Ohio introduces new opioid prescription guidelines for acute pain

By Jordyn Grzelewski



Mahoning County officials hope new rules governing the prescribing of opiate medications will help the county continue an encouraging trend.

“We have seen a real curbing in prescription opioids,” said Brenda Heidinger, associate director for the Mahoning County Mental Health and Recovery Board.

State officials say new rules related to acute pain management that went into effect Aug. 31 will further curb the state’s overprescribing trend, which started in the 1990s.

Those rules, detailed in a recent news conference hosted by Gov. John Kasich, establish these limits for doctors prescribing opiates for acute pain:

No more than seven days of opiates can be prescribed for adults.

No more than five days of opiates can be prescribed for minors.

Health care providers can prescribe opiates in excess of the limits only if they provide a specific reason in the patient’s medical record.

Except for certain conditions, the total morphine equivalent dose (MED) of a prescription for acute pain cannot exceed an average of 30 MED per day.

The new limits do not apply to opiates prescribed for cancer, palliative care, end-of-life/hospice care or medication-assisted treatment for addiction.

Prescribers also will be required, beginning Dec. 29, to provide to the state a diagnosis or procedure code for every opiate prescription. Beginning June 1, they will be required to do the same for other controlled-substance prescriptions.

“If you’re a dentist, if you’re a doctor, I don’t care who you are – you violate these guidelines, and the medical board will come after you. You will be disciplined and perhaps even lose your license,” Kasich said at the news conference, where he was joined by the presidents of the state pharmacy, medical, dental and nursing boards. “You [prescribers] have a responsibility to do this the right way.”

State officials say the new guidelines will reduce prescription opiates by an estimated 109 million doses, building on previous efforts to control the prescribing of opiates.

“We were one of the very first states to establish opiate-prescribing guidelines, beginning in 2012, first for emergency departments, then for chronic pain, and then for acute pain,” said Dr. Mark Hurst, medical director for the Ohio Department of Mental Health & Addiction Services, at the news conference.

Megan Marchal, president of the state pharmacy board, noted from 2012 to 2016, the amount of opiates dispensed to Ohio patients decreased by 162 million doses.

“What’s more, data for the first quarter of 2017 indicates that Ohio is continuing this downward trend in opiate prescribing,” she said.

That trend can be seen in Mahoning County, too, according to data from the Ohio Automated Rx Reporting System, OARRS.

According to that data, the county’s number of prescription opioid doses per capita peaked in 2013 at 81.3. That year, 19,420,393 doses of opiate medications were dispensed in the county.

From 2013 on, those numbers have gradually declined.

In 2016, 15,328,203 opiate doses were dispensed, and the number of doses per capita fell to 64. And in the first quarter of this year, those numbers were down slightly compared with the first quarter of 2016.

Mahoning County officials see the new acute-pain guidelines as helpful.

“The governor has made a major step forward in fighting addiction by implementing opioid-prescribing guidelines,” said Duane Piccirilli, executive director of the Mahoning County Mental Health and Recovery Board. “I cannot tell you how many stories I have heard from people in recovery, both locally and nationally, that their addiction started with prescription drugs, prescribed for an injury.”

Heidinger called the guidelines “very helpful.”

“Mainly, because, two things can happen: The person who gets the prescription can become addicted, but they also tend to leave it in their medicine cabinets, and then it’s available to people who may be in or out of their house.”

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