However, many states not having regulations or requirements related to the opioid problem have passed bills providing for adding them. So, it is likely that more states will describe regulations for prescribing pain medications in the future. Read more about free pokie downloads indian dreaming

The state opioid prescribing regulations that are in place typically follow at least part of current practice guidelines, the CDC’s Guideline for Prescribing Opioids for Chronic Pain. Prior to its publication in 2016, state regulations often followed the similar Federation of State Medical Board’s Model Policy on the use of Opioid Analgesics in the Treatment of Chronic Painfrom 2013. These guidelines are evidence-based wherever possible and otherwise guided by expert consensus on what practices are safest and effective in pain management. Providers do not need to wait for their states to adopt regulations before they start following these practices.

State regulations for opioid prescribing vary widely in what is included. For example, only some states include each of the following regulations:

  • Urine drug testing before initial prescribing and periodically for chronic opioid prescribing.
  • Limiting the supply in an initial prescription to a few days, limiting frequency of prescribing, or limiting the dose.
  • Required consultation with a pain specialist before prescribing above a certain threshold dose.

 

Example of a State Regulation: Prescription Drug Monitoring

Many state opioid regulations require participation in the state’s Prescription Drug Monitoring Program. This is a database maintained in nearly every state that collects data on prescriptions for controlled substances in that state. Prescribing providers can then check the database to see a patient’s history of being prescribed an opioid, including who prescribed it and which pharmacist filled the prescription. Through this database, a provider can sometimes discover patients who are obtaining the same medication from multiple providers or patients who may be prescribed a dangerous combination of medications that they did not report.

Around 10 states have enacted regulations that require registering with the Prescription Drug Monitoring Plan. Fewer states have regulations requiring checking the database before prescribing. Around 6 states have rules that require checking the database before prescribing and/or say how often the PDMPsshould be checked (Ohio, Kentucky, West Virginia, Tennessee, New York, Pennsylvania). For example, Pennsylvania regulations say to check the database before each prescription. The laws do not mention sanctions for not checking the PDMP, but some states are considering these.

 

State Requirements for Continuing Education on Pain Management and Opioids

A larger number of states have a continuing education requirement for education on pain management, controlled substance prescribing, and/or opioids for physicians. Around 20 states currently have requirements in at least one of these topics. There are wide variations in how many hours, how often, and the specific topic required. Five states require that at least some of the required training must be approved by that state medical board. Several additional states, lacking any CME requirement, do require training for providers working in pain clinics.

 

The Future of State Opioid Regulations and a Role for Providers

States typically spend a long time planning regulations on prescribing opioids before they are prescribed. Providers are often invited to participate in the process by providing feedback to draft versions. By participating in what their states are planning providers can help contribute to controlling the opioid epidemic.

Providers who are interested in doing something to help with the opioid epidemic don’t have to wait for regulations to be enacted. They can follow current professional guidelines and voluntarily seek continuing education in this important area.

The following resources supply state-by-state information on prescribing regulations and continuing education requirements:

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