Learn EM

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.


  • ‘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.”


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.


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


  • HB 21 : Bill text
  • Florida Medical Association summary : Download PDF
  • MDCalc Injury Severity Score : ISS Calculator
  • Florida Health Source FAQ
  • US Dept of Health and Human Resources HHS
  • CDC: Calculating Total Daily Dose Of Opioids For Safer Dosage (PDF)
  • NYC Health Morphine Milligram Equivalent Calculator (link)

Leave A Comment