Practice AlertOn March 16th 2015 new rules and regulations for pain management and opioid use went into effect. These were the product of over a year of collaboration by representatives from all affected provider groups including RIAPA.All prescribers of controlled substance must adhere to the Rules and Regulations For Pain Management, Opioid Use and The Registration of Distribution of Controlled Substances in Rhode Island. [R21-28-CSD]The following are important provision PAs need to be aware of.......Prescription Monitoring Program (PMP)All practitioners holding a RI Controlled Substances Registration (CSR) must register with the PMP. If you are not already registered at the time of your next license/CSR renewal in June upon renewing you will automatically be registered. You are strongly encouraged to register before June if you have not already because the regulations requiring that you review the PMP before prescribing controlled substances are already in effect. You can register for the PMP here RIPMPAcute Pain Management"Acute pain" means the normal, predicted physiological response to a noxious chemical, thermal, or mechanical stimulus and typically is associated with invasive procedures, trauma, and disease. Acute pain generally is resulting from nociceptor activation due to damage to tissues. Acute pain typically resolves once the tissue damage is repaired. The duration of acute pain varies.The prescription monitoring program (PMP) shall be reviewed prior to starting any opioid.Prescribing opioids for an acute injury shall be for a reasonable duration consistent with community standards for the pain that is being treated.Chronic Pain Management "Chronic pain" means pain of greater than ninety (90) days duration, excluding pain requiring palliative care.The Prescription Monitoring Program (PMP) shall be reviewed prior to starting any opioid whether for acute pain or chronic pain.· Treatment of chronic pain requires the following elements (See the REGULATIONS for details)Documentation of Treatment Plan.Patient Education/Consent.Written Patient Treatment Agreement. (Sample pain agreement may be downloaded from www.health.ri.gov/saferx Periodic review of treatment planReferral to pain management specialistsPractitioners shall consider referral to other professionals as clinically indicated.The consideration, and documentation of consideration, for consultation threshold for adults is one hundred twenty (120) milligrams morphine equivalent dose per day (MED) (oral).In the event a practitioner prescribes a dosage amount that meets or exceeds the consultation threshold of one hundred twenty (120) milligrams MED (orally) per day, a consideration of consultation with a Pain Medicine Physician is required, and must be documented in the medical record. (This is the same as 60mg/day oxycodone or 100mg of Hydrocodone per day)If consultation is not obtained, the practitioner shall document in the patient's medical record that a consultation was considered and the rationale for not obtaining such consultation;Long-acting Opioids,Effective 15 January 2017, all practitioners prescribing long-acting opioids shall have completed an educational program compliant with the ER/LA Opioid Analgesic REMS Educational requirements issued by the U.S. Food and Drug Administration (FDA). This may be from a continuing education program or from an accredited professional preparation education program including approved residency training programs.Click here for a complete list of products covered under the ER/LA Opioid Analgesics REMS ProgramAcknowledgment that a violation of the agreement may result in action as deemed appropriate by the prescribing practitioner such as a change in the treatment plan or referral to an addiction treatment program; andA request that toxicology screens be performed at random intervals at the practitioner's discretion.At their discretion, practitioners may have a written patient treatment agreement with any patient who receives opioid medication for any duration, based on individual patient history and risk. Periodic Review. Periodic reviews, including an in-person visit, shall take place at intervals not to exceed twelve (12) months.During the periodic review, the practitioner shall determine:Patient's adherence with any medication treatment plan;If pain, function, or quality of life have improved or diminished using objective evidence; andIf continuation or modification of medications for pain management treatment is necessary based on the practitioner's evaluation of progress towards treatment objectives.The practitioner shall consider tapering, changing, or discontinuing treatment when:Function or pain does not improve after a trial period; orThere is reason to believe there has been misuse, addiction, or diversion.For patients the practitioner is maintaining on continuous opioid therapy for pain for six (6) months or longer, the practitioner shall review information from the prescription monitoring program (PMP) at least every twelve (12) months. Documentation of that review shall be noted in the patient's medical record.Click here for a complete list of products covered under the ER/LA Opioid Analgesics REMS ProgramTo view the complete set of Regulations pertaining to this topic go to:http://sos.ri.gov/documents/archives/regdocs/released/pdf/DOH/8003.pdf
