State’s new prescription rules to roll out next month

Oct 30, 2018, 5:52 PM | Updated: Oct 31, 2018, 9:50 am

Fewer pills and more oversight. Those are just some of the aspects of new state rules to help fight the opioid crisis in Washington state.

The rules are the result of legislation passed in 2017 directing five separate medical boards and commissions to collaborate and come up with new prescribing rules.

“This is the worst man made public health epidemic of our time,” said Jason McGill, a health policy adviser for Governor Jay Inslee, as the rules were announced on Monday.

More than 700 people died from an opiate overdose in our state last year — or two every day. And while overdoses linked to prescription opioids are trending down, those pain medications are still a significant part of the problem.

“In 2017, there were at least 1,615 hospitalizations for opioid overdoses, and we believe that over 300,000 Washingtonians are misusing pain relievers,” said State Health Secretary John Wiesman. “This is why we need to address the problem at all levels.”

Addressing it at all levels includes creating these new state prescription rules that will begin to roll out next month.

Blake Maresh with the state Health Department says there are several new requirements for prescribers with patients dealing with acute pain, described as pain that lasts up to six weeks.

“Conducting a history and physical on the patient, screening for risk factors and intensity of pain and considering alternatives to opioids, and re-evaluating when the patient does not seem to be recovering as indicated,” Maresh said.

“There’s also a prescribing limit of seven days for acute non-operative care and 14 days for perioperative care unless there is an exceptional need and it’s documented in the patient record,” Maresh added.

That means medical professionals will have to have a lengthier first visit and do extra screening before doling out a now limited number of opioids.

Then there are changes to what’s allowed when a patient comes back for refills and transitions to another phase of treatment known as sub-acute, which means pain that lasts from 6 to 12 weeks.

Maresh says this phase is critical as it can often be the turning point that leads to long-term addiction or misuse.

“In these situations it is critical for prescribers to reassess the continued use of opioids and not simply prescribe additional quantities of opioids, to consider screening the patient for risky behaviors, to consider alternative pain management approaches and consult with other experts,” Maresh said. “There is a prescribing limit for 14 days for sub-acute care, again, unless there’s an exceptional need documented in the patient record.”

While rules for chronic patients remain mostly unchanged from the stricter requirements the state issued a few years ago, Maresh says there are some changes.

“There is a tapering provision in the rules but it is important to understand that the new rules do not require all patients to be tapered, nor do they require that a patient be tapered to a certain minimum dose,” Maresh said. “The intent here is for prescribers to consider when it’s appropriate for their patients to have a change or a tapering in their dosage.”

A major change under these new rules: every prescriber in the state will now be required to register and use the state’s Prescription Monitoring Program, which until now had been optional.

“The task force recommend periodic PMP checks as a floor for safe practice, many individual boards and commissions have enacted somewhat stricter standards than what the task force recommendation was up to and including requiring checks at every prescription,” Maresh said.

So while the state has adopted its own rules for prescribers, so have the five boards and commissions – and some of those are more restrictive than the rules adopted by the health department. Prescribers will have to adhere to the health department rules as well as any stricter rules the board or commission they belong to has adopted. Violations of any of the rules can lead to fines or even loss of license, depending on the circumstances.

These are the five boards and commissions issuing their own rules:

• Medical Commission
• Board of Osteopathic Medicine and Surgery
• Nursing Commission
• Dental Quality Assurance Commission
• Podiatric Medical Board

Other new rules from the state include additional training for prescribers, and requiring prescribers to consider alternatives to opioids.

They will also have to discuss the risks that come with taking opioids and the importance of safely storing the medication with their patients.

Violations of any of the rules, whether from the state or the boards or commissions, can lead to fines or even loss of license, depending on the circumstances.

State officials say complaints and the Prescription Monitoring Program will help them monitor prescribers to ensure they’re following the rules.

• New rules for nurses, surgeons and podiatrists start November 1.
• New rules for MDs and physician’s assistants start January 1.
• Dentists will also have to follow the rules, but their commission has yet to finalize them, so they’re expected to start in early 2019.
• Full lists of the State Department of Health rules as well as the rules for individual boards and commissions can be viewed here.

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State’s new prescription rules to roll out next month