Rhode Island is implementing new regulations for opioid prescriptions, an effort that the state Department of Health said will enhance education opportunities and create more stringent dosage limits for those using opioids to relieve acute pain.
The updated regulations, which took effect Monday, mark the implementation of a major component of the strategic plan developed by Gov. Gina M. Raimondo’s Overdose Prevention and Intervention Task Force, according to Dr. Nicole Alexander-Scott, director of the Rhode Island Department of Health.
“These updated pain management regulations focus on dosing limitations to help reshape how we as health care providers had been taught how to approach opioid therapy, and to make sure that we’re only prescribing what’s actually needed for the treatment of acute pain,” Alexander-Scott said.
“While we work to minimize unnecessary prescribing of opioids for acute pain, it is essential that patients’ chronic pain needs are appropriately and compassionately treated,” she continued. “Although opioid prescribing in Rhode Island decreased by 16 percent between 2013 and 2015, which was the largest drop in the nation, the regulations were updated to ensure that acute pain and chronic pain are treated differently.”
The updates do not affect the long-term treatment being received by patients with chronic pain, health officials said. Those include patients with cancer or those who are under nursing home care.
“Just as a patient with diabetes would not be abruptly removed from diabetes medication, a patient receiving opioids for chronic pain should not be removed too abruptly from pain medication, but transitioned in a way that is safe for the patient to an acceptable alternative over time,” said Joseph Wendelken, spokesman for the department.
The department’s pain management regulations were initially developed in 2015. Updates to the regulations are the responsibility of the governor’s Overdose Prevention and Intervention Task Force and should fall within the guideline of the task force’s strategic plans, which also addresses other areas of focus including treatment, rescue and recovery.
The goal of the plan is to reduce the number of overdose deaths in Rhode Island by one-third within three years, Wendelken said.
To support the implementation of these updated regulations, the health department and Brown University’s Warren Alpert Medical School will offer education sessions in May in which providers will learn more about how to appropriately prescribe opioids and consider interdisciplinary approaches to treating patients with pain.
“Substance-use disorder should be treated as a lifelong disease, and substance-use disorder related to opioid use is no different,” Wendelken said. “A greater level of compassion and understanding are called for when patients with opioid-use disorder transition from pain management medication to alternative treatment.”
— Jason Vallee
Details of R.I. Opioid Management Plan
Highlights of the updated pain management regulations focusing on acute pain include:
Requiring that initial prescriptions for acute pain be limited to 20 doses and no more than 30 morphine milligram equivalents per day;
Prohibiting long-acting or extended-release opioids for initial prescriptions for acute pain;
Documenting the results of a thorough medical history, developing a treatment plan, and accessing the Rhode Island Prescription Drug Monitoring Program for prescription monitoring information, all before issuing an initial prescription for acute pain; and
Requiring continuing education training for prescribers on pain, pharmacology, potential for dependence, and alternatives to opioids for pain management.
Rhode Island offers alternative treatment options for opioid use disorder, including outpatient programs through the Rhode Island Centers of Excellence. The six centers provide Medication-Assisted Treatment, counseling and peer support. A local recovery hotline is also available by calling 401-942-STOP to receive support 24 hours a day, seven days a week.