In June 2014, the Colorado Medical Board, in collaboration with the Colorado Dental Board, State Board of Nursing, State Board of Pharmacy and the Nurse-Physician Advisory Task Force for Colorado Healthcare adopted a new policy for prescribing and dispensing opioids. The new policy is the first guidance the Medical Board has offered to physicians and other pain management specialists since the repeal of Medical Board Policy 10-14 in August 2013. The new policy, which is available here, recognizes that pain and addiction specialists are outnumbered in Colorado and that other providers often are called upon to treat painful conditions.
While the policy states that it does not “set a standard of care for prescribers and dispensers,” doctors and others who treat chronic pain should follow the guidelines set out in the policy. The policy includes guidelines for developing and maintaining competence, initiation of pain management therapy, prescribing, monitoring, patient education and discontinuing therapy. Failure to follow the guidelins may lead to discipinary action.
While the policy is broadly worded, a few specific items are conspicuous: The policy advises physicians to review relevant PDMP data before prescribing or dispensing opioids. Practitioners who prescribed often abused medications such as OxyContin, oxycodone, and other opioids would be wise to review PDMP data not only for when initially prescribing medication, but with each refill as well. The policy also advises pharmacists to use caution when dispensing to new or unknown patients, filling weekend or “late day” prescriptions, and when filling prescriptions issued by a provider far from the location of the pharmacy.
Although the policy does not explicitly state, it signals that certain prescriptions amounts and types will likely be considered substandard in the absence of a compelling reason for the prescription. For example, the policy advises that opioid doses greater than 120 mg morphine equivalent are considered dangerous, and that “benzodiazepines are known to potentiate the effects of opioids and may increase the risk of adverse outcomes.” Additionally, opioid treatment that exceeds 90 days, prescriptions for transdermal, extended relief or long-acting preparations are suspect and will likely be considered “red flags” in Board investigations.
Given the significant risks associated with narcotics and pain management, including the difficult patient population, the high incidence of abuse, and overall danger to patients, physicians who are not specially trained in pain management would be wise to avoid the practice as much as possible. Doctors who do practice pain management should strictly adhere to the Board’s policy, meticulously document their care (including maintaining copies of PDMP data in patient files), and be comfortable referring patients to addiction and pain management specialists at the first sign of trouble.
For more information, please contact Steve Kabler at firstname.lastname@example.org or 720-306-7733