At this point, it’s 2019 and you’re familiar with the opioid epidemic and its impact on addiction in our state. But, are you aware of the new guidelines you’re required to follow while treating patients with chronic pain? Learn the 5 key takeaways from the State of Ohio’s rules to help prevent your patients from falling victim to the opioid epidemic. I’ll also provide tips on how to implement them in your own practice, examples from my own experience, and more.
(1) Consider non-opioid therapies first
While many patients do need ongoing opioid treatment for chronic pain, it’s best to assess the ability to help patients reduce the dosage of opioids through a multidisciplinary approach. For example, if a patient has x, then have them try [insert non-opioid treatment here] first before referring them to a pain management specialist.
(2) Increase patient awareness
Engage in conversations with your patients. Tell them about the relevant risks that come along with utilizing opiates to treat chronic pain. Ohio remains a top-five state in opiate-related overdoses and 80% started with doctor-prescribed medications. Now that’s something worth knowing. Of course, you will engage in tailored conversations with each patient according to their medical history and current needs.
(3) Establish new thresholds for increased monitoring
The State Medical Board, Ohio Board of Nursing, and Ohio State Dental Board now require clinicians follow certain rules based on the potency of opiates in morphine equivalent doses (MEDs). Clinicians are required to do the following each MED:
| Dose | Requirement |
| 50 MED | Re-evaluate the status of the patient’s underlying condition causing pain Assess functioning Look for signs of prescription misuse Consider consultation with a pain specialist Obtain written informed consent from a pain specialist |
| 80 MED | Look for signs of prescription misuse Consult with a pain specialist Obtain a written pain-management agreement Consider prescribing naloxone, the lifesaving overdose antidote |
| 100 MED | Qualifying dentists will be limited to prescribing 100 MEDs The need for more than this amount now requires working with a pain specialist |
| 120 MED | Engage a pain-medicine specialist as |
(4) Consult with a pain medicine specialist
If you discover the need to prescribe 120 MED of opiates or more, know that you are required by the above governing bodies to regularly consult with a board certified and fellowship-trained pain medicine specialist. For example, I offer to provide referring physicians with adequate documentation and follow up with immunoassay urine drug screens to ensure they’re following the most up to date guidelines.
In Conclusion
These guidelines do apply to patients suffering from chronic pain. These rules do not apply to patients receiving medication for terminal conditions, those within a hospital or in-patient setting where they are closely monitored.
Implementing the above guidelines into your daily practice can help prevent opiate addiction in your patients. Print and download the full guidelines here, and contact us so one of our specialists can help you answer any questions you may have about pain management.
