Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 396 - BOARD OF LICENSURE OF PODIATRIC MEDICINE › Chapter 21 - USE OF CONTROLLED SUBSTANCES FOR TREATMENT OF PAIN › Section 396-21-2 - DEFINITIONS

Current through 2024-29, July 17, 2024
1.
Abuse
- A maladaptive pattern
				of drug use that results in harm or places the individual at risk of harm.Abuse
				of a prescription medication involves its use in a manner that deviates from
				approved medical, legal, and social standards, generally to achieve a euphoric
				state ("high") or to sustain opioid dependence, addiction, or that is other
				than the purpose for which the medication was prescribed.
2.
Acute pain
- The normal,
				predicted physiological response to a noxious chemical, thermal or mechanical
				stimulus and typically associated with invasive procedures, trauma and disease.
				Acute pain is generally time limited, often lasting less than 90
				days.
3.
Addiction
- A
				primary, chronic, neurobiologic disease, with genetic, psychosocial and
				environmental factors influencing its development and manifestations. Addiction
				is characterized by behaviors that include the following: impaired control over
				drug use, craving, compulsive use and continued use despite harm. Physical
				dependence and tolerance are normal physiological consequences of extended
				opioid therapy for pain and are not the same as addiction.
4.
CDC
- U.S. Department of
				Health and Human Services Centers for Disease Control and Prevention.
5.
Chronic Pain
- A state in
				which pain persists beyond the usual course of an acute disease or healing of
				an injury that may or may not be associated with an acute or chronic pathologic
				process that causes continuous or intermittent pain for more than 90 days and
				may last months or years.
6.
Clinician
- An allopathic (MD) or osteopathic (DO) physician,
				physician assistant (PA), advanced practice registered nurse (APRN), or
				podiatrist (DPM).
7.
Controlled Substance
- A drug that is subject to special
				requirements under the federal Controlled Substances Act of 1970 (CSA), as
				amended; see
				21
				U.S.C. §
										801, et seq. Most opioid
				analgesics are classified as Schedule II or III under the CSA, indicating that
				they have a significant potential for abuse, a current acceptable medical use,
				and that abuse of the drug may lead to severe psychological or physical
				dependence.
8.
Drug
				Diversion
- The transfer of a controlled substance from authorized legal
				and medically necessary use or possession to illegal and unauthorized use or
				possession.
9.
Functional
				Assessment
- An objective review of an individual's ability to perform
				key activities of daily living including mobility, self-care, ability to do
				household chores, work and engage in social interactions. It is used to
				establish or determine appropriate therapeutic interventions.
10.
Hospice Services
- Is
				defined in Title
				22 M.R.S.,
				section8621, subsection
				11
				and means a range of interdisciplinary services provided on a 24-hours-a-day,
				7-days-a-week basis to a person who is terminally ill and that person's family.
				Hospice services must be delivered in accordance with hospice philosophy.
11.
Medical Emergency
				-
Means an acute injury or illness that poses an immediate risk to a
				person's life or long-term health.
12.
Misuse
-All uses of a
				prescription medication other than those that are directed by a clinician, used
				by a patient within the law, and within the plan of treatment.
13.
Morphine Milligram Equivalent
				(MME)
- A conversion of various opioids to a morphine equivalent dose by
				the use of accepted conversion tables.
14.
Opioid
- Any compound that
				binds to an opioid receptor in the central nervous system (CNS), including
				naturally occurring, synthetic or semi-synthetic, and endogenous opioid
				peptides.
15.
Opioid
				Agonists
- Drugs that bind to the opioid receptors and provide pain
				relief. Examples include morphine, oxycodone, hydromorphone, fentanyl, codeine,
				and hydrocodone. Buprenorphine is a partial agonist, meaning it activates the
				opioid receptors in the brain, but to a much lesser degree than a true
				opioid.
16.
Opioid
				Antagonists
- Drugs that cause no opioid effect and block full agonist
				opioids such as morphine. Examples are naltrexone and naloxone. Naloxone is
				sometimes used to reverse a heroin overdose.
17.
Opioid Use Disorder
- See
				Diagnostic and Statistical Manual of Mental Disorders (DSM) DSM-5 criteria.
				https://www.buppractice.com/node/1514.
18.
Pain
- An unpleasant sensory
				and emotional experience associated with actual or potential tissue damage or
				described in terms of such damage.
19.
Palliative Care
-Is defined
				in Title
				22
				M.R.S., section1726, subsection
				1,
				paragraph A, and meanspatient-centered and family-focused medical care that
				optimizes quality of life by anticipating, preventing and treating suffering
				caused by a medical illness or a physical injury or condition that
				substantially affects a patient's quality of life, including, but not limited
				to, addressing physical, emotional, social and spiritual needs; facilitating
				patient autonomy and choice of care; providing access to information;
				discussing the patient's goals for treatment and treatment options, including,
				when appropriate, hospice care; and managing pain and symptoms comprehensively.
				Palliative care does not always include a requirement for hospice care or
				attention to spiritual needs.
20.
Serious illness
- Is defined in Title
				22
				M.R.S., section1726, subsection
				1,
				paragraph B, and means a medical illness or physical injury or condition that
				substantially affects quality of life for more than a short period of time.
				"Serious illness" includes, but is not limited to, Alzheimer's disease and
				related dementias, lung disease, cancer, heart, renal or liver failure, and
				chronic, unremitting or intractable pain such as neuropathic pain.
21.
Physical Dependence
- A
				state of adaptation manifested by drug class-specific signs and symptoms that
				can be produced by abrupt cessation, rapid dose reduction, decreasing blood
				level of the drug, and/or administration of an antagonist. Physical dependence,
				by itself, does not equate with addiction.
22.
Substance Abuse
- The use of
				any substance(s) for non-therapeutic purposes or for purposes other than those
				for which it is prescribed.
23.
Substance Misuse
- The use of a medication (with therapeutic
				intent) other than as directed or as indicated, and whether harm results or
				not.
24.
Terminally
				Ill
- Is defined in Title
				22 M.R.S.,
				section8621, subsection
				17
				and means that a person has a limited life expectancy in the opinion of the
				person's primary physician, physician assistant, advanced practice registered
				nurse, or medical director.
25.
Tolerance
-A state of physiologic adaptation in which exposure to
				a drug induces changes that result in diminution of one or more of the drug's
				effects over time. Tolerance is common in opioid treatment, has been
				demonstrated following a single dose of opioids, and is not the same as
				addiction.
26.
Universal
				Precautions
- A standardized approach to the assessment and on going
				management of all pain patients who are prescribed controlled substances.