Opioid prescribing laws to change Nov. 1
Q: This spring, the Oklahoma Legislature passed a bill that changes the laws surrounding opioid prescriptions. What does the legislation do?
A: Senate Bill 1446 places limits on the number of opioid pills that physicians can prescribe and puts in place safeguards to help curb the potential for opioid abuse. Starting on Nov. 1, physicians will only be able to initially prescribe a week’s worth of opioid drugs to manage acute pain and must limit the dosage to the lowest effective dose. Before renewing the prescription for up to seven more days, the law requires a consultation with the patient to determine that the patient needs the prescription and that the prescription does not present a risk for abuse, addiction, or diversion. If after the initial 14 days the physician determines that the patient still needs opioids to manage pain, the physician must follow the procedures to treat chronic pain that are outlined below. Additionally, the law places greater responsibility on physicians by requiring one hour of continuing education in pain management or in opioid abuse and addiction each year before the physician renews his or her license to practice and by providing for disciplinary action if a practitioner fails to check the Oklahoma Prescription Monitoring Program database. The law also aims to generally increase communication between prescribers and patients by requiring documented discussions on the risks associated with opioids.
Q: How will this law affect patients who suffer from chronic pain?
A: Patients who are prescribed opioids or other Schedule II controlled dangerous substances for chronic pain can expect to see increased safeguards in receiving their prescriptions. For instance, the physician will enter into a pain management agreement with the patient that explains the risk of dependence on opioids and documents the mutual understanding of the plan between the practitioner and patient. Additionally, a patient can expect a practitioner to review the treatment plan progress at a minimum of every three months and to assess the patient before each refill to determine if the patient is experiencing dependence problems. Patients who are prescribed a Schedule II controlled dangerous substance or any opioid drug for cancer treatment, hospice, or palliative care or who are residents in a long-term care facility are exempted from these requirements.
Q: What is the reason behind the legislation?
A: The U.S. Substance Abuse and Mental Health Services Administration announced that 11.1 million people 12 or older in the United States misused prescription opioids in 2017. The U.S. Center for Disease Control reports that from 1999 to 2016, more than 200,000 people died in the United States from overdoses related to prescription opioids. The opioid epidemic continues to be a growing crisis. “Overdose deaths involving prescription opioids were five times higher in 2016 than in 1999,” the CDC reports. Oklahoma is no exception to this nationwide trend. According to the Oklahoma Commission on Opioid Abuse Final Report released in January, “In the last 15 years, drug overdose deaths in the state have increased by 91 percent and continue to rise.” The Commission reports that the opioid crisis continues to claim an average of 1,000 Oklahomans every year. Accordingly, Oklahoma has joined several states this year in passing legislation intended to reverse the staggering statistics.
Q: The new law requires certain discussions to take place between prescribers and patients before opioids are prescribed. Who can perform these required consultations?
A: It depends on whether it is an initial prescription or a renewal. The Oklahoma Office of
Attorney General recently released guidance to the Oklahoma Medical Board, explaining that the initial seven-day prescription for patients suffering from acute pain requires a physician to have a face-to-face encounter with the patient. However, the consultation required to issue a subsequent seven-day prescription may be performed by any “practitioner,” which includes a physician assistant under the supervision of a physician, or “any other person licensed, registered, or otherwise permitted to prescribe, distribute, dispense ... or administer a controlled dangerous substance in the course of professional practice or research in this state.” If the practitioner determines through the consultation that the subsequent prescription is necessary, appropriate, and does not present a risk of abuse, then the physician may issue the subsequent prescription. Similarly, any “practitioner” may conduct the required three-month assessment for patients suffering from chronic pain. There appears to be some differences of opinion among state licensing boards on this issue, so be on the lookout for further guidance.
Q: What can patients now expect if they need to be treated for pain?
A: Patients can expect a lot more communication, disclosures, and documentation before they can receive a prescription for opioids or any other Schedule II controlled dangerous substances. As described above, the law intentionally outlines each step of the prescription process in an attempt to decrease the opportunity for addiction. These cautionary steps include a documented medical history, a thorough physical exam, a treatment plan focused on determining the cause of pain, and a limited supply of prescription opioid drugs.