Rhode Island Code of Regulations › Title 216 - Department of health › Chapter 20 - Community Health › Subchapter 20 - Drugs › Part 4 - Pain Management, Opioid Use and the Registration of Distributors of Controlled Substances in Rhode Island › Section 216-RICR-20-20-4.3 - Definitions

Current through June 14, 2024
A. Wherever used in these regulations, the
				  following terms shall be construed as follows:
1. "Act" means the R.I. Gen. Laws Chapter
				  21-28 entitled, "Uniform Controlled Substances Act."
2. "Acute pain" means the normal, predicted
				  physiological response to a noxious chemical, thermal, or mechanical stimulus
				  and typically is associated with invasive procedures, trauma, and disease.
				  Acute pain generally results from nociceptor activation due to damage to
				  tissues. Acute pain typically resolves once the tissue damage is repaired. The
				  duration of acute pain varies. For the purpose of this Part, acute pain shall
				  not include chronic pain management, pain associated with a current cancer
				  diagnosis, palliative care or nursing home care.
3. "Addiction medicine physician" means a
				  physician who is specifically trained in a wide range of prevention, evaluation
				  and treatment modalities addressing substance use disorder in ambulatory care
				  settings, acute care and long-term care facilities, psychiatric settings, and
				  residential facilities.
4.
				  "Recovery from a substance use disorder" means a process of change through
				  which individuals improve their health and wellness, live a self-directed life,
				  and strive to reach their full potential in areas of health, home, purpose and
				  community, making informed, healthy choices that support physical and emotional
				  wellbeing.
5. "Chronic pain" means
				  pain of greater than ninety (90) days duration, excluding pain requiring
				  palliative care.
6. "Common
				  carrier" means any person who or which undertakes, whether directly or by any
				  other arrangement, to transport property, or any class or classes of property,
				  by motor vehicle between points within this state; for the general public for
				  compensation, over the publicly used highways of this state, whether over
				  regular or irregular routes, pursuant to R.I. Gen. Laws §
											39-12-2.
7. "Contract carrier" means any person who or
				  which engages in transportation of property by motor vehicle, in intrastate
				  commerce for compensation, under continuing contract with one (1) person, or an
				  unlimited number of persons, for the furnishing of transportation services of a
				  special and individual nature required by the shipper, and not generally
				  provided by common carriers, pursuant to R.I. Gen. Laws §
											39-12-2.
8. "Controlled substance" means a drug,
				  substance, or immediate precursor in Schedules I-V of R.I. Gen. Laws Chapter
				  21-28. The term shall not include distilled spirits, wine, or malt beverages,
				  as those terms are defined or used in R.I. Gen. Laws Chapter 3-1, nor
				  tobacco.
9. "Department" means the
				  Rhode Island Department of Health.
10. "Director" means the Director of the
				  Rhode Island Department of Health.
11. "Distribute" means to deliver (other than
				  by administering or dispensing) a controlled substance or an imitation
				  controlled substance, and includes actual, constructive, or attempted
				  transfer.
12. "Distributor" means a
				  person who so delivers a controlled substance, or an imitation controlled
				  substance, pursuant to R.I. Gen. Laws §
											21-28-1.02(18).
13. "Electronic prescription" means a secure
				  (encrypted and encoded) technology system that allows practitioners to create,
				  sign, transmit, and file prescriptions from a computer or smart device to a
				  pharmacy computer directly and electronically. Electronic prescriptions do not
				  include handwritten, emailed, or faxed prescriptions or calling in
				  prescriptions.
14. "Hospice" means
				  a model of care that focuses on relieving symptoms and supporting patients with
				  a life expectancy of six (6) months or less. Hospice involves an
				  interdisciplinary approach to provide health care, pain management, and
				  emotional and spiritual support. The emphasis is on comfort, quality of life,
				  and patient and family support. Hospice can be provided in the patient's home
				  as well as freestanding hospice facilities, hospitals, nursing homes, or other
				  long-term care facilities.
15.
				  "Initial prescription" means first prescription given to someone who is new to
				  the prescription of opioids from your institution or office, and has not used
				  opioids in the most recent thirty (30) calendar days.
16. "Interstate carrier" means any person who
				  or which operates motor vehicles for the transportation of property of others
				  for compensation, over the publicly used highways of this state in interstate
				  commerce, authorized or certified by the Interstate Commerce Commission,
				  pursuant to R.I. Gen. Laws §
											39-12-2.
17. "Long acting and extended release
				  opioids" - opioids intended for long acting or extended use have a half-life
				  long enough that they are generally prescribed less than three (3) times a day.
				  Examples of long acting and extended release opioids include, but are not
				  limited to: Avinza (morphine sulfate) Extended-Release Capsules, Dolophine
				  (methadone hydrochloride) Tablets, Duragesic (fentanyl transdermal system),
				  Embeda (morphine sulfate and naltrexone hydrochloride) Extended-Release
				  Capsules, Exalgo (hydromorphone HCl) Extended-Release Tablets, Kadian (morphine
				  sulfate) Extended-Release Capsules, MS Contin (morphine sulfate)
				  Extended-Release Tablets, Nucynta ER (tapentadol) extended-release tablets,
				  Opana ER (oxymorphone hydrochloride) Extended-Release Tablets, Oxycontin
				  (oxycodone hydrochloride) Extended-Release Tablets, Palladone (hydromorphone
				  hydrochloride) Extended-Release Capsules) as well as other similar and future
				  U.S. FDA-approved medications in this classification as defined by the U.S.
				  FDA.
18. "Medical record" means a
				  record of a patient's medical information and treatment history maintained by
				  physicians and other medical personnel, which includes, but is not limited to,
				  information related to medical diagnosis, immunizations, allergies, x-rays,
				  copies of laboratory reports, records of prescriptions, and other technical
				  information used in assessing the patient's health condition, whether such
				  information is maintained in a paper or electronic format.
19. "Morphine milligram equivalents" or
				  "MMEs" means a conversion of various opioids to a morphine equivalent dose by
				  the use of accepted conversion tables. [A copy of this tool may be downloaded
				  from:
http://www.health.ri.gov/healthcare/medicine/about/safeopioidprescribing/
]
20. "Multidisciplinary pain clinic" means a
				  clinic or office that provides comprehensive pain management provided by
				  different health care disciplines including at least two (2) medical
				  specialties and non-physician professionals. It shall include care provided by
				  multiple available disciplines and treatment modalities in an integrated
				  fashion.
21. "Opioid induced
				  hyperalgesia" means increased perception of pain out of proportion to what is
				  expected, that results from the effects of opioids on the central nervous
				  system (CNS).
22. "Pain" means an
				  unpleasant sensory and emotional experience associated with actual or potential
				  tissue damage, or described in terms of such damage.
23. "Pain medicine physician" means a
				  physician whose usual course of practice is to treat patients who have acute
				  and/or chronic pain as a condition.
24. "Palliative care" means patient and
				  family centered medical care that optimizes quality of life by anticipating,
				  preventing, and treating suffering caused by advanced serious illness.
				  Palliative care throughout the continuum of illness involves addressing
				  physical, emotional, social and spiritual needs and facilitating patient
				  autonomy, access to information, and choice. Palliative care includes, but is
				  not limited to, discussions of the patient's goals for treatment; discussion of
				  treatment options appropriate to the patient, including, where appropriate,
				  hospice care; and comprehensive pain and symptom management.
25. "Person" means any corporation,
				  association, partnership, or one or more individuals.
26. "Physical dependence" means a state of
				  adaptation that is manifested by a drug-class-specific withdrawal syndrome that
				  can be produced by abrupt cessation, rapid dose reduction, decreasing the level
				  of the drug in the blood.
27.
				  "Practitioner" means, for the purpose of this Part, a physician licensed
				  pursuant to R.I. Gen. Laws Chapter 5-37, a physician assistant licensed
				  pursuant to R.I. Gen. Laws Chapter 5-54; an Advanced Practice Registered Nurse
				  (APRN) licensed pursuant to R.I. Gen. Laws Chapter 5-34; dentist; podiatrist;
				  veterinarian; scientific investigator; or other person licensed, registered or
				  permitted to prescribe, distribute, dispense, conduct research with respect to
				  or to administer a controlled substance in the course of professional practice
				  or research in Rhode Island.
28.
				  "Private carrier" means any person, other than a common carrier, or a contract
				  carrier, or an interstate carrier, who or which transports in intrastate or
				  interstate commerce by motor vehicle, property of which such person is the
				  owner, lessee, or bailee, when such transportation is for the purpose of sales,
				  lease, rent, or bailment, or in the furtherance of any commercial enterprise,
				  pursuant to R.I. Gen. Laws §
											39-12-2.
29. "Substance use disorder" means a
				  diagnosis provided by a licensed practitioner meeting the diagnostic criteria
				  of the Diagnostic and Statistical Manual of the American Psychiatric
				  Association (DSM-5), or the coding of the International Statistical
				  Classification of Diseases and Related Health Problems (ICD-10).
30. "Tolerance" means a state of adaptation
				  in which exposure to a substance induces changes that result in a diminution of
				  one or more of the substance's effects over time.