Opioid prescriptions have dramatically decreased but opioid overdose deaths, especially related to synthetic opioids, have soared. The increase is largely due to fentanyl, mostly illicitly manufactured fentanyl.
Repeated misuse of prescription opioids can lead to substance abuse disorder and street drugs. Through responsible opioid prescribing and monitoring, physicians and other opioid prescribers can positively impact opioid-related harm, abuse, overdoses, and deaths. Responsible opioid prescribing and monitoring involve important procedures, such as checking state databases before prescribing, and developing and maintaining opioid prescribing competency.
Checking State Databases Before Prescribing
Most states’ laws require physicians and other prescribers to use the state’s Controlled Substance Monitoring Program (“CSMP”), Prescription Drug Monitoring Program (“PDMP”), Prescription Monitoring Program (“PMP”), or Controlled Substance Database Program (“CSD”) before prescribing opioids and other controlled substances. MICA recommends using these databases even if not required by law.
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Arizona
Arizona physicians and other prescribers with active Drug Enforcement Administration (DEA) numbers and valid professional licenses must register with and check the Arizona CSMP before prescribing opioids, unless the patient and prescription fall under an exception to the requirement. Physicians and other prescribers with active DEA numbers and valid professional licenses must register even if not prescribing controlled substances.
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Colorado
The Colorado Department of Regulatory Agencies Division of Professions and Occupations (“Division”) recommends physicians and other lawful prescribers perform an opioid risk assessment of the patient and check the PDMP before prescribing opioids or benzodiazepines for the first time. The Division, however, does not require physicians and other lawful prescribers to check the PDMP for the initial prescription. After the first prescription, the Division requires all prescribers check the PDMP before prescribing additional benzodiazepines and opioids unless the patient and prescribing situation fall under an exception.
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Utah
The Utah Department of Commerce Division of Occupational and Professional Licensing requires physicians and other prescribers register with the Utah CSD, complete online training, and pass an online test of the CSD and appropriate opioid prescribing practices. Physicians and other licensed prescribers must check the CSD before prescribing an opioid.
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Nevada
Nevada physicians must register to access the Nevada PMP. Physicians must also complete and manually sign a Health Care Professional Certification Statement, available after setting up a PMP account. Physicians must check the PMP and read the patient’s utilization report before prescribing an opioid and continue to check and read the report at least once every 90 days for the duration of the treatment.
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Developing and Maintaining Competency Including Earning Opioid CME
Developing and maintaining opioid prescribing competency includes related continuing medical education (CME) courses. Most states also require physicians and other prescribers to earn a minimum number of opioid prescribing and monitoring CME credits.
MICA members can take MICA’s online opioid CME courses to develop and maintain competency. Arizona, Colorado, and Nevada physicians may also use the courses to fulfill state licensure requirements.
Log into the Member portal on the MICA website. Under the Policyholder Home Page choose “Online CME Courses.” Then use the “Click here for My Community’s Catalog” link. On the MICA and Medical Interactive Community welcome page click on “Browse Catalog.” Next, click on the plus-sign next to “Topics.” Then, choose “Controlled Substances” and look for these courses:
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- Electronic Fetal Monitoring Case Study #19: Substance and Opioid Use Disorders in Pregnancy
- Opioid Mortality: What Prescribers Can Do
- Psychotropic Medication Management in Primary Care
- Controlled Substances Series: Drug Diversion Prevention
- Controlled Substances Series: Best Practices for Prescribing
- Controlled Substances Series: Fundamentals of Addiction and Addiction Treatment
- Prescribing Controlled Substances
MICA Members: Our Senior Risk Management Consultants are available to help you with questions or concerns about opioid prescribing, monitoring, and management. Call our Risk Management Hotline at 800-705-0538, or email rm_info@mica-insurance.com to discuss.
The content of this publication or presentation is intended for educational purposes only; is not an official position statement of Mutual Insurance Company of Arizona (MICA); and should not be considered or relied upon as professional, medical, or legal advice or as a substitute for your professional judgment. Consult your attorney about your individual situation and the applicable laws. The authors, presenters, and editors made a reasonable effort to ensure the accuracy of the information at the time of publication or presentation but do not warrant or guarantee accuracy, completeness, or currency of such information. As medical and legal information is constantly changing and evolving, check for updated information and consult your attorney before making decisions.