New opioid prescribing recommendations for hospital-based physicians are going into effect this month. The update affecting Missouri includes limiting an initial prescription of opioids and requiring a doctor to discuss the risks of the medication with the patient.
The new guidelines — released by the Missouri Hospital Association (MHA), Missouri Academy of Family Physicians (MAFP), Missouri Association of Osteopathic Physicians and Surgeons, Missouri College of Emergency Physicians and a coalition of numerous other health and dental organizations — broadens guidelines established in 2015.
The first guidance the coalition released focused on opioid prescriptions written in hospital emergency departments, said Dave Dillon, the MHA vice president of public and media relations.
"Fundamentally, it hasn't changed," Dillon said. "It uses what we know are best practices for safeguarding physician prescriptions."
The major differences come from who is writing the prescriptions. Physicians of patients who underwent a procedure, such as a surgery, and are being discharged are now under the guidelines, he said.
The new guidelines encourage physicians to follow Centers for Disease Control and Prevention's guidance where it comes to prescribing opioids.
"It's a direction hospitals and hospital-based physicians should be going," Dillon said.
The coalition's guidance reflects limitations imposed by a new Missouri law. Senate Bill 826, which passed during the past General Assembly, limits an initial prescription of opioids to no more than a seven-day supply for the treatment of acute pain. Prior to writing the prescription, the prescriber is required to discuss with the patient the quantity of the opioid and the options of filling the prescription with a lesser volume.
The physician is also required to discuss the potential risks of the prescription.
If the physician thinks more than a seven-day supply is necessary, that physician may write a longer-term prescription if they note on the medical record that the condition will require it and no non-opioid pain control would be sufficient. The act does not apply to cancer patients under certain circumstances.
And, although it was considered in the 2015 guidance, the 2018 guidance recommends the physician analyzes the risk of overdose for the patient.
"For patients that physicians believe have a high risk of overdose, they should prescribe Naloxone," Dillon said. "If the individual has that, but overdoses, their mother, father or a friend can reverse it."
The new guidance recommends non-narcotic treatment of "non-traumatic" tooth pain.
The new rules come as the health care industry deals with a large number of newborns who are found to have Neonatal Abstinence Syndrome (NAS) — a group of conditions that occur when a baby withdraws from narcotics they were exposed to in the womb.
Opioid overdose deaths in 2016 cost the United States about $504 billion in 2016, according to the White House Council of Economic Advisers. In Missouri, the cost was about $12.1 billion.
"Missouri's family physicians continue to implement evidence-based strategies that both prevent opioid misuse and reduce harm associated with opioid use," said Sarah Cole, president of the MAFP. "These recommendations are clear and succinct for all physicians who care for people in the emergency department and hospital settings."