155. Drugs: Prescribing and Dispensing
155.990 Opioid Prescribing and Treatment Guidelines for Emergency Departments
Adopt the following new policies on emergency department opioid prescribing and treatment guidelines, as found in the Colorado Chapter of the American College of Emergency Physicians 2017 Colorado Emergency Department Opioid Prescribing and Treatment Guidelines:
- Limiting opioid use in the emergency department
- The Colorado prescription drug monitoring program (PDMP) should develop an automated query system that can be more readily integrated into electronic health records and accessed by emergency clinicians.
- Pain control should be removed from patient satisfaction surveys, as they may unfairly penalize physicians for exercising proper medical judgment.
- Opioid prepacks should be avoided or eliminated from emergency departments if 24-hour pharmacy support is available.
- Pain should not be considered the “fifth vital sign.”
Alternatives to opioids for the treatment of pain
- Hospitals should update institutional guidelines and put policies in place that enable clinicians to order and nurses to administer dose-dependent ketamine and IV lidocaine in non-ICU areas.
- Emergency departments are encouraged to assemble an interdisciplinary pain management team that includes clinicians, nurses, pharmacists, physical therapists, social workers, and case managers.
- Reimbursement should be available for any service directly correlated to pain management, the reduction of opioid use, and treatment of drug-addicted patients.
Harm reduction in the emergency department
- Harm reduction agencies and community programs that provide resources for people who inject drugs (PWID) should be made readily available.
- When local programs are unavailable for PWID, emergency departments should establish their own programs to provide services such as safe syringe exchanges.
Treatment of opioid addiction
- Emergency departments should work with medication assisted treatment (MAT) programs to facilitate direct referrals. When possible, physicians should consider performing a “warm handoff” where patients are initiated on medications such as buprenorphine until they are able to enroll in an appropriate MAT program.
- Access to MAT services for patients should be expanded and local, state and federal funding for these resources should be increased.
(BOD action, July 14, 2017)
155.991 Schedule II Controlled Substance Partial Fills
CMS supports the concept of schedule II controlled substance partial fills.
Click here for background information.
155.992 Pharmacy Benefit Manager (PBM) Adjudication for Physician Dispensing
The Colorado Medical Society supports the alignment of Colorado statutes with federal law to allow physicians to continue to engage in the dispensing of prescription medications to patients, and the adjudication of such transactions with Pharmacy Benefit Managers (PBMs).
The Colorado Medical Society affirms the need to remove restrictions on the adjudication of physician dispensed prescription medication transactions with Pharmacy Benefit Managers (PBMs).
(RES 14-P, AM 2013; Reaffirmed, BOD-1, AM 2014)
155.994 E-Prescribing of Controlled Substances
The Colorado Medical Society (CMS) will support the ability of properly licensed physicians to prescribe controlled substance medications using E-prescribing technology. The CMS Delegation to the American Medical Association (AMA) shall bring a similar resolution to the AMA to actively pursue changes in national regulations so that this may occur.
(RES-11, AM 2008; Reaffirmed, BOD-1, AM 2014)
155.995 “Off Label” Prescribing of Medication
The Colorado Medical Society recognizes the therapeutic importance of “off label” prescribing of medicine which is an established, safe, and necessary strategy widely utilized by physicians in compliance with community standards of care around Colorado.
(RES-34, AM 2004; Reaffirmed, BOD-1, AM 2014)
155.996 Inappropriate Use of Drug Enforcement Administration Number
The Colorado Medical Society supports the position of the Drug Enforcement Administration (DEA) which strongly opposes the health insurance industry’s requirement that physicians provide their DEA registration number on all prescriptions for identification and reimbursement purposes.
(RES-55, AM 1996; Reaffirmed, BOD-1, AM 2014)
155.997 Physician Dispensing of Drugs
The Colorado Medical Society supports the American Medical Association’s (AMA) policy on physician dispensing which states that physicians have a “right to dispense drugs and devices when it is in the best interest of the patient and consistent with AMA’s ethical guidelines.”
(Motion of the Board, February 1988; Reaffirmed, BOD-1, AM 2014)