Doctors writing opioid prescriptions for chronic pain will have new rules to follow as the doses increase in intensity under a proposal unveiled last week by Governor John Kasich and the state's medical professional boards.
The proposed rules don't limit the doses or duration of opioid pain relievers for chronic pain, as similar regulations have done for acute pain and emergency room prescriptions. They do require more conscientious efforts by doctors to help patients avoid addiction.
"If you have chronic pain, you don't need to worry that your medication is going to be cut off," Kasich said in announcing the proposal at the Statehouse. "The message is that you're going to be treated in a very special, special way."
The proposal, with rules to be promulgated by the State Medical Board, Ohio Board of Nursing and the State Dental Board, would create a series of checkpoints as doses of opioids for chronic pain increase for patients.
The benchmarks are measured in morphine-equivalent doses. At 50 MED, prescribers will be required to re-evaluate the patient's underlying condition, look for signs of misuse, consider consulting a specialist and obtain written informed consent from the patient.
At 80 MED, the prescriber will again look for signs of opioid misuse, consult a specialist, obtain a written pain management agreement and consider a prescription for naloxone.
If the prescription reaches 120 MED, the prescriber will have to bring in a pain medicine specialist as a prescriber or consultant. Qualifying dentists will be limited to 100 MED for chronic pain, and any exceptions must be done in conjunction with a pain specialist.
"What we're trying to do with these guidelines is not tie the hands of clinicians but establish a consistent standard of safety that underscores the importance of clear communication and consent for patients as well as the rest of the medical team," said Dr. Mary Applegate, medical director for the Department of Medicaid.
The proposed rules, which will have to go through each board's rulemaking process before they proceed to the Common Sense Initiative and Joint Committee on Agency Rule Review, are expected to be in place in the fall, officials said.
They're also designed to encourage prescribers to consider non-opioid medications and ways of treating pain without drugs, such as acupuncture, State Medical Board President Robert Giacalone said.
"Ohio's new rules will not take away medication from those that need it but instead improve communication between patients and clinicians by establishing these checkpoints," he said.
The rules are the latest step the Kasich administration has taken in trying to reduce the overprescribing of opioid pain relievers. Past efforts have included guidelines for chronic pain and rules limiting the dosage for acute pain and for patients upon release from an emergency room. (Gongwer News Service)
To review a fact sheet prepared on the new initiative, click here.