If you prescribe opioids in your practice, it is important to be familiar with current clinical practice guidelines for prescribing opioids, DEA requirements, and federal and state laws and regulations to reduce your professional and administrative liability risk. In this article we will discuss some of the guidelines, requirements, and regulations relating to prescribing opioids.
CDC Clinical Practice Guideline for Prescribing Opioids
In November 2022, the Centers for Disease Control (CDC) released an updated clinical practice guideline for prescribing opioids for pain, which can be found here: CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022 | MMWR.
This updated guideline includes recommendations for managing acute, subacute, and chronic pain of patients 18 and over in the outpatient setting. The recommendations do not apply to pain related to sickle cell disease, cancer, or to patients receiving palliative or end of life care.
The guideline addresses four areas:
- Determining whether to initiate opioids for pain
- Selecting opioids and determining opioid dosages
- Deciding duration of initial opioid prescription and conducting follow-up
- Assessing risk and addressing potential harms of opioid use
The revised guideline removed the previously recommended ceiling for opioid dosage and encourages providers to use their best judgement when prescribing opioids. The guidelines also recommend use of non-opioid therapies as an initial treatment. The CDC provides a “Guideline at a Glance” for applying the 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain, and that can be found here: Clinical Practice Guideline at a Glance | Guidelines | Healthcare Professionals | Opioids | CDC.
Prescription Drug Monitoring Programs (PDMPs)
The 2022 Clinical Practice Guideline discussed above recommends that clinicians who are prescribing initial opioid therapy should first review a patient’s history of controlled substance prescriptions using a state PDMP. A PDMP is an electronic database that tracks controlled substance prescriptions.
The CDC recommends checking the PDMP when initiating opioid therapy for acute, subacute, or chronic pain and every three months or more frequently when continuing opioid therapy. The CDC provides an overview of using a PDMP and you can access it here: Prescription Drug Monitoring Programs (PDMPs) | Healthcare Professionals | Opioids | CDC.
Drug Enforcement Administration (DEA) Medication Assisted Treatment Training (MATE)
The Consolidated Appropriations Act of 2023 enacted a new one-time, eight-hour training requirement for all DEA-registered practitioners (except veterinarians) on the treatment and management of patients with opioid or other substance use disorders.
All DEA-registered and new medical practitioners are required to attest to completion of the training when renewing or completing an initial registration.
The DEA sent all DEA registered practitioners a letter notifying them of the MATE training requirement and providing information and instructions on how to satisfy the requirement. You can review that letter here: MATE_Training_Letter_Final.pdf (usdoj.gov.
State Laws on Opioid Prescribing
The restrictions on opioid prescriptions can vary significantly from state to state. While 39 states had enacted limits by the end of December 2019, the specific details and scope of these limits differ based on individual state policies. The most common duration limit for opioid prescriptions is 7 days, although some states impose shorter or longer limits varying from 3 days to 31 days.
Additionally, as of January 2022, 38 states have implemented policies or guidelines setting limits on the supply of opioids that can be prescribed by doctors. The specifics of these limits, such as the maximum dosage, duration, and exceptions, can vary widely. Some states may focus on limiting initial prescriptions, while others may address ongoing refills and long-term use. Some states apply limits specifically to Medicaid recipients.
Many states require physicians to use PDMPs. The specific requirements vary by state. Some states have strict mandates, while others provide more flexibility. States may differ in terms of which medications fall under PDMP requirements, frequency of checks, and penalties for non-compliance. Please be sure to understand your own state’s restrictions and regulations.
State Licensing Board Continuing Education Requirements
State licensing boards set forth requirements for continuing education needed for license renewal. State requirements vary and many states require continuing education on opioid prescribing and opioid abuse. Continuing education requirements can be found on your state licensing board website or by contacting your state licensing board.
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The information contained on the PICA Blog does not establish a standard of care, nor does it constitute legal advice. The information is for general informational purposes only. We encourage all blog visitors to consult with their personal attorneys for legal advice, as specific legal requirements may vary from state to state. Links or references to organizations, websites, or other information is for reference use only and do not constitute the rendering of legal, financial, or other professional advice or recommendations. All information contained on the blog is subject to change.