How Will Florida’s New Law on Prescribing Pain Medications Effect You?
Typically if you have surgery, dental work, or happen to slip and fall and wake up later with pain your doctor may prescribe a pain reliever that often contains an opioid. It is not unusual to receive a prescription with 15–30 pain tablets, prescribed every four hours as needed. That process is all changing.
Beginning July 1, 2018 a prescription for a Schedule II opioid for the treatment of “acute pain” may not exceed a three-day supply. The three day limit may be increased to seven days if determined to be medically necessary with proper documentation and “Acute Pain Exception” written on the face of the prescription. The prescriber must document in the patient’s medical record the acute medical condition and lack of alternative treatment options that justify deviation from the three day supply limit.
Acute pain is statutorily defined as “the normal, predicted, physiological, and time-limited response to an adverse chemical, thermal, or mechanical stimulus associated with surgery, trauma, or acute illness.” It’s almost easier to understand what is defined as non-acute pain. Acute pain does not include pain related to cancer, terminal conditions (death to occur within one year), pain treated with palliative care (incurable, progressive illness or injury), or traumatic injuries with an Injury Severity Score of 9 or greater (an internationally recognized scoring system). Schedule II opioids you may recognize include: codeine, hydrocodone, morphine, oxycodone, and amphetamines. A complete list of Schedule II medications is listed in Chapter 893.03 of the Florida Statutes.
If you are prescribed a medication that includes a controlled substance your prescription is entered into a statewide database. The Department of Health is required to maintain this electronic system to collect and store controlled substance dispensing information in Florida. The Prescription Drug Monitoring Program (PDMP) known as E-FORCSE, Electronic-Florida Online Reporting of Controlled Substances Evaluation Program maintains patient’s controlled substance dispensing history. The dispensing of a controlled substance must be reported to the database no later than the next business day. The new law requires health care practitioners to consult the database to review the patient’s controlled substance history before prescribing or dispensing a controlled substance for a patient who is 16 years of age or older. This requirement is for almost any controlled substance, for any reason, not just acute pain or chronic nonmalignant pain.
One of the goals of the PDMP is to help prevent drug abuse, however for the prescribing practitioner there are not specific guidelines of how they should respond or prescribe after reviewing the patient’s controlled substance dispensing history. This may need to be tackled by the State Medical Boards.
The Center for Disease Control states Opioids are the main driver of drug overdose deaths. Florida had over 4,500 deaths related to overdose in 2016. In 2017 Governor Scott declared Florida’s Opioid epidemic a Public Health Emergency. Finding the balance between treating patients with pain and discovering who may be an addict is challenging.
Medical providers registered with the Drug Enforcement Agency (DEA) and authorized to prescribe controlled substances must take a board-approved two hour continuing education course on prescribing controlled substances by January 31, 2019. (4) While this course may be helpful for understanding the new law I have to wonder how much education will be made available or required to recognize, diagnose and treat addiction.
More information and FAQ’s are available at Florida Take Control, a website describing the new law is available at http://www.flhealthsource.gov/FloridaTakeControl/.
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