New Ohio Opioid Prescribing Rules Unveiled
By Tammy Lundstrom, MD, JD, interim chief clinical officer and interim president, Premier Physician Network, Premier Health
The Ohio Board of Medicine has released the long-awaited rules on opioid prescribing that track the Centers for Disease Control and Prevention guidelines. These rules took effect on August 31. They include the following basics that apply to the first opioid analgesic prescription for the treatment of an episode of acute pain:
- No more than seven days of opioids can be prescribed for adults.
- No more than five days of opioids can be prescribed for minors and only after the written consent of the parent or guardian is obtained.
- Except as provided for in the rules, the total morphine equivalent dose (MED) of a prescription for acute pain cannot exceed an average of 30 MED per day.
- Health care providers may prescribe opioids in excess of the day supply limits only if they provide a specific reason documented in the medical record.
The new limits do not apply to opioids prescribed for cancer, palliative care, end-of-life/hospice care or medication-assisted treatment for addiction. Prescribers should be aware that MED will be calculated on the maximum use potential on PRN prescriptions. Those allowing for more than four Vicodin tablets or the equivalent will be in violation of the limits. More details can be found in the following documents:
An additional rule requiring the inclusion of the first four digits of the ICD-10 diagnosis or CPT code to the prescription when prescribing opioids for acute pain becomes effective in December 2017. On June 1, 2018, this will be a requirement for all controlled substance prescriptions. Our IT team is working with the EPIC developers on strategies to assist providers in meeting these requirements. The OSBM has also announced that it intends to audit providers who exceed the guidelines and promised strict enforcement per Gov. John Kasich’s direction.
The MED limit is one that will likely trip up some doctors. Four 5mg vicodin in a 24-hour period will max out the limit. Many of the surgeons write for one to two every six hours, and that will require supporting documentation in the record.
More information can be found on the Ohio Automated RX Reporting System (OARRS) MED calculator.
Back to the October 2017 issue of Premier Pulse
