Indiana Administrative Code › Title 848 - INDIANA STATE BOARD OF NURSING › Article 5 - PRESCRIPTIVE AUTHORITY FOR ADVANCED PRACTICE NURSING › Rule 4 - Opioid Prescribing Requirements › Section 4-8 - Drug monitoring testing

Current through July 10, 2024
Authority: IC
				  25-22.5-13-3; IC
				  25-23-1-7
Affected: IC
				  25-1-9; IC 25-23
Sec. 8.
(a) At any
				time the advanced practice nurse with prescriptive authority determines that it
				is medically necessary, whether at the outset of an opioid treatment plan, or
				any time thereafter, an advanced practice nurse with prescriptive authority
				prescribing opioids for a patient shall perform or order a drug monitoring
				test, which must include a confirmatory test using a method selective enough to
				differentiate individual drugs within a drug class, on the patient.
(b) In determining whether a drug monitoring
				test under subsection (a) is medically necessary, the advanced practice nurse
				with prescriptive authority shall consider, subject to the provisions of
				subsection (c), each of the following factors where applicable and reasonably
				feasible:
(1) Whether there is reason to
				believe a patient is not taking the prescribed opioids or is diverting the
				opioids.
(2) Whether there has been
				no appreciable impact on the patient's chronic pain despite being prescribed
				opioids for a period of time that would generally have an impact.
(3) Whether there is reason to believe the
				patient is taking or using controlled substances other than opioids or other
				drugs or medications including illicit street drugs that might produce
				significant polypharmacological effects or have other detrimental interaction
				effects.
(4) Whether there is
				reason to believe the patient is taking or using opioids in addition to the
				opioids being prescribed by the advanced practice nurse with prescriptive
				authority and any other treating practitioner.
(5) Attempts by the patient to obtain early
				refills of opioid containing prescriptions.
(6) The number of instances in which the
				patient alleges that the patient's opioid containing prescription has been lost
				or stolen.
(7) When the patient's
				INSPECT report provides irregular or inconsistent information.
(8) When a previous drug monitoring test
				conducted on the patient raised concerns about the patient's usage of
				opioids.
(9) Necessity of verifying
				that the patient no longer has substances in the patient's system that are not
				appropriate under the patient's treatment plan.
(10) When the patient engages in apparent
				aberrant behaviors or shows apparent intoxication.
(11) When the patient's opioid usage shows an
				unauthorized dose escalation.
(12)
				When the patient is reluctant to change medications or is demanding certain
				medications.
(13) When the patient
				refuses to participate in or cooperate with a full diagnostic workup or
				examination.
(14) Whether a patient
				has a history of substance abuse.
(15) When the patient has a health status
				change (for example, pregnancy).
(16) Co-morbid psychiatric
				diagnoses.
(17) Other evidence of
				chronic opioid use, controlled substance abuse or misuse, illegal drug use or
				addiction, or medication noncompliance.
(18) Any other factor the advanced practice
				nurse with prescriptive authority believes is relevant to making an informed
				professional judgment about the medical necessity of a prescription.