OPIOID ABUSE AND PRESCRIBING:
MANAGING THE DELICATE BALANCE

 

New Opioid prescribing regulations in effect April 1, 2017.  Are you familiar with the new rules?

Delaware Opioid Prescribing Rules 

USCA REGULATION 9.0 SAFE PRESCRIBING OF OPIOID ANALGESICS

Workflow for Opioid Regulation Section 9 (Effective April 1)

Download a “Patient’s informed consent for the use of controlled substances for the treatment of pain” form.

Highmark Issues Opioid Prescribing Restrictions

Effective March 8, 2018 Highmark is now implementing measures to prevent the development of opioid use disorder following the Centers for Disease Control (CDC) guidelines. The new regulations include a seven day limit for short-acting opioids for new patients and prior authorization for new users of long-acting opioids. In an effort to clarify for our physicians and their practices, MSD has been in communication with Highmark and clarified the following information to help prescriber workflow:
  • All prescriptions >7 days for an immediate release opioid (e.g., Vicodin, Percocet, Oxycodone, Morphine Sulfate, etc.) will need prior authorization.
  • Prescriptions for 7 days or less of an immediate release opioid do not require a prior authorization.
  • Most amounts below 30 pills will likely be approved as 'under 7 days' (the limit is based on the days the drug will be used, not the quantity and this is based on an informal discussion between MSD & Highmark, so this amount is not a hard line either way).
  • Authorizations can be done via the Highmark form, the NaviNet system online or via a practice’s own prior authorization form.
  • The additional work being required is only the form. The other work (listed on the form) should already be a part of the current prescriber workflow, based on the MSD Workflow from April 2017.
  • Does not apply to Health Options – that is a different product and already has its own limits/authorization. No changes to that.
To view a copy of the notice sent from Highmark visit: https://tinyurl.com/HMOpioidPrescribing.
To view the MSD workflow visit: https://tinyurl.com/MSDWorkflow.
To view a copy of Highmark’s Short Acting Opioid Form visit: https://tinyurl.com/HMShortActingOpioidForm.

CONTROLLED SUBSTANCE EDUCATION

Current CSR holders must complete two-hours of non-Delaware-specific education biennially each renewal period to renew their Controlled Substance Registration. New applicants for a CSR must also complete a one-time requirement of a one-hour education course on Delaware law, regulation, and programs (i.e., Delaware-specific education).

ONE-HOUR OF DELAWARE-SPECIFIC EDUCATION

This is a one-time requirement for practitioners to receive a controlled substance registration. To fulfill the mandatory course requirement, the Delaware-specific education must contain curriculum approved by the Delaware Secretary of State.  Courses that have not been approved will not fulfill the mandatory requirement.  The Division of Professional Regulation offers the only course that is currently approvedThis course does not qualify for credit as continuing medical education or any other profession-related contact hours required for maintaining your professional license.

If you have already satisfied this requirement, you do not need to complete this education prior to renewing your current CSR.

TWO-HOUR NON-DELAWARE SPECIFIC EDUCATION

Controlled Substance Registrants must attest to the completion of two-hours of non-Delaware-specific education in the areas of controlled substance prescribing practices, treatment of chronic pain, or other topics related to the prescribing of controlled substances. This education is required for each controlled substance registration renewal period and must be completed by June 30th of odd years.

MSD has provided suggested resources below to assist you in meeting the two-hour education requirement.  The education hours vary by course.  You may also participate in eligible courses through other means.

OPTIONS FOR NON-DELAWARE SPECIFIC EDUCATION

The following organizations offer education in prescribing controlled substances.

(Please note: The CMEs offered for each activity vary. Please read the information on the websites to determine the credit offered.)
American Medical Association State and Specialty Specific Education - As part of its continued advocacy efforts to help reverse the nation's opioid epidemic, the AMA has launched a microsite focused on providing physicians with state- and specialty-specific education and training resources. The microsite, www.end-opioid-epidemic.org, includes nearly 300 education and training resources.

American College of Physicians SAFE Opioid Prescribing

Centers for Disease Control and Prevention (CDC) Addressing the Unique Challenges of Opioid Use Disorder in Women

MedChi Department of Continuing Medical Education (some courses require payment) 

Office of Disease Prevention and Health Promotion (ODPHP): Pathways to Safer Opioid Use

PriMed SAFE Opioid Prescribing

Prescribers’ Clinical Support System for Opioid Therapies (PCSS)

Stanford Medicine Safe Opioid Prescribing and Risk Evaluation and Mitigation Strategies