Opioid-rules draft sets doctor stipulations

Doctors who prescribe large amounts of narcotic painkillers would be required to take extra precautions under draft regulations unanimously approved by the Arkansas State Medical Board on Thursday.

The requirements would kick in when doctors write prescriptions for more than 50 morphine milligram equivalents — equal to about 10 5-milligram tablets of hydrocodone or two 15-milligram tablets of oxycodone — per day.

The rules would also limit prescriptions for treatment of acute pain, such as after surgery, to a seven-day supply.

The limits would not apply to prescriptions written for patients with cancer, in hospice or palliative care, or being treated in hospitals or during emergencies.

Based on guidelines issued last year by the federal Centers for Disease Control and Prevention, the rules are aimed at reducing the abuse of opioid medications such as hydrocodone, oxycodone and morphine.

Gov. Asa Hutchinson, who had urged the Medical Board to adopt the CDC guidelines, praised the board “for this important step.”

“Opioid abuse is an escalating danger in Arkansas, and we have to curtail the abuse,” Hutchinson said in a statement Thursday.

According to the CDC, doctors should “carefully reassess evidence of individual benefits and risks” when prescribing more than 50 morphine milligram equivalents per day and avoid or “carefully justify” prescribing

more than 90 morphine milligram equivalents per day.

Ronald Tilley, a pain specialist and member of the Medical Board’s pain management review committee, told the board on Thursday that Arkansas’ high rates of poverty, obesity and smoking make for a “chronic pain nightmare” and “perfect storm for opioid prescribing.”

According to the CDC, Arkansas health care providers wrote 114.6 opioid prescriptions for every 100 residents in the state last year.

That was the second-highest prescribing rate in the country behind Alabama, which had 121 prescriptions per 100 residents.

The national rate was 66.5 prescriptions per 100 residents.

The rate of deaths from drug overdoses in Arkansas has increased from 5.1 per 100,000 people in 2000 to 13.4 last year, according to a state Health Department presentation to lawmakers in July.

About half of drug overdose deaths nationally have been attributed to opioids.

Under the draft regulations approved Thursday, doctors who prescribe more than 50 morphine milligram equivalents per day would be required to explore alternative treatment plans and document “objective findings” such as laboratory tests, showing the need for the treatment.

Doctors would also be required to inform patients of the risks and addictive nature of the drugs. When prescribing 90 morphine milligram equivalents or more per day, doctors who are not pain-management specialists would be required to consult with such a specialist.

The board published a draft of the rules earlier this year and revised it in response to feedback from doctors. For instance, the Arkansas Medical Society recommended addressing acute care and spelling out the limits on morphine milligram equivalents based on the CDC recommendation.

The version adopted Thursday will be published on the Medical Board’s

website and in an advertisement in the Arkansas Democrat-Gazette within the next couple of weeks, said Kevin O’Dwyer, an attorney for the board.

The rules could be revised based on comments the board receives in writing and in a public hearing in February, he said. If no significant changes are made, the rules will be submitted to the Legislature for final approval after the hearing.

Joe Thompson, director of the Arkansas Center for Health Improvement, said the regulations go beyond the CDC guidelines by providing details on the steps doctors should take when prescribing large amounts of opioids.

“I think this makes sense,” he said. “The application is always where the devil’s in the details, and we’ll have to see how this plays out over time.”

Act 820, passed by the Legislature this year, requires doctors to check a database of prescriptions for painkillers and other frequently abused drugs before prescribing such a drug.

The law also calls on the state boards that license doctors, pharmacists, nurses, dentists, optometrists and veterinarians to develop rules limiting the amount of opioids that can be prescribed or dispensed to patients.

Tilley called the regulations “a great start.”

“I fear that if we don’t do it as a medical profession, then the lawmakers are going to do it for us, and we’re going to have a huge problem,” he said.