Massachusetts Medical Society: What You Must Know About the New Opioid Laws

What You Must Know About the New Opioid Laws

MMS Opioid Legislation Practice Guide Now Available

All Massachusetts physicians are immediately subject to many of the new provisions in the opioid prescribing law passed in March.

These include several new legal requirements related to opioid prescribing which became effective immediately and should be incorporated into your clinical practice.

Unless otherwise noted, these provisions became effective March 14, 2016.

The law imposes a seven-day limit on prescribing of opiates to a patient for the first time. Provision applies to minors for every such prescription, with parental notification. For outpatient cases only. Exceptions for acute medical conditions, chronic pain, -cancer and palliative care.

Other highlights of the law related to the practice of medicine include the following:

  • Prescribers must check the Prescription Monitoring Program (PMP) every time for a Schedule II and III narcotic is prescribed. The law maintains current statutory language requiring regulations to recognize circumstances under which such narcotics may be prescribed without first utilizing the PMP, and permits delegates to use the PMP on behalf of the prescriber. Effective Oct. 15, 2016.
  • The law allows patients to request a partially filled opioid prescription. The pharmacist must notify the prescriber within seven days. Prescribers must discuss with the patient the quantity of the prescription and the option to partial fill. Remainder of the prescription becomes void.
  • All prescribers must complete appropriate training in pain management and addiction, to be determined by boards of registration.
  • Prior to issuing an extended-release long-acting opioid in a non-abuse deterrent form for outpatient use for the first time, a practitioner must evaluate the patient’s current condition, risk factors, history of substance abuse, if any, and current medications; and inform the patient and note in the patient’s medical record that the prescribed medication, in the prescriber’s medical opinion, is an appropriate course of treatment based on the medical need of the patient.
  • Prescriptions for extended-release long-acting opioids require the prescriber and patient to enter into a written pain management treatment agreement.
  • The law requires the Department of Public Health to establish a voluntary non-opiate directive form, indicating to all practitioners that an individual shall not be administered or offered a prescription or medication order for an opioid. Directive may be revoked at any time, in writing or verbally. Directive to be recorded in patient’s medical records. Exemptions for emergencies. Liability protections for prescribers and pharmacists. Effective Dec. 1, 2016.
  • The law establishes a benchmarking mechanism for prescribers. The Department of Public Health determines mean and median quantity and volume of prescriptions for opiates, within categories of similar specialty or practice types. Prescribers who exceed mean or median will be sent notice. Rankings are confidential, are not admissible as evidence in a civil or criminal proceeding, and are not to be used as the sole basis for an investigation by the board of registration. Effective Dec. 1, 2016.
  • The law requires the establishment of a drug stewardship program to be paid for by drug companies that makes it easier for patients to safety dispose of unwanted and unused medications. Effective Jan. 1, 2017.
  • The law requires overdose and naloxone patients in emergency departments to undergo a substance abuse evaluation by a licensed mental health professional or through an emergency service program within 24 hours. Patients can’t be discharged before 24 hours or before evaluation, whichever comes first. Clinicians cannot be held liable in a civil suit for releasing a patient who does not wish to remain in the emergency department after stabilization but before a substance abuse evaluation has taken place. Parents of overdose minors must be notified. Emergency departments must notify a patient’s primary care provider, if known. Private insurers must pay for substance abuse evaluations without prior authorization. Effective July 1, 2016.
The new MMS Mass. Opioid Legislation Practice Guide is now available and addresses several key changes to prescribing laws. Access it at www.massmed.org.

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