Senate Bill 848

For acute pain, prescriber shall not issue an initial prescription for an opioid drug in a quantity exceeding seven (7) day supply.

Prescription shall be for the lowest effective dose of immediate-release opioid drug and must state “acute pain” on the face of the prescription. 63 O.S. §2-309I(A).

Following the initial seven (7) days, after consultation* (in person or by telephone), a subsequent 7-day prescription may be issued if prescriber determines the prescription is necessary and appropriate, documents the rationale for prescribing, and determines and documents the prescription does not present undue risk of abuse, addiction or diversion. A second 7-day prescription of an immediate-release opioid drug in a quantity not to exceed seven (7) days may be issued on the same day as the initial prescription if: (i) The subsequent prescription is due to a major surgical procedure and/or “confined to home” status as defined in 42 U.S.C. 1395n(a); (ii) The practitioner provides the subsequent prescription on the same day as the initial prescription; (iii) The practitioner provides written instruction on the subsequent prescription indicating the earliest date on which the prescription may be filled (i.e. “do not fill until” date); and (iv) The subsequent prescription is dispensed no more than five (5) days after the “do not fill until” date indicated on the prescription. 63 O.S. §2-309(I)(B)(5);

*For best practice, the 7-day consultation should be performed by the physician; however, it does not appear to be required. If a medication needs to be changed due to allergy, ineffective dose or other medical condition, document thoroughly in the record the need and rationale for change.

If continuing treatment for three months or more, practitioner shall: (1) review every three (3) months the
course of treatment, any new information regarding etiology of pain and progress toward treatment objectives; (2) assess patient prior to every renewal to determine if patient is experiencing dependency and document assessment; (3) periodically make reasonable efforts, unless clinically contraindicated to stop, decrease dosage, or try other treatment modalities; (4) review PMP; (5) monitor compliance with patient provider agreement, and state “chronic pain” on the face of the prescription. After one year of compliance with the patient provider agreement, physician may review treatment plan and assess patient at six-month intervals. 63 O.S. §2-309I(F).

*Assessment may be performed by a mid-level PA/APRN. Face-to-face assessment is recommended but not required. For best practice, the PMP should be checked more frequently than 180 days, but it is not required by 63 O.S. §2-309(D).

 

http://www.okmedicalboard.org/download/884/Opioid_Best_Practices.pdf