Division of Professions and Occupations (DPO): Opioid Guidelines - Under Review and Pending Update
Highlights
Overview
On March 14, 2019, the revised Guidelines for Prescribing and Dispensing Opioids were adopted by all six of Colorado's prescribing and dispensing Boards: the Colorado Dental Board, the Colorado Medical Board, the State Board of Nursing, the State Board of Optometry, the Colorado Podiatry Board, and the State Board of Pharmacy, and endorsed by the State Board of Veterinary Medicine.
Revisions were necessary due to the new requirements in Senate Bill 18-22 Clinical Practice for Opioid Prescribing. This new state law went into effect on May 21, 2018, immediately upon the Governor's signature. The law sets forth prescribing requirements, such as the number of opioids to be prescribed and required Prescription Drug Monitoring Program checks in certain clinical situations. The law also provides specific exemptions to these requirements.
The Boards will continue to evaluate the Policy, incorporating new legislation and collaborating with other state agencies, researchers, practitioners, patients, the Colorado Consortium for Prescription Drug Abuse Prevention, and other stakeholders to identify and evaluate outcomes. The Boards remain committed to this Policy as a living document, reflective of the evolving science, technology, policy and law in their ongoing efforts to address Colorado's opioid crisis.
Key Points and Recommendations
- These guidelines do not have the force of law, but instead are intended to assist practitioners evaluate and make informed decisions about the safe prescribing and dispensing of opioids.
- Collaboration with Mental and Behavioral Health.
- Consideration of alternatives to opioids.
- Partnership with the patient to develop a treatment plan, including functional goals and an exit strategy.
- Patient education, including the risks and benefits of opioid therapy, which is crucial prior to initiating therapy, before increasing the dosage and upon meeting the "bright line" safe prescribing thresholds.
- Reduction in days of treatment for acute pain.
- Assessment of patient functionality early and often.
- Frequent re-balancing of the risks and benefits of continued opioid therapy.
- Incorporation of three "bright line" safe prescribing thresholds upon which the prescriber should re-evaluate the patient and the effectiveness of the opioid treatment and employ risk mitigation strategies, including prescriptions for Naloxone, if opioid treatment is to continue:
- Dosage: 50 mme/day
- Formulation: Long-acting or extended-relief formulation
- Duration:
- 3-7 days for acute, non-traumatic or non-surgical pain
- 30 days for sub-acute pain
- 90 days for chronic, non-cancer pain
Q&A Webinar
The Division of Professions and Occupations held an informational session on April 20, 2018, to educate stakeholders on the new Guidelines for Prescribing and Dispensing Opioids.
More information clarifying and explaining core aspects of the Guidelines will be available in the coming weeks. Written questions may be provided at any time to holli.weaver@state.co.us. Questions received in person, via webinar or in writing will help the Division develop a Frequently Asked Questions (FAQ) document, which will be posted on the prescribing and dispensing Board's websites at a later date.