Florida Opioid Prescribing Law

Effective July 1, 2018

Quantity of Schedule II Opioids

3 day limit on prescriptions for “acute pain”
7 day supply for acute pain may be prescribed if Rx contains “Acute Pain Exception” AND the reason for exception is documented in the medical record.

E-FORCSE ( Login Page)

Must access for EVERY prescription of schedule II-IV opioids.
Only exception is schedule V non-opioids.
May be accessed by designated staff with individual log-in.
If cannot be accessed due to system down or other error, must document in the medical record:
- the prescription
- time and date
- reason unable to access

Continuing Medical Education:

All physicians licensed in Florida AND holding a DEA license, must complete a 2 hour mandatory CME course before January 1, 2019
Must be completed again for each subsequent license renewal.
Only accessible from certain state-wide medical societies.

Opioid Antagonist:

Prescriptions of schedule II controlled substances for the treatment of pain related to a traumatic injury with a severity score of 9 or greater must concurrently prescribe an emergency opioid antagonist.

Definitions:

‘Acute Pain’ means “the normal, predicted, physiological, and time-limited response to an adverse chemical, thermal, or mechanical stimulus associated with surgery, trauma or acute illness.” The term does not include pain related to:
- Cancer
- Terminal conditions
- Palliative Care to provide relief of symptoms related to an incurable, progressive illness or injury.
- A traumatic injury with an Injury Severity Score of 9 or greater. (MDCalc ISS)
‘Terminal condition’ means “a progressive disease or medical or surgical condition that causes significant functional impairment, is not considered by a treating physician to be reversible without the administration of life-sustaining procedures, and will result in death within 1 year after diagnosis if the condition runs its normal course.”

MME

The Florida law does not stipulate a maximum daily quantity of any specific analgesic. However, the CDC has advised that daily doses over 50 morphine milligram equivalents (MME) double a patient’s risk of overdose. A description of morphine milligram equivalents is provided by the CDC here along with the calculation. However, the state of New York provides a free calculator online here.

Other:

The bill also covers numerous other areas including:

Authorizes electronic prescribing of controlled substances.
Significant details regarding the treatment of Chronic Pain including:
- Definitions
- Documentation required
- Referrals to pain management and psychiatry required.
- Documentation of alternative therapies
- Documentation of patient consent to opioid therapy
- Monitoring of patient’s progress according to documented treatment plan
Each medical board is required to adopt rules establishing guidelines for prescribing controlled substances for acute pain, including standards for:
- Miinimum documentation
- Documenting treatment plan
- Patient informed consent and agreement to treatment.
Pain management clinic registration
Definitions of Schedule I-V medications
Dispensation of medication requirements