Limits on opioid prescriptions start

WARREN — Doctors and pharmacies are now limited to writing seven-day prescriptions with no refills to adults with non-chronic pain, a time period a local doctor says is plenty for most acute pain situations.

The State of Ohio Board of Pharmacy enacted the rule changes in response to the growing opioid addiction epidemic that often can begin with a legitimate prescription for opioid drugs, but can evolve into a dependency on cheaper, opioid-based street drugs like heroin, which often comes laced with stronger, synthetic drugs.

“Most patients that have acute pain due to trauma, including surgery, realistically have their pain controlled within the first week,” said Dr. James LaPolla.

The limit is reduced to a five-day supply for children. The restriction does not apply to patients with chronic pain, only acute pain.

Acute pain is pain that normally fades with healing, is related to tissue damage, significantly alters a patient’s typical function and is expected to be time limited, according to the board.

LaPolla, a podiatrist with Northeast Ohio Foot, Ankle & Wound Center Inc. on East Market Street in Howland and an office on Warren Sharon Road in Brookfield, said doctors still have control when it comes to writing a prescription for their patients.

“For my practice, I don’t see this being a major factor,” LaPolla said. “As a physician and surgeon, I am still allowed to prescribe past seven days, as long as I show appropriate documentation that additional days are warranted.”

The regulations outline situations of acute pain that warrant a longer prescription for dentists and doctors — like severe burns and limb amputation. The law does not place restrictions on the opioids found in drugs that are meant to help a patient wean themselves from an addiction, like methadone, or patients in hospice or suffering from cancer.

“This new law does allow patients to continue pain management for chronic pain like cancer and severe arthritis. Most times, these are prescribed by a pain management physician who follow a different set of prescribing protocols,” LaPolla said.

According to the pharmacy board, each time a doctor prescribes an opioid, he or she will have to enter the information into the state prescription drug monitoring system with a special code identifying the reason why the prescription was made for more than seven days, and include the detail in medical records.

“The rules have the potential to reduce the number of opioids prescribed for acute pain by an additional 109 million doses,” said State of Ohio Board of Pharmacy Executive Director Steven W. Schierholt. “These practical limitations on opioid prescribing will build on Ohio’s progress in reducing the overall supply of pain medications available for misuse and addiction.”

Prescription opiates often are the gateway to heroin, and 74 percent of those who died of a drug overdose in 2015 had a previous prescription for a controlled substance, according to the state.

Doctors also are required to outline the risks of addiction to patients receiving the prescription.


New regulations

New regulations on opioids set by the State of Ohio Board of Pharmacy:

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

• No more than five days of opioids can be prescribed for minors and only after the written consent of the parent or guardian is obtained.

• Health care providers may prescribe opioids in excess of the day supply limits only if they provide a specific reason in the patient’s medical record.

• Except as provided for in the rules, 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 opioids prescribed for cancer, palliative care, end-of-life/hospice care or medication-assisted treatment for addiction.

• The rules apply to the first opioid prescription for the treatment of an episode of acute pain.