Prescriber rules for opioids

On March 30, 2017, Ohio Governor John Kasich issued a policy statement imposing new limits on prescribing opiates, which became effective August 31, 2017. The new regulations, among other requirements, limit the amount of opioid drugs that primary care prescribers can prescribe for acute pain. These limits include a maximum seven days’ supply of opioid drugs for adults and five days’ supply for minors, unless the prescriber’s medical judgment suggests a greater supply is necessary. They also restrict opioid prescriptions to a maximum of 30 morphine equivalent doses (MED) per day for acute pain.

Prescribers are also subject to increased reporting requirements in patient records and on prescriptions. Nurses, physicians and pharmacists are all required by rules promulgated by their licensing boards to comply with OAC 4729-5-30, which strictly describes the manner of issuance of a valid prescription. To enforce the new rules and their exceptions, and to improve data collection to measure opioid trends, as of December 29, 2017, prescribers are also required to include a diagnosis or procedure code on every opiate prescription. The code must be entered into Ohio’s prescription monitoring program, OARRS. This requirement will be expanded to encompass all non-opioid controlled substance prescriptions starting on June 1, 2018.

In response to Governor Kasich’s statement, each of the State Medical Board of Ohio, the Ohio State Dental Board, the State of Ohio Board of Pharmacy and the Ohio Board of Nursing have released and adopted rules to implement the new guidelines. Each of the licensing boards has broad discretion to issue penalties for violating the new rules, ranging from reprimand and probation to suspension or revocation of professional licenses. In light of recent attention given to inappropriate opioid prescribing necessitated by today’s opiate epidemic, and the broad authority of the various boards to penalize professionals, these licensed health care professionals should be aware of prescribing limitations and requirements. Likewise, health systems and other employers of these professionals should educate their practitioners on these new prescribing limitations to ensure compliance.