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Opioid Prescribing Safety
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SB 1001: AZ OPIOID EPIDEMIC ACT 2018 - Your resource for prescribing opioids under Arizona law.

 

Page Map:

 

Background of the new law: 

 
  • Read the bill (SB 1001) HERE

  • For more resources provided by the Arizona Department of Health Services on the opioid epidemic, click HERE  

 

OPIOID ABUSE EPIDEMIC IN ARIZONA

 

The impact of opioid misuse is significant in our communities and the public health system. On June 1, 2017, the Arizona Department of Health Services (ADHS) released its latest data on opioid overdoses in Arizona showing the highest number of deaths in ten years. In 2016, 790 Arizonans died from opioid overdoses. This trend shows a startling increase of 74 percent over the past four years.


The 2016 opioid report shows over half of the 1,497 drug overdose deaths in that year were due to opioids as the primary cause of death. Opioids include heroin as well as prescription medication. The number of heroin deaths alone has tripled since 2012.

 

Research has found that approximately 3 out of 4 new heroin users report having abused prescription opioids prior to using heroin. Heroin is an opioid, and both drugs act on the same receptors in the brain to produce similar effects.

 

On January 25, 2018 the Arizona Legislature passed SB 1001, the Arizona Opioid Epidemic Act, which was signed into law by Governor Ducey on January 26, 2018. The Arizona Opioid Epidemic Act is an omnibus bill dedicated to curbing the opioid crisis. The legislation establishes requirements and certain limitations regarding the prescribing, administration and dispensing of schedule II opioids.

 

THE BASICS:

 

The bill has (6) major requirements that our Arizona Physicians (including residents) need to know:

 

STARTING APRIL 26, 2018

 

1. 5-day Limit on Initial Opioid Prescriptions

  

Limits the initial prescription for a patient for a schedule II controlled substance that is an opioid to no more than a five (5) day supply, except an initial prescription for a schedule II controlled substance that is an opioid following a surgical procedure is limited to no more than a fourteen (14) day supply.

 

An initial prescription is defined as follows:

 

“A prescription for a schedule II controlled substance that is an opioid that has not covered any portion of the past sixty days before the date the pharmacy dispenses the current prescription as evidenced by the controlled substances prescription monitoring program’s (CSPMP) central database tracking system.”

 

Exceptions to the initial prescription limitations apply if the patient: 

 
  • Has an active oncology diagnosis. 

  • Has a traumatic injury, not including a surgical procedure. 

  • Is receiving hospice care. 

  • Is receiving end-of-life care. 

  • Is receiving palliative care. 

  • Is receiving skilled nursing facility care. 

  • Is receiving treatment for burns. 

  • Is receiving medication assisted treatment for a substance use disorder. 

  • Is an infant who is being weaned off opioids at the time of hospital discharge. 

 

2. 90 MME Dosage Limits

 

Prohibits healthcare providers from issuing a new prescription for a schedule II controlled substance that is an opioid that exceeds 90 MMEs per day. 

The 90 MME limitation does not apply to: 

 
  • A continuation of a prior prescription order that was issued within the previous 60 days. 

  • An opioid with a maximum approved total daily dose in the labeling as approved by the United States FDA. 

  • A prescription that is issued following a surgical procedure and is limited to not more than a 14 day supply. 

  • A patient who:

  • Has an active oncology diagnosis. 

  • Has a traumatic injury, not including a surgical procedure. 

  • Is receiving hospice care. 

  • Is receiving end-of-life-care. 

  • Is receiving palliative care. 

  • Is receiving skilled nursing facility care. 

  • Is receiving treatment for burns. 

  • Is receiving medication-assisted treatment for substance use disorders. 

  • Is hospitalized. 

 

A new prescription above 90 MME may be issued to a nonexempt patient after first consulting with a physician who is board-certificated in pain, or an opioid assistance and referral call service that is designated by DHS. If the opioid call service agrees with the higher dose, the health professional may issue a prescription for more than 90 MME. If the consulting physician is not available within 48 hours of the request the healthcare professional may prescribe and subsequently have the consultation; teleconference consultation is permissible. Physicians who are board-certified in pain may issue a prescription order above 90 MME without a consultation. If a patient is issued a new prescription above 90 MME per day, the prescriber must also prescribe Naloxone or other opioid antagonists.

 

Also, in response to the opioid epidemic the Arizona Department of Health Services, in conjunction with the Poison and Drug Information Centers in Arizona, has launched a 24/7 hotline which provides free, real-time consultations for clinicians with complex patients with pain and opioid use disorder.

 

 OARLine: Opioid Assistance + Referral Line for Arizona Providers: 1-888-688-4222 

 

Additional Resources:

 

3. Prohibits dispensing of opioids

 

Prohibits healthcare professionals from dispensing Schedule II controlled substances that are opioids and establishes violations as an act of unprofessional conduct. The law allows health care professionals to dispense an opioid that is an implantable device or that is for medication-assisted treatment for substance use disorders.

 

4. New CME Requirements – 3 hours of opioid education

 

Physicians who have a DEA registration number and are renewing their licenses are required to complete three (3) hours of opioid-related, substance use disorder-related or addiction-related continuing medical education as part of the 40 hours required. 

Currently, a comprehensive course is available for free to all Arizona prescribers through the University of Arizona Office of Continuing Medical Education. 

 

5. Medical Education – 3 hours of opioid education

 

Requires a student enrolled in a public or private medical program in this state and whose intended degree may make the student eligible for a United States Drug Enforcement Administration registration to take at least three hours of opioid-related clinical education.

 

6. Controlled Substances Prescription Monitor Program (CSPMP)

 

Eliminates the exemption that allows a health professional to not check the CSPMP if prescribing no more than a 5-day supply when the CSPMP has been reviewed in the last 30 days. 

There are other provisions with upcoming implementation dates you should start preparing for now. Some of these will be impacted by other legislation currently in development. 

 

BEST PRACTICE RECOMMENDATIONS: 

 

CSMP (Controlled Substance Monitoring Program)

 

EFFECTIVE OCTOBER 16, 2017: All prescribers are required to obtain a patient utilization report from the Controlled Substances Prescription Monitoring Program (PMP) prior to prescribing an opioid analgesic or benzodiazepine controlled substance. It is the prescriber’s responsibility to understand the new law and the requirements.  

ArMA and the Arizona Osteopathic Medical Association (AOMA) have created a compliance checklist resource: it can be downloaded here: CSPMP Compliance Checklist! 
 

Overdose Reporting:

 

Review the final reporting rules HERE  

 

Required reporters include the following:

 
• Healthcare professionals licensed under A.R.S. Titles 32 & 36, including physicians, are required reporters.
• Administrators of a healthcare institution or correctional facility 
• Medical examiners 
• Pharmacists 
• Emergency Medical Services/Ambulance agencies (first response agencies, ground and air ambulance agencies) 
• Law enforcement officers 
 
Health conditions to be reported by physicians and other healthcare professionals under A.R.S. Title 32:

 
• Suspected opioid overdoses 
• Suspected opioid deaths 
• Neonatal abstinence syndrome

 

Reporting System:

 

Required reporters, including physicians, must use MEDSIS, for reporting the above listed health conditions. MEDSIS is the communicable disease reporting system, and it has been amended with new reporting fields. 

 

E-Prescribing:

 

SB 1001 mandates that beginning January 1, 2019 a schedule II controlled substance that is an opioid may be dispensed in a county with a population of 150,000 or more only with an electronic prescription order as prescribed by federal law or regulation.

 

Beginning July 1, 2019, a schedule II controlled substance that is an opioid may be dispensed in a county with a population of less than 150,000 only with an electronic prescription order as prescribed by federal law or regulation.

 

WHAT PHYSICIANS AND OTHER CLINICIANS CAN DO NOW:

 

Here are immediate steps physicians can take to help our patient populations. 

  • If initiating opioids, use the lowest effective dosage and limit initial prescriptions to 7 days view the AHCCCS policy here, and the AHCCCS policy exemptions here.  

  • Take a detailed medication history. Avoid combined use of opioids and benzodiazepines, and advise patients of the risk of adverse events. Make sure patients understand the dangers of combining opioids with other medications that could cause an overdose. 

  • Co-prescribe naloxone to patients at higher risk for overdose, including history of overdose or substance use, opioid dosages ≥50 MME/day (calculate) or concurrent benzodiazepine use. 

 

 

ADDITIONAL RESOURCES: 

 
  • How clinicians can empower patients to self-manage chronic pain: The Pain Project.

  • Download the CDC Opioid Guide Mobile App. 

  • Review Arizona Clinical Guidelines and References.

  • ADHS Opioid Abuse Epidemic website for the latest clinician recommendations. 

  • CDC dedicated website on opioid overdose epidemic. 

  • Buprenorphine Training, available through SAMHSA.

  •  FREE Online Arizona CME from the University of Arizona OCME.

  •  AMA’s End the Opioid Epidemic website offers access to education resources, and promotes comprehensive, appropriate pain treatment while safeguarding against opioid overdose. Their resources also support treating patients with substance use disorders and expanding access to Naloxone.

  •  PCSS-MAT and PCSS-O offers free education on medication assisted treatment and coordination of care. It is outlined at: https://www.psychiatry.org/psychiatrists/practice/professional-interests/addiction-psychiatry

  •  PCSS neonatal abstinence syndrome education: https://pcssmat.org/neonatal-abstinence-syndrome/ NIDAMED resources for treating pregnant women with OUD.

  •  The Arizona Home Visiting programs can provide mothers and families the needed support and links to resources for behavioral health and/or treatment services for a substance use disorder in the community they serve.  All the contractors are trained in SBIRT and provide links to treatment resources in their communities for pregnant and parenting women. The Strong Families website provides the list of all the Arizona Home Visiting Programs available by community. All of the programs can provide support and resources to women and their families if a SUD is identified.

  •  Arizona Society for Addiction Medicine has an assortment of resources on their website.

  •  This is a link to the Winter 2018 AMB Newsletter featuring an article regarding SB1001.

  •  This video features the Arizona Medical Board's Chief Medical Consultant Dr. Wolf discussing SB1001.