In response to the current opioid epidemic in Ohio, the State Medical Board has released new rules regarding a physician’s prescribing of opioids for acute pain that will take effect on Aug. 31, 2017. The new rules do not apply with respect to prescribing for chronic pain or for the treatment of acute pain in patients who are in hospice, receiving palliative care, have been diagnosed with a terminal condition or have cancer or another condition associated with cancer.
The new rules generally limit a physician’s ability to prescribe opioids for acute pain as follows:
- No extended-release or long-acting opioids can be prescribed for acute pain.
- The physician must first consider non-opioid options for the treatment of the patient’s acute pain. If the physician determines opioids are required, he/she can prescribe only the minimum quantity and potency needed to treat the pain, with the assumption that a three-day supply or less is sufficient.
- When opioids are prescribed for acute pain, the first prescription for an episode of treatment shall be:
- No more than seven days for adults, with no refills.
- No more than five days for minors, with no refills, and only after the written consent of a parent or other authorized individual has been obtained.
- The day supply limits can be exceeded based on the pathology causing the pain. In such cases, the physician must document the reasons the limits are being exceeded in the patient’s medical record. However, the number of days of the prescription cannot exceed the amount required to treat the expected duration of the pain.
- When opioids are prescribed to a minor, the parent or guardian must be advised of the risks and benefits of the opioids, including the potential for addiction, and such advice must be documented in the medical record.
- The total morphine equivalent dose ("MED") cannot exceed an average of 30 MED per day. Exceptions do apply, such as for cases when the pain cannot be managed within the 30 MED limit based on prevailing standards of care (e.g., cases of amputation or severe burns).