April 2, 2018

In This Issue
Licensing Boards Issue New Joint Rule Chapter 21 re: Opioid Prescribing
Maine Providers Standing Up for Health Care Press Conference Tuesday in the State House Welcome Center
Step-by-step Naloxone Education Video Now Available
National AAP to Award Senator Susan Collins the Excellence in Public Service Award
CDC Reports Opioid Overdose Deaths Increasing in Nearly All Segments of US Population
Open Payments Reminder: 45-day Review-and-Dispute Period Starts April 1
New AMA Survey: Patient Clinical Outcomes Shortchanged by Prior Authorization
Take Our Survey: Do you hold a DEA X-waiver to prescribe buprenorphine?
Legislative Call This Tuesday, April 3rd
Legislative Report: Destigmatizing language changes, child services, and more
LEGISLATIVE ALERT: Maine Senate's Initial Vote on MMA PA Bill, L.D. 1032, Strongly Favors Passage
QC2018: Building Communities of Practice through Innovation - Wednesday, April 4, 2018
MMA and Jackson Laboratory Seeking Volunteers to Assist with 2018 Maine Cancer Genomics Initiative Forum - April 6-8
FREE 8-Hr. MAT Waiver Training Being Offered in Dover, NH - Friday, April 27th
Maine Society of Eye Physicians and Surgeons Spring Educational Program & Business Meeting - Friday, May 4th
Introduction to Lean in Healthcare Full-Day Workshop on Tuesday, May 8
Maine Chapter, American College of Surgeons Annual Meeting in Kennebunkport, ME - May 18-20
One River, One Ocean: June 2-14, 2018
New Free CME on Alzheimer's Risk, Detection, and Management
Peer Navigation Program from Facing Our Risk of Cancer Empowered (FORCE)
Online Learning Opportunities Offering CME Credits - from the Northern New England Practice Transformation Network
Psychiatry Faculty, Division of Child & Adolescent Psychiatry
Psychiatric Medical Director
Maine's Largest FQHC in need of Physician for Geriatric Program
Multiple Family Med Opportunities in Beloved Community Health Centers
Medical Board Physician
Outpatient Only - Internal Medicine with Loan Repayment & Sign-on Bonus
Family Practice Physician - Bucksport Regional Health Center
Hospice Physician Lewiston, ME
Internal Medicine Outpatient Physician
Outpatient Internal Medicine Physician Bangor, Maine
Relocate to Beautiful Southwestern Maine - Medical Director/Family Practice Physician
Clinical Cardiology Opportunity
Opportunities at the VA for Volunteer Physicians

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Licensing Boards Issue New Joint Rule Chapter 21 re: Opioid Prescribing

Most significantly, the Joint Rule requires the use and documentation of Universal Precautions in prescribing controlled substances. The precautions including conducting a risk assessment to minimize the potential for adverse effects, abuse, misuse, diversion, addiction and overdose, developing a treatment plan, obtaining informed consent, employing a treatment agreement, monitoring, and creating and maintaining adequate medical records to document compliance. There are appropriate exceptions for emergency situations which MMA requested in comments filed on the rule in 2017. The definition of a "medical emergency" is defined in Section 2 of the rule.

The Rule clarifies the obligation of licensees when illegal acts occur and cross references the CDC Guidelines for prescribing opioids issued in 2016 (CDC Guideline for Prescribing Opioids for Chronic Pain- United States, 2016). 
In the purpose section of the Rule the Boards state as follows:
"Clinicians should not fear disciplinary action from the Boards for prescribing controlled substances, including opioid analgesics, for a legitimate medical purpose and in the course of professional practice if they are following standards of care, established guidelines and the requirements of this rule. Judgment regarding the propriety of any specific course of action must be made based on all of the circumstances presented, and thoroughly documented in the patient's medical record.
The new Rule also brings up to date the language in the previous rule in order to conform to the requirements of Chapter 488 and its subsequent amendments enacted and signed into law last year. 
Among the new requirements is language requiring the prescribing clinician to periodically review and document in the patient's medical record the course of pain treatment and any new information about the etiology of the pain or the patient's state of health and level of function. The frequency of this review is determined by the patient's risk factors, the medication dose and other clinical indicators but a chart is provided dictating the frequency of the required review. For instance, for a patient at high risk or receiving 90 mg/day MME the review would take every 1 to 3 months.
Clinicians should pay particular attention to the required toxicology drug screens which are required for any patient receiving a controlled substance for chronic non-cancer/non-hospice/non-end-of-life pain for 90 days or more. A drug screen must be done prior to initiating such treatment and at least annually thereafter but with frequency based upon the patient's level of risk.
A full copy of the rule can be accessed on the website of the Board of Licensure in Medicine or, alternatively, through the MMA website at www.mainemed.com (MMA Spotlight section).
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