The Exchange

Commentary and Observations from
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Update: State Regulatory Environment for Opioid Prescribing

Update: State Regulatory Environment for Opioid Prescribing

As prescribers for patients with acute and chronic pain in primary care, NPs and PAs are very much aware of the national opioid epidemic, including ways in which health care providers and agencies, the criminal justice system, and social services are working to reduce the incidence of opioid-related deaths. If you live in a state where the state government has passed legislation to limit the prescribing of certain opioids and benzodiazepines, your professional associations and state regulatory boards have likely provided information on new laws and regulations surrounding this topic; all prescribers are included in the new laws and regulations, not just advanced practice providers (APPs).

As of October 2018, 33 states had enacted legislation related to opioid prescribing limits, and additional states will enact legislation this year. As a prescriber, you may or may not be aware of other states' limitations when you are prescribing across state lines (eg, via mail-order pharmacies). The National Conference of State Legislatures (NCSL) has published a policy brief outlining state legislative action, providing information on statutory limits for opioid prescribing. Although each state varies, state laws and regulations address prescribing for acute pain, including: limits on the number of days of treatment (ranging from 3 ‐ 14 days depending on the state), morphine milligram equivalents (MMEs), authorization for promulgation of regulations by state agencies, boards, and bureaus to set limits or guidelines on prescribing of opioids, and/or guidance on opioid prescribing. Seven states include additional limitations for minors. Virtually all states provide clear exceptions for chronic pain management.

In addition to prescribing limitations, you are likely aware of additional measures for prevention of and intervention against opioid misuse, including state-required prescription drug monitoring programs (PDMP), continuing education requirements for pain management, and access to medication-assisted therapy (MAT) with naloxone. If you are not aware of these requirements, the NCSL website has a database of state requirements (see reference below). From there, you can search your state regulatory board's webpage for provider-specific information, such as requirements to register with your state's PDMP, continuing education requirements for licensure/certification, and pain clinic regulatory guidelines.

  • Center for Disease Control and Prevention. Guideline resources: CDC opioid guideline mobile app. Accessed September 13 2019.
  • Center for Disease Control and Prevention. Calculating total daily dose of opioids for safer dosage. Accessed September 13 2019.
  • National Conference of State Legislatures. Prescribing policies: states confront opioid overdose epidemic. Accessed September 13 2019.

Filed under: Health Policy and Trends, NPs & PAs, Substance Abuse

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