Ohio Medical Board Announces New Opioid Prescription Limits for Acute Pain

The State Medical Board of Ohio recently announced new rules regarding the prescription of opioids for the treatment of acute pain (the “rules”). These new rules¹ are designed to curb the opioid epidemic in Ohio, one of the hardest hit states in the nation.

The Buckeye State has garnered national attention for the impact the nation’s opioid crisis has had on its population and budget. In 2016, over 4,140 Ohioans died due to an unintentional overdose, a 36 percent increase from 2015. Montgomery County, Ohio is notably the hardest hit county in the nation.

The Rules, which encompass a bi-partisan compromise on prescription reporting, will take effect on August 31, 2017. They effectively limit the prescription of opioids for acute pain management by:

• Limiting the supply of prescribed opioids for adults to no more than seven days.
• Limiting opioid prescriptions for minors to no more than five days, and only after the provider has obtained the written consent of a parent or guardian. 
• Providers may prescribe opioids beyond the above supply limits if they provide specific reasons as documented in the patient’s medical records.
• The total morphine equivalent dose (MED) of a prescription cannot exceed an average of 30 MED per day, unless otherwise authorized by the Rules. To help prescribers calculate the patient’s MED, the State of Ohio Board of Pharmacy has developed a convenient conversion chart.

In addition, starting December 29, 2017, health care providers must include the first four characters of the ICD-10 diagnosis code or the full procedure code on all opioid prescriptions (Ohio Administrative Code (“OAC”) 4729-5-30). Pharmacists will then enter the codes in the Ohio Automated RX Reporting System (“OARSS”) database to enable the state to track trends and identify providers that do not curb their prescription habits.  

It is important to note that the new Rules only apply to acute pain management and therefore exclude opioids prescribed to assist patients with chronic pain due to cancer, palliative care, end-of-life/hospice care, or medication-assisted treatment for addiction. 

Faced with an unprecedented epidemic across all population strata, Ohio is attacking the problem on multiple fronts in an attempt to rapidly curb the alarming trends. In addition to the new Rules, it has developed treatment guidelines and multiple resources available on the Ohio Department of Health to assist providers in treating chronic pain using opioid prescriptions, e.g. pocket cards, patient handouts, screening tool, sample pain agreements, and discharge/follow-up care instructions. The new Ohio prescribing limits and the state’s treatment guidelines are congruent with the findings of recent clinical studies, which demonstrate that patients who use painkillers for long periods of time are more likely to become addicted. As a result, the Center for Disease Control and Prevention now recommends shorter durations for opioid prescriptions. 

As Ohio responds to the opioid crisis, health care providers can anticipate strict scrutiny over the implementation of the new Rules. Facilities such as hospitals, ambulatory surgery centers, and pain management clinics should take a proactive stance and at minimum, (1) review and revise their protocols; (2) implement policies and procedures regarding the prescribing of opioids; (3) actively train health care providers, including, but not limited to, all employees, independent contractors, and Medical Staff; (4) document such training; and (5) rapidly conduct self-audits to ensure prompt compliance with the new Rules. 

For additional questions regarding the new limits on prescription opioids for acute pain, please contact one of the attorneys below.

1. Dental Board: OAC 4715-6-02 - Prescribing opioid analgesics for acute pain
    Medical Board: OAC 4731-11-01 - Definitions (related to controlled substances)
                             OAC 4731-11-02 - General provisions (related to controlled substances)
                             OAC 4731-11-13 - Prescribing of opioid analgesics for acute pain
    Nursing Board: OAC 4723-9-10 - Formulary; standards of prescribing for advanced practice registered nurses   designated as clinical nurse specialists, certified nurse-midwives, or certified nurse                                practitioners.
    Pharmacy Board: OAC 4729-5-30 - Manner of issuance of a prescription (effective December 29, 2017).