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
Links:
-
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)