Ohio State Dental Board considering additional opioid rules

Ohio Gov. John Kasich recently announced new proposed regulations for prescription opiates for the treatment of long-term pain (lasting 12 weeks or more) and sub-acute pain (lasting between six and 12 weeks).

According to the proposed regulations, only dentists with specific training and those treating long-term conditions such as chronic neuropathic pain and temporomandibular joint (TMJ) dysfunction would be allowed to prescribe opioids for chronic pain.

The proposed rules establish new thresholds for increased monitoring to promote greater collaboration between prescribers and specialists and prescribers and their patients.

  • At 50 MED, clinicians will be required to re-evaluate the status of the patient’s underlying condition causing pain, assess functioning, look for signs of prescription misuse, consider consultation with a specialist and obtain written informed consent.
  • At 80 MED, clinicians will be required to look for signs of prescription misuse, consult with a specialist, obtain a written pain-management agreement and consider a prescription for naloxone, the lifesaving overdose antidote.
  • Qualifying dentists will be limited to prescribing 100 MEDs. If necessary, they must work with a pain specialist.

These regulations are expected to be enacted through rules adopted by the Ohio State Dental Board, Ohio State Medical Board and Ohio Board of Nursing. The OSDB has drafted a proposed new rule that will be up for a public hearing in July.

These proposed regulations are part of the state’s continuing effort to prevent opioid abuse and addiction. Last year, the OSDB and other health care regulatory boards adopted rules on prescribing opioids for acute pain that went into effect on Aug. 31, 2017. Those rules generally include the following limits:

  • No more than seven days of opiates can be prescribed for adults;
  • No more than five days of opiates can be prescribed for minors and only after the written consent of the parent or guardian is obtained;
  • The total morphine equivalent dose (MED) of a prescription for acute pain cannot exceed an average of 30 MED per day.

The Ohio State Dental Board’s rules permit the seven-day limit for adults and the five-day limit for minors to be exceeded only “for pain that is expected to persist for longer than seven days based on the pathology causing the pain.” In this circumstance, “the reason that the limits are being exceeded and the reason that a non-opioid medication was not appropriate to treat the patient’s condition shall be documented in the patient’s record.”

The Ohio State Board of Pharmacy has posted a calculator on its website to assist prescribers in calculating the MED equivalent for opioid prescriptions, which can be found at ohiopmp.gov/MED_Calculator.aspx.

The rules permit a dentist to exceed the 30 MED limit only where all of the following apply:

(1) The patient has significant and prolonged acute pain related to one of the following conditions:

(a) Traumatic oro-facial tissue injury with major mandibular/maxillary surgical procedures,

(b) Severe cellulitis of facial planes, or

(c) Severely impacted teeth with facial space infection necessitating surgical management; and

(2) The dentist determines that, for the 72 hour period following the procedure, it is absolutely necessary to exceed the 30 MED daily limit based on the patient’s needs but may not exceed 90 MED per day; and

(3) The dentist has documented the reason for exceeding the 30 MED average in the patient record and why it is the lowest dose consistent with the patient’s medical condition.

Dentists also now must include a full procedure code (Current Dental Terminology – CDT Code) and indicate the days’ supply on all controlled substance prescriptions. The 5-digit procedure code is based on the dental treatment that warrants a prescription, not any treatment that is expected to be performed in the future. For example, if a dentist sees a patient for an emergency exam and plans to perform a root canal in the future, the code on the prescription would be for the emergency exam. If the dentist then needs to write a prescription for an opioid after performing the root canal, the dentist would use the procedure code for a root canal on the prescription at that time.

The American Dental Association’s “CDT 2018: Dental Procedure Codes” is the HIPAA-recognized code set for dentistry and provides full details on all of the codes. The ADA offers several CDT coding products, including books, training tools and an app, which can be found at adacatalog.org or by calling the ADA Member Service Center at (800) 947-4746.