Oklahoma has joined in the nationwide movement to restrict opioid prescriptions not only in our state but across the United States. Starting November 1st, 2018, Senate Bill 1446 will go into effect that will place limits on the number of opioid pills that a doctor can prescribe as well as places safeguards to help curb the potential for opioid abuse and dependency.

Opopid OverdoseAcute Pain

As of November 1st, 2018, practitioners will only be allowed by law to initially prescribe a week’s worth of opioid drugs to manage acute pain to manage acute pain and must limit the dosage to the lowest effective dose. Prior to issuing the initial prescription of a Schedule II controlled dangerous substance or any opioid drug to manage acute pain, the practitioner must discuss with the patient (or the patient’s guardian)the risks that are associated with the drugs, including the risk of addiction and overdose as well as the dangers of taking opioid drugs with alcohol, benzodiazepines and other central nervous system depressants, the reasons why the prescription is necessary, and alternative treatments that may be available.

Before renewing the prescription for up to seven more days, the law requires a consultation with the patient to determine that the patient needs the prescription and that the prescription does not present a risk for abuse, addiction, or diversion. If after the initial 14 days the practitioner determines that the patient still need opioids to manage acute pain, the practitioner must again discuss the risks associated with the drugs, the reason why the prescription is necessary, and alternative treatments that may be available. The practitioner must also enter into a patient-provider agreement with the patient.

Chronic Pain

I addition to restricting certain prescriptions for acute pain, the law implements increased safeguards for patients who are prescribed opioids or other Schedule II controlled dangerous substances for chronic pain. For instance, practitioners are now required to enter into a patient-provider agreement with the patient that explains the risk of dependence on opioids and documents the mutual understanding of the plan between patient and practitioner. The law also requires the practitioner to review the treatment plan progress at a minimum of every three months and to assess the patient before each renewal to determine if the patient is experiencing dependence problems.

Patients who are prescribed a Schedule II controlled dangerous substance or any opioid drug for cancer treatment, hospice, or palliative care who are residents in a long-term-care facility are exempt from these requirements. 

Additional Requirements

The law also requires physicians to participate in one hour of continuing education in pain management or opioid abuse and addiction each year before the physician renews his or her license to practice medicine. As written, the law only amends the CME requirements for MD’s, but it expected that the Oklahoma State Board of Osteopathic Examiners to follow suit. Notably, the law provides for disciplinary action if a practitioner fails to check the Oklahoma Prescription Monitoring Program (PMP) database as required by law.

The changes to opioid prescribing requirements have given a rise to a number of questions from healthcare providers, including questions about the ability of level-minded providers and other staff to perform the required visits and consultations and the necessity of face-to-face visits for each required discussion with the patient.  Physicians, mid-level providers, hospitals, and health care providers will all be impacted by these new opioid prescribing requirements.

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