Delaware

Division of Professional Regulation release new set of rules to monitor the abuse of opioids

opioids in Delaware

DELAWARE - In Delaware, the Division of Professional Regulation recently released a new set of rules to monitor the abuse of opiate pain medication.

The new requirements expand on procedures related to prescribing opiates for acute episodes as well as for chronic, long-term pain management.

A few of the requirements include, first- time prescriptions to an adult patient cannot exceed a 7-day supply, as well as no prescription to a minor can exceed a 7-day supply at any time.

The state director for the Division of Public Health tells us Delaware is identified as a state high in prescriptions of opioid pain relievers but they are continuing to improve their efforts. 

For a full list of the regulations: 

Key elements related to prescribing for an acute episode (injury or procedure) include:
• A first-time prescription to an adult patient for an acute episode cannot exceed a 7-day supply
• No prescription to a minor can exceed a 7-day supply at any time
• If professional judgment dictates more than a 7-day supply is necessary
o Document the condition triggering the prescription
o Query the Prescription Monitoring Program to obtain a prescription history
o Indicate that a non-opiate alternative was not appropriate
o Obtain Informed Consent
o Administer a fluid drug screen, at the discretion of the provider
o Conduct a physical examination which must include a documented discussion to elicit relevant history, explain risks/benefits of opioid analgesics and possible alternatives, and establish other treatments tried or considered
o Schedule periodic follow-up visits and evaluations to monitor progress, whether there is an available alternative to opiate use, and whether to refer the patient for a pain management or substance abuse consultation

Key elements related to prescribing for chronic, long-term treatment with an opiate include:
• Those listed above
• Query the PMP
o At least every six months and more frequently if clinically indicated
o Whenever the patient is also being prescribed a benzodiazepine
o Whenever the patient is assessed to potentially be at risk for substance abuse or misuse
o Whenever the patient demonstrates loss of prescriptions, requests for early refills, or similar behavior
• Administer fluid drug screens at least every six months
• Obtain a signed Treatment Agreement

Informed Consent elements must include at least:
• The drug’s potential for addiction, abuse, and misuse
• The risks of life-threatening respiratory depression associated with the drug
• Potential for fatal overdose as a result of accidental exposure, especially in children
• Neonatal opioid withdrawal symptoms
• Potential for fatal overdose when interacting with alcohol
• Other potentially fatal drug interactions, such as with benzodiazepines

Treatment Agreement elements must include:
• The patient’s agreement to take medications at the dose 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
• 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 referral to an addiction treatment programs
• The requirement that fluid drug screens be performed at random intervals at the practitioner’s discretion, but no less than every six months.


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