Ohio takes steps to limit prescription of opiates for acute pain


On March 30, 2017, Ohio Governor John Kasich announced plans for establishing new limits for opiate prescriptions related to acute pain. The limits will be enacted through new rules issued by the Ohio Nursing, Medical, Pharmacy and Dental Boards. 

The rules, currently in proposed form, will impose new opiate prescribing limits for acute pain. The proposed rules from each of the boards are slightly different. However, the common goal is to curtail opioid prescribing. Through the rulemaking process, the boards will likely harmonize their opiate prescribing guidelines.

The proposed opiate prescribing rules include the following:

  1. No more than a seven-day supply of opiates can be prescribed for adults (without refills).
  2. No more than a five-day supply of opiates can be prescribed for minors (without refills).
  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 may prescribe opiates in excess of the new limits only if they provide a specific reason in the patient’s medical record.
  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, Ohio Automated Rx Reporting System (OARRS).
  6. The new limits will not apply to opiates prescribed for cancer, palliative care, end-of-life/hospice care or medication-assisted treatment for addiction.
  7. Non-opioid treatment plans for acute pain must be considered and documented, and patients must be advised of the benefits and risks of opioid prescriptions, including the risk of addiction.

The new prescribing limits will be finalized through final rules issued by the boards.  The Medical Board accepted public comments for its proposed rules through April 28, 2017; the Pharmacy Board accepted public comments on its proposed rules through April 19, 2017; the Nursing Board accepted public comments on its proposed rules through April 28, 2017; and the Dental Board accepted public comments for its proposed rules through April 8, 2017. 

These new opiate prescribing rules come on the heels of two companion bills introduced in the Ohio House and Senate (HB 167 and SB 119), which would impose their own limits on opioid prescribing. The limits in these bills differ from those in the boards’ rules. In particular, the bills are more restrictive about prescribing by primary care physicians and dentists.

When finalized, the boards’ rules, and any new laws arising out of HB 167 and SB 119, will affect all opiate prescribers in Ohio.   

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