Controlled Substance Policy for Pain Control

POLICY: Howard County Medical Center (HCMC) Acknowledges compliance with controlled substance prescribing and education for patients regarding the risks of controlled substance and opioid use.

PURPOSE: To have a standardize practice in the clinic among providers when prescribing and educating patients on the use of controlled substances and opioid use. 
  
DEFINITIONS: 
Provider:  Any licensed medical provider who is able to prescribe controlled substances. 

Controlled Substances:  Any Scheduled II-IV drug used for pain control.  

Opioid: Class of medications that act on opioid receptors and are highly addictive.

Pain Management Agreement:  Signed agreement made between a patient and a provider utilizing the form adapted
from the American Academy of Pain Medicine.

Acute Pain:  Sudden and usually sharp in feeling. Serves as a warning sign or threat to the body. Can be caused by broken bones, burns, cuts, surgery, etc.

Chronic Pain:  An unpleasant sense of discomfort that persists or progresses over a long period. Typically persists over
time and is often resistant to medical treatments and is not from cancer.

Prescription:  Medication that is written to be filled at a pharmacy by a provider to treat a disease or treat a medical condition.

MME: Milligram Morphine Equivalent (MME) is a value assigned to represent their relative potencies. 

Attached documents: Patient Acknowledgment of Risk of Controlled Substance and Opioid Use, Pain Management Agreement.

RATIONALE:  Guidelines for prescribing opioids for chronic pain is intended to improve communication between providers and patients about risks and benefits of opioid therapy for chronic pain, improve the safety and effectiveness of pain treatment, and reduce the risks associated with long-term opioid use disorder and overdose. The guideline is not intended for patients who are in active cancer treatment, palliative care or end-of-life care. 

IMPLEMENTATION:

• When prescribing a controlled substance for the first time the provider will provide the Patient Acknowledgment of Risk of Controlled Substance and Opioid Use see attached. This will be put in the chart and a copy to the patient.
  • This acknowledgment will cover the risks and alternatives to opioid therapy.
  • The patient and the provider will sign (If the patient is a minor, the guardian will sign).
  • If the prescription is for more than 7 days, the reason will be documented on this form. 
  • It is also noted on the acknowledgment form that if the patient is opioids for chronic pain control that the prescription will be written for 30 days and that the patient will need to be seen every 90 to 180 days while receiving this treatment. 
  • Patients 18 years or younger should not be prescribed more than 7 days or opioids (unless there is documentation in the on why in the patient’s chart).

• The Patient Acknowledgment of Risk of Controlled Substance and Opioid Use form will be reviewed after the third prescription and then yearly for patients on chronic opioid use.
• Patients receiving opioids for chronic pain should be seen by the ordering provider every 90-180 days to discuss goals and reinforce patient education about opioid use. And to discuss non-opioid treatment options.
• Providers will have a goal of keeping the MME less than or equal to 50 MME/day, if dosing greater than 50 MME/day is required the risk and benefits should be weighed.
• If a patient requires more than 90 MME/day of opioids, the provider will need to document the rationale in the patient’s chart.
• Naloxone for the patient to have at home should be considered if the patient receiving more than 90 MME/day.
• Providers will also avoid prescribing opioids and Benzodiazepines concurrently whenever possible.
• The provider will place patients on the Pain Management Agreement at their discretion for the best patient care.