Ohio Administrative Code › Title 4731 - State Medical Board › Chapter 4731-11 - Controlled Substances › Section 4731-11-13 - Prescribing of opiate analgesics for acute pain

Current through all regulations passed and filed through July 1, 2024
(A)
								For the treatment
			 of acute pain, the physician 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 physician
			 shall first consider non- opioid treatment options. If opioid analgesic
			 medications are required as determined by a history and physical examination,
			 the physician 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 analgesics are
			 prescribed for acute pain:
(a)
										Except as provided in paragraph (B) of this rule, the
			 duration of 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 physician shall comply with section
			 3719.061 of the Revised Code,
			 including but not limited to obtaining from the parent, guardian, or another
			 adult who is authorized to consent to the minor's medical treatment 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 medical 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 initially 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
			 medical record. The patient or the minor patient's parent, guardian or another
			 adult who is authorized to consent to the minor's medical treatment 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
			 medical 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
			 suffers from medical conditions, surgical outcomes or injuries of such severity
			 that pain cannot be managed within the thirty MED average limit as determined
			 by the treating physician based upon prevailing standards of medical care, such
			 as:
(a)
												
			 Traumatic crushing of tissue;
(b)
												
			 Amputation;
(c)
												Major orthopedic surgery;
(d)
												Severe
			 burns
(ii)
											The physician determines that exceeding the thirty MED
			 average limit is necessary based on the physician's clinical judgment and the
			 patient's needs.
(iii)
											The physician shall document in the patient's medical
			 record the reason for exceeding the thirty MED average and the reason it is the
			 lowest dose consistent with the patient's medical condition.
(iv)
											Only the
			 prescribing physician for the conditions in paragraph (A)(3) (c)(i) of this
			 rule may exceed the thirty MED average. The prescribing physician shall be held
			 singularly accountable for prescriptions that exceed the thirty MED
			 average.
(v)
											In circumstances when the thirty MED average is
			 exceeded, the dose shall not exceed the dose required to treat the severity of
			 the pain as noted in paragraph (A) (2) of this rule.
(d)
										Prescriptions
			 that exceed the five or seven day supply or thirty MED average daily dose are
			 subject to additional review by the state medical board. The dosage, days
			 supplied, and condition for which the opioid analgesic is prescribed will be
			 considered as part of this additional review.