|April 2, 2018
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).Next Article >
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