Prescriber Requirements to Regularly See Pain Management Patients

Description

Prescriber requirements to regularly see pain management patients are instituted by states or state medical boards, who can require regular visits to patients who have been prescribed opioids—monitoring their dosages, re-evaluating their continued need and their treatment plans, and monitoring them for warning signs of addiction or abuse (National Alliance for Model State Drug Laws, 2010).

Objective(s)

To monitor and control the use of opioids by pain management patients

Typical Elements

  • Note: The Federation of State Medical Boards (FSMB) released model policies for the prescription of opioids in 1998, with updates released in 2004 and 2013. Most state medical boards have implemented regulations based on these model policies (FSMB, n.d., 2013).

The state- or state medical board-imposed requirements can include the following elements:

  • Prescriber understanding of best practices in pain management (FSMB, 2013)
  • A comprehensive initial exam provided to patients prior to prescribing opioids (FSMB, 2013)
  • Individual treatment plans and goals developed in collaboration with the patient (FSMB, 2013)
  • Individual treatment contracts developed in collaboration with the patient, outlining the rights and responsibilities of the patient and the prescriber regarding the use of opioids (Bendix, Verdon, & Zimlich, 2013)
  • Implementation of opioid trial periods—which include set evaluation points and feature regular adjustments in prescription dosage until the appropriate amount is set—prior to issuing long-term prescriptions (FSMB, 2013)
  • Ongoing monitoring of long-term opioid use, adjusting the treatment plan and goals based on the results of regular, in-person patient visits (FSMB, 2013)
    • Note: Patients who regularly delay or miss scheduled monitoring sessions are often at risk for developing substance use disorders (Oliver & Taylor, 2003). As part of the monitoring process, prescribers are often required to see opioid patients at least once per month and whenever a prescription needs renewal.
  • Documentation of patient medication status, functional impairment, and awareness during the re-evaluation process (Oliver & Taylor, 2003)
  • Periodic urine testing to assess treatment plan adherence and to determine the presence of non-prescribed opioids, as appropriate (FSMB, 2013)
  • Referral of patients to substance abuse or mental health professionals, as necessary (FSMB, 2013)
  • Discontinuation of opioid use after additional consultation with a patient if the treatment plan goals are being met (FSMB, 2013)
  • Maintenance of comprehensive medical records (FSMB, 2013)
  • Compliance with DEA “closed system” requirements and regulations regarding transmitting prescriptions to pharmacies (FSMB, 2013)
    • Note: Requirements to regularly see pain management patients are based on the premise that unintentional and inappropriate prescriptions are primarily the result of prescribers’ insufficient understanding of a patient’s initial assessment, overuse of opioid prescriptions to treat pain, inadequate monitoring of opioid use, failure to adhere to patient education and informed consent practices, improper dosing, and/or failure to use opioid risk mitigation strategies (FSMB, 2013).

Populations

Prescribers, patients using controlled substances

Outcomes

No outcome data have been found regarding the role of prescriber requirements to regularly see patients in preventing the nonmedical use of prescription drugs or its consequences.

Guidelines

Model Policy on the Use of Opioid Analgesics in the Treatment of Chronic Pain. 

Pain Management Polices: Board-by-Board Overview. 

Acknowledged by

No acknowledgements have been found regarding the role of prescriber requirements to regularly see patients in preventing the nonmedical use of prescription drugs or its consequences.

References

Bendix, J., Verdon, D. R., & Zimlich, R. (2013). The true cost of pain management in your practice: Physicians cite need for better communication to successfully treat pain and monitor for possible abuse. Medical Economics, 90(5), 30–33. 

Federation of State Medical Boards. (n.d.). Pain management policies: Board-by-board overview. Retrieved from http://www.fsmb.org/siteassets/advocacy/key-issues/pain-management-by-state.pdf

Federation of State Medical Boards. (2013). Model policy on the use of opioid analgesics in the treatment of chronic pain. Retrieved from http://www.azdo.gov/Files/FSMBPainMgmt.pdf

National Alliance for Model State Drug Laws. (2010). Pain management and pain clinics: State statutes and regulations. Retrieved from https://namsdl.org/wp-content/uploads/State-Statutes-and-Regulations-Relative-to-Chronic-Pain-and-Pain-Management.pdf

Oliver, R. L., & Taylor, A. (2003). Chronic opioid rules: Prescribing opioids for chronic pain requires set rules, a written plan, periodic re-evaluation, and vigilance to prevent illegal diversion of controlled substances. Practical Pain Management, 3(2), 1–8. Retrieved from https://www.practicalpainmanagement.com/treatments/pharmacological/opioids/chronic-opioid-rules