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08/31/2017

New Pharmacy Board Rules for Acute Pain Prescribing Go Into Effect

Effective August 31, 2017, the State of Ohio has new rules for prescribing opioid analgesics for the treatment of acute pain. These rules are only apply only to the treatment of conditions resulting in acute pain including those which normally fade with healing, such as a surgical procedure or bone fracture. 

  1. The rules limit the prescribing of opioid analgesics for acute pain as follows: No more than seven days of opioids can be prescribed for adults. 
  2. No more than five days of opioids can be prescribed for minors. 
  3. Health care providers may prescribe opioids in excess of the day supply limits only if they provide a specific reason in the patient’s medical record; unless a reason is given, the healthcare provider is prohibited from prescribing opioids that exceed Ohio's limits. 
  4. 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. 
  5. The new limits do not apply to opioids prescribed for cancer, palliative care, end-of-life/hospice care or medication-assisted treatment for addiction. 
  6. The rules apply to the first opioid analgesic prescription for the treatment of an episode of acute pain. 

Starting December 29, 2017, rule 4729-5-30 will require prescribers to include the first four characters (ex. M16.5) of the diagnosis code (ICD-10) or the full procedure code (Current Dental Terminology - CDT) on all opioid prescriptions, which will then be entered by the pharmacy into Ohio’s prescription monitoring program, OARRS. This requirement will take effect for all other controlled substance prescriptions on June 1, 2018. 

For more information, check out this information sheet from the State Board of Pharmacy and this release from the Governor's Office

Ohio ACEP and several other medical associations have actively opposed portions of the new rules, particularly the rule requiring ICD-10 codes on prescriptions for controlled substances, which will create substantial administrative burdens and barriers to providing patients with the best possible care. Rather than eliminate that rule, the Pharmacy Board instead delayed its implementation and will now require only the first four characters rather than the full ICD-10 code. We remain concerned about this rule and that the delay in implementation will still not allow sufficient time for compliance. Ohio ACEP, the OSMA and other organizations are communicating with the Board of Pharmacy on these December implementation challenges.