New Jersey has one of the toughest opioid prescribing laws in the country. It took effect last year and places new restrictions on how practitioners may prescribe opioids and other Schedule II controlled substances.
Many practitioners continue to have questions about the new requirements, so here’s a list of frequently asked questions:
Which providers are subject to the new law?
Physicians, physician assistants, dentists, optometrists, podiatrists, certified nurse midwives or advanced practice nurses authorized to prescribe controlled substances.
What are the prescribing restrictions on initial opioid prescriptions?
When a patient is first prescribed opioids to treat acute pain, such as after surgery or extensive dental work, the prescription must be:
- For an immediate-release opioid drug
- In the lowest effective dose
- A five-day supply or less.
What is considered an “initial” prescription?
An initial prescription means that the patient hasn’t had a prescription for that medication (or a pharmaceutical equivalent) within the past year.
What documentation is required for initial opioid prescriptions?
The physician do and document the following:
- Discuss the risks of taking opioids
- Take a thorough medical history, including the patient’s substance abuse history and experience with non-opioid medication and non-pharmacological pain management approaches.
- Develop a customized treatment plan
- Review the New Jersey Prescription Monitoring Program (NJPMP) database.
Can the initial prescription be renewed?
Yes, but only after four days or more, and only for a 30 day-supply or less.
Prior to issuing any subsequent prescription, the practitioner must assess the patient and document why the refill is necessary and why it doesn’t present an undue risk of abuse.
If a third prescription order is necessary, the practitioner must follow the requirements for chronic opioid use (see below).
What are the requirements for prescribing opioids to patients with chronic acute pain?
Practitioners perform and document the following:
- Review the NJPMP database.
- Create a pain-management agreement when the third prescription is necessary and monitor the patient’s compliance with it.
- Review, at least every three months, the course of treatment, any new information about the etiology of the pain, and the patient’s progress toward treatment objectives.
- Assess the patient prior to every renewal to determine whether the patient is becoming physically or psychologically dependent.
- Periodically make reasonable efforts, unless clinically contraindicated, to either stop the use of the controlled substance, decrease the dosage, try other drugs or treatment modalities and document the specific efforts undertaken.
What qualifies as a “Pain Management Agreement?”
The “pain management agreement” is a written contract executed between the practitioner and the patient, prior to treating chronic pain with a Schedule II controlled dangerous substance or any other prescription opioid drug.
The agreement must:
- Document both parties’ understanding of the plan.
- Establish the patient’s rights and obligations regarding responsible use of the medication.
- Include alternative medications or treatments, such as physical therapy or exercise, relaxation, or psychological counseling.
- Outline how the practitioner will monitor the patient’s compliance, including but not limited to random specimen screens and pill counts.
- Describe how and under what circumstances the agreement will be terminated.
What types of patients or situations are exempt?
The following are exempt:
- Inpatients (patients being discharged with an outpatient prescription are NOT exempt);
- Patients who are in active treatment for cancer;
- Hospice patients;
- Long-term care residents;
- Medications prescribed to treat substance abuse or opioid dependence.
When are practitioners required to review Prescription Monitoring Program data?
Practitioners must access prescription monitoring information at the following points:
- The first time they prescribe a Schedule II controlled dangerous substance or any opioid to a new patient for acute or chronic pain;
- The first time they prescribe a benzodiazepine drug that is a Schedule III or Schedule IV controlled dangerous substance;
- If the practitioner suspects drug-seeking behavior;
- If the practitioner prescribes a Schedule II controlled dangerous substance for acute or chronic pain to a patient receiving care or treatment in the ED;
- On a quarterly basis for patients who continue to receive a prescription.
What type of Continuing Education is required?
Physicians, physician assistants, dentists, optometrists, pharmacists, professional nurses, practical nurses and certified nurse midwives must complete one continuing education credit related to prescribing opioid drugs safely.
The credit is part of the existing 100 hours for biennial license renewal and will be effective for the 2017-2019 renewal.