Prescribing For Pain – Staying Out of Trouble

One of, if not the biggest, hot-button issues in the practice of medicine right now is the prescribing of controlled substances, and particularly opioid pain medications.  The significant increase in the use and abuse of narcotic pain medication is well documented throughout the media and in medical literature.  Physicians who practice in this area, even those who meet or exceed the standard of care are frequently subjected to investigations and complaints by Colorado’s DORA health care boards (i.e., Colorado Medical Board and Colorado Nursing Board).    

Until recently, the Colorado Medical Board had in place a policy addressing the standards for pain management which offered some guidance for pain management doctors.  On August 15, 2013, the Board repealed its policy and did not replace it.  The Board’s website merely indicates that former policy 10-14 is “no longer consistent with the current standards and practices of pain and symptom management.”

Although the Board now offers no “official” guidance on these issues.  The Colorado Medical Board’s website directs practitioners to the Federation of State Medical Boards publication, “Responsible Opioid Prescribing:  A Clinician’s Guide,” which is available from the FSMB here.  The CMB also recommends that physicians consider a CME developed by the FSMB with Boston University called “Safe and Competent Opioid Prescribing Education (SCOPE) of Pain.”  The program, is a free online education seminar available at   Doctors and other health care providers, including physician assistants, nurse practitioners and others, who practice pain management should also review, understand and follow the FSMB’s “Model Policy on the Use of Opioid Analgesics in the Treatment of Chronic Pain,” which is available here:  Model Opioid Policy. 

There is no assurance that following the protocols recommended by the FSMB will prevent Board investigations.  However, learning, understanding and adhering to the Model Policy, the Clinician’s Guide and Scope of Pain recommendations may serve to minimize the potential for complaints and discipline.

For more information contact Steve Kabler at Miller Kabler, P.C. – 720-306-7537

FDA’s Pending Reclassification of Hydrocodone

One of the biggest issues facing physicians and other health care providers is the prescribing of pain medications.   The FDA recently announced its plan to reclassify hydrocodone-containing pain medications from Schedule III to Schedule II.  The new regulations are expected to take effect in 2014.  The reclassification will decrease the number of pills that can be prescribe without obtaining a new prescription.  Currently, patients may refill hydrocodone prescriptions for up to six months, this will likely be shortened to 90 days.

The new regulation, when it goes into effect, will impact physicians in many areas of practice who treat patients with chronic pain symptoms, by requiring more frequent patient visits, and limiting the refills that may be prescribed.  Because physicians and others who practice pain management are often targets of investigations by the Colorado Medical Board, the DEA and other law enforcement agencies, it is advisable to prescribe as if the reclassification has already taken place.  Doctors who are not trained and specialized in pain management should be very cautious before taking on chronic pain patients.  It is nearly always the best course of action to refer chronic pain management patients to a specialist rather than attempting to treat such a difficult patient population.