Opioid Prescribing Rules for Healthcare Providers

In recent years, therapeutic opioid prescriptions have significantly increased across the United States causing an increase in opioid abuse. Abuse of opioids is now a serious health problem among Americans, causing opioid addiction, overdose, and unintentional death.

The Board of Medical Licensure and Discipline understands the complexities of treating patients with acute and chronic pain. We have always supported physicians undertaking the care of difficult-to-treat pain when the care is supported by well-documented records and acceptable care. Both patient and doctor have a role in responsibly managing the use of opioids. Here are some of the rules for opioid prescribing.

Rules for Opioid Prescribing

Adherence to state and federal laws

Adherence to state and federal laws is always required. Federal law permits the electronic prescribing of controlled substances. However, the electronic infrastructure for the transmission of controlled substance prescriptions has not been approved by the Drug Enforcement Administration; therefore no electronic transmission of controlled substance prescriptions is permitted at this time.

Schedule II Drugs

• Requires written Rx signed by prescriber.
• No refills allowed.
• Prescriptions become void unless dispensed within 90 days of original date of the prescription.
• Oral order in emergencies, however must receive written order in 7 days-RPh to notify DEA if it is not received.
• Exceptions for Schedule II fax Rxs as original Rx:
  • Home infusion/IV pain therapy
  • Long Term Care Facilities
  • Hospice/Terminally ill patient
• Current Quantity Limitations:
  • 30 day supply
  • Practitioners may write up to three separate prescriptions, each for up to a one-month supply, each signed and dated on the date written. Practitioner must write the earliest date each of those subsequent prescriptions may be filled, with directions to the pharmacist to fill no earlier than the date specified on the face of the prescription.

Schedule III Drugs

• Cannot be written or dispensed for more than 100 dosage units.
• Prescriptions become void unless dispensed within 180 days from original date written.
• May be refilled up to 5 times in 6 months.
• May be communicated orally, in writing, or by fax.

Schedule IV-V Drugs

• May be written and dispensed for up to a 90 day supply based on directions. No more than 360 dosage units may be dispensed at one time.
• Prescriptions become void unless dispensed within 180 days of original date written.
• May be refilled up to 5 times in 6 months.
• May be communicated orally, in writing, or by fax.

Doctor-Patient Relationship

Establish a bona-fide doctor patient relationship wherein an appropriate history, physical examination, documented treatment plan, and meaningful follow-up examination are completed. An appropriate level of suspicion is often warranted.

Level of Care and Documentation

Chronic pain management with opioids requires a higher level of care and documentation. A function based diagnosis and treatment paradigm with a list of function losses and gains is helpful.

Informed Consent

A meaningful informed consent and agreement for treatment is required by both law and ethics.

Periodic Review

Monitoring outcomes and adverse effects must be clearly documented. Often, a referral to pain management clinical experts should be done.