SMBO Releases Rules for Prescribing Opioids for Acute Pain

As the AMCNO has previously reported, the State Medical Board of Ohio (SMBO) has been working on new prescribing rules for the treatment of acute pain. The rule became effective as of August 31, 2017.  Physicians should review their practice to be sure they are in compliance.

Following is an overview of the final rule.

For the treatment of acute pain, the physician shall comply with the following:

Extended-release or long-acting opioid analgesics shall not be prescribed for treatment of acute pain; and before prescribing an opioid analgesic, a physician should first consider non-opioid treatment options.  

If opioid analgesics are prescribed for acute pain the following will apply:

  • There is a 7-day limit for adults with no refills. There is a 5-day limit for minors with no refills, and written consent is required prior to prescribing to a minor.  
  • Physicians can prescribe opiates in excess of the 7-day limit but only if they provide a specific reason that shows why the limits are being exceeded AND that a non-opioid medication was not appropriate to treat the patient’s condition–this information must be documented in the patient’s record. 

The total MED (morphine equivalent dose) of a prescription for acute pain cannot exceed an average of 30 MED per day, with the following exceptions:

  • The patient suffers from medical conditions, surgical outcomes or injuries of such severity that his or her pain cannot be managed within the 30 MED average limit as determined by the treating physician based upon prevailing standards of medical care, such as: traumatic crushing of tissue, amputation, major orthopedic surgery, or severe burns
  • The physician determines that exceeding the 30 MED average limit is necessary based on the physician’s clinical judgment and the patient’s needs.
  • The physician shall document in the patient’s medical record the reason for exceeding the 30 MED average and the reason it is the lowest dose consistent with the patient’s medical condition.
  • Only the prescribing physician for the conditions listed above may exceed the 30 MED average. The prescribing physician shall be held accountable for prescriptions that exceed the 30 MED average.
  • In circumstances when the 30 MED average is exceeded, the dose shall not exceed the dose required to treat the severity of the pain as noted above.
  • Prescriptions that exceed the 5- or 7-day supply or 30 MED average daily dose are subject to additional review by the SMBO. The dosage, days supplied, and condition for which the opioid analgesic is prescribed will be considered as part of this additional review.

The requirements of this rule apply to treatment of acute pain and do not apply when an opioid analgesic is prescribed to an individual who is a hospice patient or in a hospice care program, receiving palliative care, diagnosed with a terminal condition, or cancer or another condition associated with the individual’s cancer or history of cancer.

This rule does not apply to prescriptions for opioid analgesics for the treatment of opioid addiction utilizing a Schedule III, IV or V controlled substance narcotic that is approved by the Federal Drug Administration for opioid detoxification or maintenance treatment. This rule does not apply to inpatient prescriptions.

More information can be found on the SMBO’s website by clicking here.

The SMBO also amends rules for chronic pain:

Recently amended rules applicable to physicians and physician assistants who prescribe a drug for the treatment of chronic pain can be found here. On this webpage you’ll find definitions of terms, how to utilize prescription drugs for the treatment of intractable pain, exceptions, and more. The guidelines for prescribing for chronic pain can be found here.



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