New Opioid Prescribing Law Effective Nov. 1, 2018 

Senate Bill 1446 will impact prescribing practices

Prescription drug abuse is Oklahoma’s fastest growing drug problem. Out of 3200 unintentional deaths in Oklahoma from 2007 to 2011, 81 percent involved at least one prescription drug.

Prescription pain killers (opioids) are the most common class of drug involved in Oklahoma overdose deaths.  

SB1446 is a result of this ongoing issue and the need for Oklahoma and INTEGRIS to unite to lead the way in opioid stewardship.  

Please review and make yourself familiar with the upcoming changes. We will communicate regularly regarding the EPIC workflow and CEM  updates that will help you be ready when the new law becomes effective Nov. 1.

What is an initial prescription? 
An initial prescription is issued to a patient who:
Has not been issued a prescription for the drug or its pharmaceutical equivalent in the past year OR
Requires a prescription for the drug or its pharmaceutical equivalent due to a surgical procedure or new acute event and has previously had a prescription for the drug or its pharmaceutical equivalent within the past year.

What must I do for an initial 7-day prescription?                 
Prescribe lowest effective dose not to exceed 7-day supply
Perform medical history, physical exam and develop treatment plan
Check PMP
Minors: Physicians must enter into a patient-provider agreement with parent/guardian
Pregnant woman: Physicians must enter into a patient-provider agreement 

Can I prescribe a second 7-day prescription?
Physician (after consultation with patient) may issue subsequent prescription:
Quantity not to exceed 7 days
Document the rationale for issuance of subsequent prescription
Determine issuance of prescription does not present undue risk of abuse, addition or   diversion (and document determination).

What if my patient needs opioids beyond the second 7-day prescription?
At time of issuance of third opioid prescription, physician and patient must enter into pain-management agreement
Review at least every three months: course of treatment, new information about etiology of pain
Assess patient prior to every renewal to determine whether patient experiences problems associated with dependence
Periodically make reasonable efforts to stop use, decrease dosage and/or try other drugs to reduce abuse/dependence potential 
Review PMP
Monitor compliance with pain-management agreement

NOTE: Prior to the initial and third prescriptions, physicians must discuss risks with patient or minor patient’s guardian/parent and document discussion in the EMR. 
One hour of continuing education in pain management or in opioid use or addiction will be required annually prior to a provider renewing their license to practice.

INTEGRIS providers are working with key stakeholders to design the EMR to support these changes. Look for further communication detailing new workflows and information that helps us all respond to the new law. 

Tommy Ibrahim, M.D.