IBM Releases Chronic Pain Management Rules

The Iowa Board of Medicine is currently promulgating rules related to the use of opioids. These rules are required to implement HF 2377, otherwise known as the "Opioid Bill”, which was signed into law in May 2018. Key provisions of the rules include:

Mandatory Registration with the PMP: A physician must register with the Prescription Monitoring Program (PMP) at the time of initial registration or renewal of a Controlled Substance Act Registration (CSAR) with the Iowa Board of Pharmacy.

Mandatory Use of the PMP: A physician or the physician’s designated agent must utilize the PMP prior to issuing an opioid prescription to assist the physician in determining appropriate treatment options and to improve the quality of patient care. A physician is not required to utilize the prescription monitoring program to assist in the treatment of a patient receiving inpatient hospice care or long-term residential facility patient care. An order issued in an inpatient hospital setting is not considered a prescription for the purposes of these rules. Patient safety is adequately protected in an inpatient hospital setting and physicians caring for patients in an inpatient hospital setting do not prescribe. A link to the prescription monitoring program may be found here.

Mandatory Training Requirements: A physician who has a permanent or special license who has prescribed opioids to a patient during the previous license period must complete at least two hours of category 1 credit regarding the United States Centers for Disease Control and Prevention (CDC) guideline for prescribing opioids for chronic pain, including recommendations on limitations on dosages and the length of prescriptions, risk factors for abuse, and nonopioid and nonpharmacologic therapy options every five years. A physician who had a permanent or special license on January 1, 2019, has until January 1, 2024, to complete the chronic pain management training, and shall then complete the training once every five years thereafter. The two hours count towards the 40 hours of continuing medical education required for license renewal. Physicians who did not prescribe opioids during the previous renewal period may attest that they are not subject to this requirement due to the fact that they did not prescribe opioids during the time period, on their license renewal application.

Grounds for Discipline: Prescribing opioids in dosage amounts exceeding what would be prescribed by a reasonably prudent physician in the state of Iowa acting in the same or similar circumstances may be grounds for discipline.

Electronic Prescriptions: Beginning January 1, 2020, every prescription issued for a controlled substance shall be transmitted electronically as an electronic prescription pursuant to Iowa Code section 124.308. The prescription shall be transmitted to a pharmacy by the physician or the physician’s authorized agent in compliance with federal law and regulation for electronic prescriptions of controlled substances.

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