Proposed Opioid and Prescription Rules Designed to Combat Opioid Crisis
Opioid use continues to be a growing crisis in North Carolina and across the country. In an effort to continue to take steps to reduce availability and use of prescription pain killers, the Rules Review Commission, part of the Industrial Commission, recently issued proposed rules regarding opioids, prescriptions, and pain management. The rules are specifically meant to address problems arising from the intersection of the opioid epidemic and related workers’ compensation issues.
Some highlights from the proposed rules include a section governing the initial prescribing of a medication. For example, proposed rule 04 NCAC 10M .0201 indicates that during the “acute phase,” meaning within 12 weeks of treatment for pain following an incident, a provider cannot prescribe more than one targeted controlled substance at the time of the first prescription, and must prescribe the lowest number of days’ supply and dosage, not to exceed a five day supply. There are also proposed rules governing the type of substances a provider can prescribe. For example, a provider is instructed not to provide benzodiazepines for pain or as a muscle relaxant in the “acute phase.” In order to avoid drug-seeking behavior, providers would be required to review information pertaining to the employee’s medication use for the 12 month period preceding the first prescription.
After the first prescription, proposed rule 04 NCAC 10M.0202, requires providers who plan to continue to utilize a targeted controlled substance as part of their treatment plan to use urine drug testing, medical records screening tools, and to follow strict documenting requirements. Even after the “acute phase,” providers would be required to continue using limited dosage and supply, as well utilizing the random drug and 12 month medication history screenings.
The proposed rules also encourage non-pharmacological treatment, to include acupuncture, massage, physical therapy, and functional restoration programs. In the event a provider suspects abuse of targeted controlled substances, the rules indicate a provider would refer the patient to a health care provider specializing in treatment to facilitate discontinuation and weaning.
These rules are scheduled to go into effect no later than May 2018. At this time, the preliminary rules have been released to allow for feedback and proposed changes. We have no information concerning how the medical community will react to these rules, but, based on the ongoing opioid crisis, we know that some medical communities are implementing similar rules on their own. Ultimately, it is clear that policymakers across the board continued to recognize opioid use as an epidemic. Ideally, these rules will go into effect and these limitations on certain substances will help reduce claim costs and facilitate rehabilitation and return to work. Please contact a member of our workers’ compensation team with any questions or to discuss this issue in more detail.