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The Fallacy of Ohio’s 7 and 5 Day Limit For RXing of Acute Pain

Published: Apr 13, 2017 by Levi Tkach

Those following Ohio’s legislative news or those who caught the State-of-the-State speech know about a new set of rules in Ohio. These new rules prohibit medical professionals from authorizing prescriptions of controlled substances for any period longer than seven days for adults, and no more than five days for minors.

For the past several years, the Ohio legislature and the executive agencies have joined forces in changing the authorization and administration of controlled substances in Ohio. Recent efforts include the enactment of Senate Bill 319. On March 30, 2017, the Governor order Ohio’s top health care agencies to revise their rules regulating the use of opioids in treating acute pain. Acute pain typically refers to short-term pain relating to an isolated condition or injury. Common examples of acute injuries include sprained ankles and paper cuts.

To implement the Governor’s new order, the Pharmacy, Medical, Nursing, and Dental Boards are proposing rule amendments. Proposed rules from these Boards aim to achieve:

  1. No more than seven days of opiates can be prescribed for adults;
  2. No more than five days of opiates can be prescribed for minors;
  3. The total morphine equivalent dose (MED) of a prescription for acute pain cannot exceed an average of 30 MED per day;
  4. Health care providers can prescribe opiates in excess of the new limits only if they provide a specific reason in the patient’s medical record. Unless such a reason is given, a health care provider is prohibited from prescribing opiates that exceed Ohio’s limits;
  5. Prescribers will be required to include a diagnosis or procedure code on every controlled substance prescription, which will be entered into Ohio’s prescription monitoring program, OARRS; and
  6. The new limits do not apply to opiates prescribed for cancer, palliative care, end-of-life/hospice care or medication-assisted treatment for addiction.

As of April 13, 2017, none of the Board have formally adopted new rules, however, proposed rules by the Pharmacy and Medical Boards are open for comment by the public.

The Medical Board claims its proposed rules set a ceiling for prescribing for acute pain at seven days. However, the current draft of the rule actually creates a presumption for a three-day supply or less. Based on recent trends in Medical Board disciplinary cases, physicians who routinely prescribe for initial acute pain at the seven-day ceiling will likely have their medical charts investigated by the Board.

If the proposed rule is adopted as drafted, medical professionals should only prescribe for initial acute pain when medically necessary and with the presumption that no more than a three-day supply is appropriate. Prescribers must also document in the patient’s chart advice of the benefits and risks of the opioid analgesic. The risks discussed must include a discussion on the potential for addiction. The Medical Board has also proposed a new definition for acute pain to mean, pain that normally fades with healing, is related to tissue damage, significantly alters a patient’s typical function and is expected to be time limited.

Any person affected by the Medical Board’s current proposed rules may submit comments no later than April 26, 2017. The Pharmacy Board is accepting comments on its rules through April 19, 2017. The Nursing and Dental Boards have not yet released their proposed rules.

If you are a medical professional who treats patients for acute pain and you would like to know how these proposed rules may impact you, consider contacting an attorney at Graff & McGovern, LPA, for a no-cost consultation. Levi Tkach is available to take your questions at 614-228-5800, extension 4.