Mandatory Requirements Help to Keep Your Patients Safe
As a prescriber of controlled substances, you have both a professional responsibility and a legal obligation to abide by certain requirements in Delaware. Checking the Prescription Monitoring Program (PMP) before you issue certain prescriptions is mandatory. You also must participate in the two-part Controlled Substance Registration (CSR) webinar upon receiving your first CSR license. Every two years after that, in order to renew your license to prescribe controlled substances, you must again complete the CSR webinar. CME credits are offered for webinar completion. You are also required to document informed consent and treatment agreements between you and your patients. These requirements not only help to keep your patients informed, but can also help to reduce the threat of opioid-related overdoses and deaths in our state.
Prescription Monitoring Program capabilities include:
- Timesaving NARX Score – a three-digit score that corresponds to overall overdose risk – that automatically calculates and displays, at a glance, a patient’s current level of risk based on prescription history, without having to drill down to details.
- Generation of multiple patients’ reports in one click
- Prescriber reports to compare your rates with other prescribers in your specialty, emailed quarterly
- My Rx reports that detail your prescribing data for any specific time period, and can be run at any time
- Data sharing with many other states — new states added regularly
- Integration into your practice flow within your EHR, using a single sign-on (ask your vendor for details)
- Morphine milligram equivalent (MME) automatically calculated for patient reports
- CDC resources, including helpful fact sheets about prescription drug monitoring programs
- Training and educational videos
Mandatory Controlled Substance Regulations Webinar
This webinar provides training and is required to be completed every two years by those who prescribe controlled substances. It offers updates on regulations as well as safe prescribing and pain management practices. This webinar has been accredited in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME). To receive CME credit, you must complete a questionnaire that will be provided after you watch both Part 1 and Part 2 of the webinar.
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint-providership of the Medical Society of Delaware and the Delaware Division of Public Health. The Medical Society of Delaware is accredited by the ACCME to provide continuing medical education for physicians.
The Medical Society of Delaware designates this live activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
It is the policy of the Medical Society of Delaware to comply with the ACCME Standards for Commercial Support of Continuing Medical Education. In keeping with these standards, all faculty participating in continuing medical education provided by MSD are expected to disclose to the activity audience any real or apparent conflicts of interest related to the content of their presentations.
Joint providership of CME by MSD in no way implies endorsement of any product or service.
This activity is not supported by commercial funding.
- How to treat patients with chronic pain
- Non-opioid pain management approaches
- Opioid risks and side effects
- Prescription dosage calculation recommendations
- How to use the PMP
- Fluid drug screening and Narcan guidelines
- Opioid prescribing CSR regulations and rules
- How to prevent prescription fraud
- How to taper dosages and discontinue opioids
- Effective screening tools
- Signs of addiction and treatment referral resources
Regulations Regarding Safe Prescribing of Opioids
Safe Opioid Prescribing Regulations detail requirements for safe prescribing of opioids for both acute episodes and chronic, long-term pain management. Delaware regulations limit a first-time prescription of opioids to no more than a seven-day supply for an adult patient for an acute episode with some narrow exceptions. The regulations delineate minimal standards to be followed— some at the discretion of the provider — prior to prescribing opioids. These include querying the Prescription Drug Monitoring Program (PMP), performing a fluid drug screen, and obtaining an informed consent from the patient.
A Signed Consent Agreement Confirms an Understanding of the Risks and Expectations.
The informed consent confirms that the patient understands the risks of opioid therapy and the drug’s potential for addiction. The document should be signed by both the prescriber and the patient and become part of the patient’s medical record.
Informed consent should include a statement that the material risks associated with taking these controlled substances include but are not limited to:
- Sedation that may interfere with your ability to drive and operate machinery safely
- Interference with breathing, which could become life-threatening, or urinary and bowel function (constipation) serious enough to warrant urgent medical treatment
- Physical dependence
- The potential for addiction, abuse, and misuse
- Nausea, vomiting, itching, mood changes, muscle twitching, and allergic reactions
- Injury to the fetus or unborn child in a pregnant woman
- Overdose as a result of accidental exposure (especially in children)
- Neonatal opioid withdrawal (for females who could be pregnant)
- Potentially fatal overdose resulting from interactions with alcohol and other drugs
A Signed Treatment Agreement Confirms Expectations.
The treatment agreement confirms expectations for both the provider and the patient. The document should be signed by both the prescriber and the patient and become part of the patient’s medical record.
The Treatment Agreement (provided as an example) could include:
- The patient’s agreement to take medications at the dosage and frequency prescribed, with a specific protocol for lost prescriptions and early refills
- Reasons for which medication therapy may be re-evaluated, tapered, or discontinued, including, but not limited to, violation of the Treatment Agreement or lack of effectiveness
- The requirement that all chronic pain management prescriptions are provided by a single practitioner or a limited, agreed-upon group of practitioners
- The patient’s agreement to not abuse alcohol or use other medically unauthorized substances or medications
- The requirement for individuals who are prescribed opioids for chronic pain management that fluid drug screens be performed at random intervals at the practitioner’s discretion, but no less than once every six months
- Pill counts may be requested at the discretion of the provider
- Acknowledgment that a violation of the agreement may result in action as deemed appropriate by the prescribing practitioner, such as a change in the treatment plan, a referral to a pain specialist, or a referral to an addiction treatment program