On Monday, Gov. John Hickenlooper signed SB18-22: Clinical Practice for Opioid Prescribing. This state law limits the number of opioid pills that can be prescribed by all healthcare providers. Colorado dentists who prescribe opioids are affected by this new law. Though there is likely to be some enforcement flexibility to start, you should make changes in your prescribing practices now, as these new requirements took effect with Monday’s signing of the law.
Under the new law, a prescriber must limit a patient’s initial prescription of an opioid to a seven-day supply, if the prescriber has not written an opioid prescription for the patient in the past 12 months. The prescriber may exercise discretion in including a second fill for a seven-day supply.
These limits do not apply, if, in the judgment of the prescriber, the patient:
- is experiencing post-surgical pain, that, because of the nature of the procedure, is expected to last more than 14 days;
- has been diagnosed with cancer and is experiencing cancer-related pain; or
- has chronic pain that typically lasts longer than 90 days or past the time of normal healing, as determined by the prescriber, or following transfer of care from another prescriber who prescribed an opioid to the patient.
Before prescribing the second fill (refill) of an opioid prescription for the same patient, the prescriber is required to check the Prescription Drug Monitoring Program (PDMP) database. Failure to check the PDMP constitutes unprofessional conduct. The Colorado Dental Board might take disciplinary action if the prescriber repeatedly fails to comply with the PDMP check requirement. A PDMP check prior to the second fill of an opioid prescription is not required when a patient:
- is experiencing post-surgical pain, that, because of the nature of the procedure, is expected to last more than 14 days;
- has been diagnosed with cancer and is experiencing cancer-related pain;
- is receiving the opioid in a hospital, skilled nursing facility, residential facility, or correctional facility;
- is undergoing palliative care or hospice care;
- is receiving treatment during a natural disaster or during an incident where mass casualties have taken place; or
- has received only a single dose to relieve pain for a single test or procedure.
After the second opioid prescription, the law has no further restrictions on the healthcare provider’s prescribing practices.
The new law will require a healthcare provider, or the provider’s designee, to specify the provider’s specialty upon the initial query of the PDMP. It should also result in some improvements to the PDMP interface, including movement toward integration with existing electronic records platforms.
These new prescribing requirements apply to all providers that write prescriptions for opioids. While this bill requires change in practice protocols, the CDA advocated to make the changes as minimally disruptive to dentists as feasible given the serious opioid crisis at hand in our state and nation. In addition to SB18-22, which addressed prescriber behavior, five additional bills passed during the state legislative session that ended May 9 to address various aspects of the opioid crisis, including increasing community awareness, mental health services and treatment options.
If you have any questions, please email the Colorado Dental Board at dora_dentalboard@state.co.us.