Ohio Administrative Code › Title 4715 - State Dental Board › Chapter 4715-6 - Review of Ohio automated Rx reporting system › Section 4715-6-02 - Prescribing opioid analgesics for acute pain

Current through all regulations passed and filed through July 1, 2024
(A) For the treatment of acute pain, the
			 dentist shall comply with the following:
(1)
			 Extended-release or long-acting opioid analgesics shall not be prescribed for
			 treatment of acute pain;
(2) Before
			 prescribing an opioid analgesic, the dentist shall first consider non-opioid
			 treatment options. If opioid analgesics are required as determined by a patient
			 history and clinical examination, the dentist shall prescribe for the minimum
			 quantity and potency needed to treat the expected duration of pain, with a
			 presumption that a three-day supply or less is frequently sufficient and that
			 limiting the duration of opioid use to the necessary period will decrease the
			 likelihood of subsequent chronic use or dependence.
(3) In all circumstances where opioid
			 anangesics are prescribed for acute pain:
(a)
			 Except as provided in paragraph (B) of this rule, the first opioid analgesic
			 prescription for the treatment of an episode of acute pain shall be:
(i) For adults, not more than a seven-day
			 supply with no refills;
(ii) For
			 minors, not more than a five-day supply with no refills. A dentist shall comply
			 with section 3719.061 of the Revised Code,
			 including but not limited to obtaining the parent or guardian's written consent
			 prior to prescribing an opioid analgesic to a minor;
(iii) The seven-day limit for adults and
			 five-day limit for minors may be exceeded for pain that is expected to persist
			 for longer than seven days based on the pathology causing the pain. In this
			 circumstance, the reason that the limits are being exceeded and the reason that
			 a non-opioid medication was not appropriate to treat the patient's conditions
			 shall be documented in the patient's record; the number of days of the
			 prescription shall not exceed the amount required to treat the expected
			 duration of the pain as noted in paragraph (A)(2) of this rule; and
(iv) If a patient is allergic to or otherwise
			 unable to tolerate the initial prescribed opioid medication, a prescription for
			 a different, appropriate opioid may be issued at any time during the initial
			 seven or five-day dosing period and shall be subject to all other provisions of
			 this rule. The allergy and/or intolerance shall be documented in the patient's
			 record. The patient or the minor patients, parent, guardian or other
			 responsible adult must be provided education of the safe disposal of the unused
			 medication.
(b) The
			 patient, or a minor's parent or guardian, shall be advised of the benefits and
			 risks of the opioid analgesic, including the potential for addiction, and the
			 advice shall be documented in the patient's record; and
(c) The total morphine equivalent dose (MED)
			 of a prescription for opioid analgesics for treatment of acute pain shall not
			 exceed an average of thirty MED per day, except when all of the following
			 apply:
(i) The patient has significant and
			 prolonged acute pain related to one of the following conditions:
(a) Traumatic oro-facial tissue injury with
			 major mandibular/maxillary surgical procedures;
(b) Severe cellulitis of facial planes;
			 or
(c) Severely impacted teeth with
			 facial space infection necessitating surgical management.
(ii) The dentist determines that, for the
			 seventy-two hour period following the procedure, it is absolutely necessary to
			 exceed the thirty MED daily limit based on the patient's needs but may not
			 exceed ninety MED per day.
(iii)
			 The dentist has documented the reason for exceeding the thirty MED average in
			 the patient record and why it is the lowest dose consistent with the patient's
			 medical condition.
(iv) In
			 circumstances when the thirty MED average is exceeded, the dose shall not
			 exceed the dose required to treat the severity for the pain as noted in
			 paragraph (A)(2) of this rule and furthermore, the dose will not exceed ninety
			 MED per day within the initial seventy-two hour period as noted in paragraph
			 (A)(3)(c)(ii) of this rule.
(d) Prescriptions which exceed the five or
			 seven day supply or thirty MED average daily dose are subject to additional
			 review by the board.
(e) All
			 prescriptions for opioid analgesics for the treatment of acute pain shall
			 comply with rules 
										4729:5-5-05 and 
										4729:5-5-15
			 of the Administrative Code and all other federal and state controlled substance
			 laws, rules and regulations.