Gov. John Kasich proposes new opioid rules for chronic pain patients

May 2, 2018 GMT

Gov. John Kasich proposes new opioid rules for chronic pain patients

COLUMBUS, Ohio -- Gov. John Kasich on Wednesday announced new rules he said will help prevent chronic pain patients from becoming addicted to prescription painkillers.

The new rules for chronic pain do not set limits on what can be dispensed. The rules call for doctors to reevaluate patients’ opioid use at periodic “checkpoints” when patients are increased larger doses of painkillers.

Physicians will look for signs of opioid misuse when patents are upped to 50, 80 and 120 morphine equivalent doses per day. About 97,000 Ohio patients were prescribed more than 50 MED in 2017, according to the Ohio Board of Pharmacy.

For patients prescribed 80 morphine equivalent doses per day, physicians will have obtain a pain management agreement and consider prescribing naloxone, which is used to reverse overdoses.

The new rules won’t apply to hospice patients or those with terminal conditions, patients in inpatient settings or patients already being treated for chronic pain unless their dosages increase. They’re expected to take effect this fall.

Kasich said most doctors are already doing periodic reevaluations and trying to identify alternative treatments. He said chronic pain patients shouldn’t worry their medications will be cut off.

“Don’t worry -- you’ll get what you need and you’ll get it in a more positive, more successful way,” Kasich said at a Wednesday news conference.

Ohio led the nation in opioid overdose deaths in 2014, and deaths have continued to rise with increased use of heroin and illegal fentanyl. But prescription drugs have been directly responsible for fewer deaths in recent years.

The state has cracked down on opioid prescriptions through stricter rules on prescribers, guidelines advising physicians to seek alternatives to opioids and tracking drugs through the state’s Ohio Automated Rx Reporting System database.

The total doses of opioids dispensed in Ohio has decreased from a high of 793 million in 2012 to 568 million in 2017.

Kasich attributed the decrease to the state’s medical regulatory boards for backing tighter controls on prescribers.

“Everything is seamless and that’s why it’s working,” Kasich said. “Other states are beginning to look to us to say How are you doing this?”

Last year, Kasich pushed a seven-day supply limit to treat acute, short-term pain such as pain from a wisdom tooth extraction.

The state’s efforts to address the heroin crisis from the prescriber side has had unintended consequences for many chronic pain patients, the Plain Dealer reported last month. Patients said doctors are less willing to prescribe the drugs due to increased scrutiny and requirements, even though they had been taking the medications for decades.

Sen. Matt Dolan, a Chagrin Falls Republican, said legislating the practice of medicine won’t help patients. Dolan is sponsoring a bill to encourage pharmacists to discuss painkillers with patients when they pick up their prescriptions.

“I believe, as does Gov. Kasich, that we in government should let the medical community decide what is best for a patient living with a 30-year old football injury, or someone who is suffering from bone cancer,” Dolan said in a statement.