Guidelines

National Guidelines

The nationally recognized clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain can be accessed at the American Academy of Pain Medicine.  These guidelines provide recommendations developed by a multidisciplinary expert panel after a systematic review of the evidence associated with chronic opioid therapy. The guidelines include various appendices to help assist in evaluating and managing patients on chronic opioid therapy. These include risk assessment tools as well as a sample patient consent form.

The following additional guidelines for responsible opioid prescribing as well as an evidence based approach, predictors and strategies to curb opioid abuse can be found at the Pain Physician Journal.

Prevention of Opioid Abuse in Chronic Non-Cancer Pain: Algorithmic, Evidence Based Approach

Review of Opioid Abuse Predictors & Strategies to Curb Opioid Abuse

American Society of Interventional Pain Physicians (ASIPP) Guidelines for Responsible Opioid Prescribing in Non-Cancer Pain: Part I - Evidence Assessement

Florida Prescription Drug Monitoring Program/E-FORCSE

The Florida Prescription Drug Monitoring Program (PDMP) was established in 2009 by the Florida legislature to encourage safer prescribing of controlled substances and reduce drug abuse and diversion within Florida. Also known as E-FORCSE (Electronic-Florida Online Reporting Controlled Substance Evaluation), Florida’s PDMP provides schedule II, III and IV controlled substance data from pharmacies and dispensing practitioners. The information is accessible through a database and available to registered health care practitioners to help guide decisions in prescribing and dispensing highly-abused prescription drugs.

Reporting

Health care practitioners are required to report to the PDMP each time a controlled substance is dispensed to an individual according to Section 893.055, Florida Statutes (F.S.).  Section 893.02(7) F.S., defines “dispense” as the transfer of possession of one or more doses of a medicinal drug by a pharmacist or other licensed practitioner to the ultimate consumer thereof or to one who represents that it is his or her intention not to consume or use the same, but to transfer the same to the ultimate consumer or user for consumption by the ultimate consumer of user. The statute requires the health care practitioner to report electronically within seven days of dispensing the controlled substance. This includes pharmacies licensed under chapter 465, F.S., including mail order and Internet pharmacies and health care practitioners licensed under chapters 458, 459, 461, 462 or 466, F.S.

The statute does not require the health care practitioner to report to E-FORCSE when any of the following conditions are met:

  • The controlled substance is administered to a patient and the amount is sufficient to treat the patient during that particular treatment session
  • The controlled substance is administered to a patient or resident receiving care as a patient at a hospital, nursing home, ambulatory surgical center, hospice or intermediate care facility for the developmentally disabled
  • The controlled substance is administered in the health care system of the Florida Department of Corrections
  • The controlled substance is administered in the emergency room of a licensed hospital
  • The controlled substance is administered or dispensed to a patient less than 16 years of age, or
  • The controlled substance is dispensed as a one-time, 72-hour resupply.

The following information must be reported each time a controlled substance is dispensed:

  • Name of the prescribing practitioner and the prescribing practitioner’s federal Drug Enforcement Administration (DEA) number
  • Prescribing practitioner’s National Provider Identification (NPI) number (or other appropriate identification number)
  • Date of the prescription
  • Date the prescription was filled/dispensed
  • Refill number
  • Patient’s method of payment (e.g., private pay, Medicaid, Medicare, commercial insurance, military installations and Veteran’s Administration, worker’s compensation, Indian nation or other)
  • Name, National Drug Control (NDC) number, quantity and strength of the controlled substance dispensed
  • Full name, DEA number and address of the pharmacy or other location from which a controlled substance was dispensed (if the controlled substance as dispensed by a practitioner other than a pharmacist, the practitioner’s full name, DEA number and address)
  • Name of the pharmacy or practitioner, other than a pharmacist, dispensing the controlled substance and the practitioner’s NPI, and
  • Other appropriate identifying information as determined by Department of Health (DOH) rule

Step-by-step instructions on how to register as an uploader, and how to upload controlled substance dispensing information is available in the Dispenser’s Implementation Guide at http://www.hidinc.com/flpdmp.

Access

Health care practitioners are not required by law to access E-FORCSE. A prescriber or dispenser who is subject to licensure or regulation by the Department of Health under chapter 458, 459, 461, 462, 464, 465, or 466, F.S., has direct access to their specific patient’s information. Other direct access to information is limited to the E-FORCSE program manager and designated staff for the purpose of program management. E-FORCSE grants system access accounts to practitioners and pharmacists so that they may look up, view and print controlled substance dispensing information on their specific patients directly through a user name and password. Access is granted to individuals only, not to clinics, hospitals, pharmacies or any other health care facility. Step-by-step instructions on requesting an account is available in the Training Guide for Florida Practitioners and Pharmacists at http://www.hidinc.com/assets/files/flpdms/FL%20PDMP_Training%20Guide%20for%20Practitioners%20and%20Pharmacists.pdf

Once the account request is approved, the health care practitioner can access a patient advisory report (PAR) for a specific patient. The PAR is a summary of the controlled substance prescription information that was reported to E-FORCSE for a specific patient for a specific period of time. The PAR is a helpful tool to supplement patient evaluation, confirm the patient’s prescription history, document compliance with a therapeutic regimen, and identify potentially hazardous or fatal interactions. It may assist health care practitioners in determining if a patient is “doctor shopping” or trying to obtain multiple prescriptions for controlled substances from multiple health care practitioners. “Doctor shopping” is considered a felony in the state of Florida.

Penalties

  • A health care practitioner who willfully and knowingly fails to report the dispensing of controlled substances is committing a first-degree misdemeanor
  • Any person who willfully and knowingly violates federal HIPAA requirements is committing a third-degree felony

 Florida Blue Medical Coverage Guidelines

Access Florida Blue Medical Coverage Guidelines for Oxycontin and Opana ER by clicking the links below.

Oxycontin (oxycodone ER)   

Opana ER (oxymorphone ER)