NMC Commentary

What Are the Rules Regarding Prescribing Powerful Pain Medications?

Just over a year ago, the rules governing how providers prescribe opioids were changed to ensure that powerful medications for pain (which include OxyContin, Vicodin, and Percocet) are used properly for their intended clinical purpose.  Primary care providers, specialists, and emergency departments across Vermont are following these rules with their patients.  As a member of Vermont’s Opioid Coordination Council, I believe this was an important step forward in our work as a state to address addiction.  Patients occasionally ask questions about the rules, so I would like to re-share this summary from last summer.

The regulation changes were an amendment to previously existing rules regarding opioid prescribing, extending them from a focus on long-term prescriptions to cover all opioid prescriptions including those for acute pain.  The new rules established ‘universal precautions’ for when a patient is being prescribed opioids for the first time, regardless of whether the medical need relates to acute pain or chronic pain.  Patients taking opioids need to understand the potential side effects, the risk of dependence (addiction) and overdose, the alternatives, the steps to taper their use, and methods of safe storage and disposal.  This thorough educational approach helps ensure that patients more fully understand what they are being prescribed and how to safely use these medications and prevent their abuse.

The rules call for an exploration of alternatives to opioids for each new patient, better ensuring that other methods with less risk are considered or attempted to manage pain levels before turning to opioids. Alternatives include NSAIDS (nonsteroidal anti-inflammatory agents) that are known by many brand names, including Advil, Motrin, and Aleve. Acetaminophen, known by brand names such as Tylenol or Excedrin) is another alternative to opioids that may prove effective for patients.  Physical therapy can be very effective in managing pain and other alternatives include massage, chiropractic care, and acupuncture. Using these strategies when appropriate can reduce or eliminate patients’ exposure to opioids, thereby bypassing concerns about their use. As you visit our primary care practices, specialists’ offices, and our emergency department, you will find much more emphasis on helping you successfully manage pain in ways that do not require opioid medications.

In addition to considering alternatives, for prescriptions of more than 10 opioid pills, prescribers are required to query the Vermont Prescription Monitoring System to see a patient’s medication history and querying the system is recommended for smaller prescriptions as well.  This will better inform conversations about possible patterns of use that could be concerning.  This querying is not required for prescriptions relating to special causes including management of chronic pain, palliative care and ‘end of life’ care.  Limits on the number of pills prescribed for acute pain for patients new to the use of opioids have been established.  This reduces the chances of misuse.  The new regulations also specify the co-prescription of Naloxone (Narcan) in certain scenarios.  Naloxone is a medication to be used in emergency situations that can counter the effects of opioids and may save the life of someone who has overdosed.  The regulations also call for consultation and collaboration with the primary care provider by the prescribing provider for prescriptions to be used by children.

With these new rules in place, patients throughout our community are being cared for in alignment with this safety-focused approach.  Primary care providers, specialists, and emergency departments are all working to help patients manage pain without automatically prescribing powerful opioids.  This is an important step forward, as opioid abuse is a major concern across the state as it is across our country.  Because of that concern, I am serving on the State’s Opioid Coordination Council.  This multi-sector group is focused on ensuring “full inter- and intra-agency coordination between state and local governments in the area of prevention, treatment, recovery, and law enforcement activities.”  It is so important that all of us across the state in all sectors are working together to address opioid concerns and I welcome the challenge of helping identify and implement continued improvements.

Each of us individually plays a role in this effort.  Be an active participant in your care and work with your medical provider to ensure you understand your medications.  Store them safely and dispose of them properly to prevent misuse by others.  Do not hesitate to ask questions or to reach out for assistance if you have concerns.  Together, we can make a difference and achieve a healthier future.

— Jill Berry Bowen, NMC’s Chief Executive Officer