Updated regulations intended to make the prescribing of opioids more judicious and safe in Rhode Island are now in effect, marking the implementation of a major component of the Strategic Plan developed by Governor Gina M. Raimondo's Overdose Prevention and Intervention Task Force.
"These updated pain management regulations focus on dosing limitations to help reshape how we as healthcare providers had been taught how to approach opioid therapy, and to make sure that we're only prescribing what's actually needed for the treatment of acute pain," said Nicole Alexander-Scott, MD, MPH, Director of the Rhode Island Department of Health (RIDOH). "While we work to minimize unnecessary prescribing of opioids for acute pain, it is essential that patients' chronic pain needs are appropriately and compassionately treated. Although opioid prescribing in Rhode Island decreased by 16% between 2013 and 2015, which was the largest drop in the nation, the regulations were updated to ensure that acute pain and chronic pain are treated differently."
These updates do not affect the long-term treatment being received by patients with chronic pain. Examples of patients receiving chronic pain treatment include patients with cancer-associated pain diagnoses and patients in palliative/nursing home care. Just as a patient with diabetes would not be abruptly removed from diabetes medication, a patient receiving opioids for chronic pain should not be removed too abruptly from pain medication, but transitioned in a way that is safe for the patient to an acceptable alternative over time. Acute pain is pain that comes on quickly and usually does not last longer than a few days, weeks, or months. Examples of causes of acute pain include dental work, a broken bone, and certain back injuries.
Highlights of the updated pain management regulations focusing on acute pain include: • Requiring that initial prescriptions for acute pain be limited to 20 doses and no more than 30 morphine milligram equivalents per day; • Prohibiting long-acting or extended-release opioids for initial prescriptions for acute pain; • Documenting the results of a thorough medical history, developing a treatment plan, and accessing the Rhode Island Prescription Drug Monitoring Program (PDMP) for relevant prescription monitoring information, all prior to issuing an initial prescription for acute pain; and • Requiring continuing education training for prescribers on topics such as appropriate prescribing for pain, pharmacology, potential for dependence, and alternatives to opioids for pain management. RIDOH's original pain management regulations were developed in 2015. The work of updating these regulations falls within the prevention strategy of the Governor's Overdose Prevention and Intervention Task Force's Strategic Plan. The other three focus areas of the plan are treatment, rescue, and recovery. The goal of the Strategic Plan is to reduce the number of overdose deaths in Rhode Island by one-third within three years.
RIDOH began work on updating the state's pain management regulations after the Rhode Island General Assembly passed a law requiring tighter regulations on opioid prescribing. The lead sponsors of this bill were Representative David Bennett and Senator Joshua Miller. Before promulgating these updated regulations, RIDOH opened up a public comment period to hear from healthcare providers, community advocates, and the public.
To support the implementation of these updated regulations, RIDOH and Brown University's Warren Alpert Medical School will offer education sessions in May. Providers will learn more about how to appropriately prescribe opioids and consider interdisciplinary approaches to treating patients with pain.
Substance-use disorder should be treated as a life-long disease, and substance-use disorder related to opioid use is no different. A greater level of compassion and understanding are called for when patients with opioid-use disorder transition from pain management medication to alternative treatment. Rhode Island offers alternative treatment options for opioid use disorder, including outpatient programs through the Rhode Island Centers of Excellence. The six Centers throughout the state provide Medication-Assisted Treatment (MAT), counseling, peer support, and vocational counseling. A local recovery hotline is also available to connect individuals in crisis with treatment and recovery support. People can call 401-942-STOP (7867) to receive treatment and recovery support 24 hours a day, seven days a week. English and Spanish-speaking counselors who are licensed in chemical-dependency are available.