The Legislature has delayed the effective date of a key provision in the new controlled substance prescribing laws until March 31, 2019, or until the Michigan Department of Licensing and Regulatory Affairs (LARA) promulgates rules on the subject.
The recently enacted prescribing legislative package required a physician or other prescriber to establish a “bona fide prescriber-patient relationship” before prescribing any controlled substances. To have a bona-fide relationship, the prescriber is required to review the patient’s medical or clinical records and complete a full assessment of the patient’s medical history and clinical condition, including a medical evaluation in person or by telehealth visit.
The current definition restricted the ability to treat established patients in common circumstances, including:
• In emergency situations
• When another prescriber is providing care when the primary prescriber is unavailable
• When another licensed member of the health care team has been delegated to provide care
• During transitions of care such as from a hospital to a nursing home or hospice.
Delaying the effective date allows time to consider ways to address these concerns resulting from the definition of “bona fide prescriber-patient relationship.”
Other provisions of the new prescribing laws will take effect on June 1, 2018, as scheduled. These requirements include:
• A prescriber must register with MAPS by June 1, 2018, to be able to prescribe controlled substances.
• A MAPS report must be obtained and reviewed before prescribing more than a three-day supply of a controlled substance.
• A prescriber must act in regular course of professional treatment to an individual under treatment for a pathology or condition other than physical or psychological dependence upon or addiction to a controlled substance.
• A prescriber must ask about other controlled substances the patient may be using and record the patient's response in the medical or clinical record.
• A prescriber must provide follow-up care to monitor the efficacy of using controlled substances as a treatment, and if unable to provide follow-up care, must refer the patient to his or her primary care provider or another licensed prescriber for follow-up care.
• A prescriber must inform patients (and a minor’s parent or guardian) about specific information before issuing a new prescription for an opioid, and place a signed consent form in the patient record.
• No more than a seven-day supply of opioids may be prescribed for acute pain within a seven-day period.