A number of new laws went into effect on August 1, but one law in particular could be a godsend for certain chronic pain patients in Minnesota. The law clarifies and updates how doctors can prescribe medications to patients battling chronic pain, which will make it easier for some patients battling complex pain problems to receive the medications they so desperately need.
The new law came after some concerns developed in the wake of the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain. Those guidelines really attempted to reduce opioid addiction and overdose deaths by placing limits and restrictions on the types of medication that patients with chronic pain could receive. However, as we’ve talked about on the blog in the past, chronic pain is highly individualized, so attempting to paint all pain patients with a broad brush stroke and subject them all to the same restrictions was bound to cause problems for some patients.
The 2016 guidelines featured specific numeric thresholds for opioid prescribing, which were later adopted widely and used in regulations and state laws to police opioid prescribing. But these restrictions also had an unintended effect – patients who could no longer get the crucial medication they needed to help with their pain would sometimes turn to the streets for painkillers.
“Many have turned to the streets out of desperation,” said Laura Johnson, a chronic pain patient who spoke to the Minnesota Senate during a spring hearing. “Many more have ended their lives.”
Both the American Medical Association and the Minnesota Medical Association backed up Johnson’s testimony, sending letters in support of a proposed change.
The New Guidelines
The updated guidelines essentially allow doctors more freedom to continue prescribing opioids past the previous threshold so long as they are doing so with a clear purpose and accurate documentation. The revised statute provides new or updated definitions for treating problems like intractable pain, palliative care and other rare conditions. Here’s what they say:
- No physician, advanced practice registered nurse, or physician assistant shall be subject to disciplinary action by the Board of Medical Practice or Board of Nursing for appropriately prescribing or administering a controlled substance in Schedules II to V of section 152.02 in the course of treatment of a patient for intractable pain, provided the physician, advanced practice registered nurse, or physician assistant keeps accurate records of the purpose, use, prescription, and disposal of controlled substances, writes accurate prescriptions, and prescribes medications in conformance with chapter 147 or 148 or in accordance with the current standard of care.
- No physician, advanced practice registered nurse, or physician assistant, acting in good faith and based on the needs of the patient, shall be subject to disenrollment or termination by the commissioner of health solely for prescribing a dosage that equates to an upward deviation from morphine milligram equivalent dosage recommendations or thresholds specified in state or federal opioid prescribing guidelines or policies, including but not limited to the Guideline for Prescribing Opioids for Chronic Pain issued by the Centers for Disease Control and Prevention and Minnesota Opioid Prescribing Guidelines.
- Prescribers are prohibited from tapering a patient’s medication dosage solely to meet a predetermined dosage recommendation or threshold if the patient is stable; is experiencing no serious harm from the level of medication prescribed, and is in compliance with treatment plan and patient-provider agreement.
- No pharmacist, health plan company or pharmacy benefit manager shall refuse to fill a prescription for an opiate issued by a licensed practitioner authorized to prescribe opiates solely based on the prescription exceeding a predetermined morphine milligram equivalent dosage recommendation or threshold.
- Prescribers and patients are required to enter into an agreement that includes the patient’s and prescriber’s expectations, responsibilities, and rights according to the best practices and current standard of care with agreement to be signed by the patient and the prescriber, and a copy of the agreement included with the patient’s medical record and a copy to the patient, to be reviewed at least annually and when there are any changes to treatment plan.
- Absent clear evidence of drug diversion, nonadherence with the agreement must not be used as the sole reason to stop a patient’s treatment with scheduled drugs.
These updated guidelines should ensure that patients and providers who are doing everything in their power to correctly address a chronic pain issue won’t run into problems with access to medications that they need. Hopefully we see these intended results in the near future. And if you need help with a pain issue in the greater Twin Cities area, reach out to Dr. Cohn and his team today at (953) 738-4580.