An interim legislative task force met over the summer to discuss Colorado’s current opioid abuse epidemic and possible solutions. The task force has primarily focused on prescribing behavior, among numerous other topics ranging from education and prevention to treatment options. Possible prescriber reforms the task force discussed included opioid reduction CE for providers, Prescription Drug Monitoring Program (PDMP) system improvements, mandatory PDMP usage, limitations on dosage or duration prescribed, mandatory e-prescribing, and concurrent naloxone prescribing requirements.
In late October, the interim task force voted to introduce a bill (Bill B) in the 2018 legislative session to address reforms applicable to all prescribers of opioids, including dentists. Bill B includes the following provisions related to treatment of acute pain:
- Only seven days of opioids may be prescribed to a patient in an initial fill
- One additional seven-day fill may be authorized by the prescriber
- A PDMP check would be required prior to any subsequent refills
- Providers would be required to indicate their area of specialty to the PDMP system
- Electronic prescribing of opioids is encouraged
Exemptions from both the day limitations and the PDMP check are provided for chronic pain patients, cancer patients, surgical patients whose pain would routinely exceed 14 days, and drugs that contain added abuse deterrents. Legislators have discussed additional concepts for inclusion in this bill, including mandatory e-prescribing, a mandatory PDMP check, and limitation on total dosage (at 250 morphine milligram equivalent or MME) prescribed. At this point, these concepts are not included in the proposed bill, but they could resurface as part of legislative discussions during the upcoming legislative session.
In addition to legislative discussions, the Colorado Department of Regulatory Agencies (DORA), the agency responsible for the Colorado Dental Board, is in the process of revising a quad regulatory board policy regarding the prescribing and dispensing of opioids. This policy – originally drafted by the medical, dental, pharmacy and nursing boards – asks prescribers to use risk-mitigation practice in prescribing opioids and set a threshold of 120 MME for additional safeguards like patient contracts and exit strategies. DORA’s latest revision proposes to reduce the dosage threshold for these additional safeguards to 50 MME, consistent with recent recommendations of the U.S. Centers for Disease Control and Prevention. Additional safeguards are also proposed for any use of certain formulations (extended release and transdermals) as well as durations exceeding three to seven days for acute pain and 90 days for chronic pain (this threshold is currently 90 days for all patients). Prescribing alternatives to opioid therapy is strongly encouraged. The policy seems to indicate that a PDMP check should be performed with every prescription (initial and refills), in contrast to the legislative proposal discussed above. DORA is accepting comments and suggestions on proposed revisions to its opioid policy.
The CDA has been and will continue to be actively engaged in shaping policy around both provider and payer reforms related to the opioid epidemic. If you are interested in participating in a dentist workgroup to provide input on pending opioid bills and policies, please contact Jennifer Goodrum at jennifer@cdaonline.org.