On May 4, 2017, Governor Nathan Deal signed  HB 249, legislation which addresses issues of opioid abuse. HB 249 moves the Prescription Drug Monitoring Program (PDMP) from the Georgia Drugs and Narcotics Agency to the Department of Public Health. SB 121 and SB 88 were also signed into law by Governor Deal. SB 121 exempts Naloxone, the emergency drug used to reverse opioid overdoses, from the dangerous drug list when it is used for drug overdose prevention and supplied by a dispenser for various types of rescue kits.

 

This legislation also codifies the executive orders put in place by Deal in 2016. SB 88, the Narcotic Treatment Programs Enforcement Act, requires the Department of Community Health to create minimum standards and quality of services for narcotic treatment programs seeking licensure in Georgia. HB 249 also contains several requirements that directly affect Georgia physicians.

 

 

1.    History

 

a.     Effective January 1, 2018: PDMP sign up is required if have DEA license

 

b.     Effective July 1, 2018:  Prescribers (or their approved delegates) must check the PDMP prior to writing an initial prescription for all benzodiazepines and also for opioids on paragraphs 1 and 2 of § 16-13-26 Schedule II list.  This requirement does NOT apply to non-benzodiazepine sleeping pills.  PDMP rechecks are required every 90 days.

 

c.      Effective July 1, 2017:  Patient Education: written or oral,  HB 249 also requires prescribers who issue a prescription for an opioid to “provide the patient receiving the prescription information on the addictive risks of using opioids and information on options available for safely disposing of any unused opioids where such options exist.” This information may be provided in either oral or written form.

 

d.     Effective January 1, 2018:  Three hours of CME related to the safe prescribing of Opioids is a one time requirement for GA medical license or renewal.

 

 

2.     Free Sources of CME that will fulfill Georgia Composite Board Requirements

The Doctors Company offers an online Safe Opioid Prescribing course that is 3.5 hours. This course covers all of the required elements of the Risk Evaluation and Mitigation (REMS) criteria. There is NO Charge for this course.  

 

Click here for SAFE Opioid Prescribing CME

 

 

3.  Patient Education Resource Materials that satisfy HB249 requirements

 

• ACP Foundation Patient Education Materials on Opioids (English and Spanish)

• Safe Opioid Use: Patient Facts

• FDA: Disposal of Unused Medicines: What you should know 

• Controlled Substance Public Disposal Locations (search by zip code)

 

 

4. Helpful Links

 

•  Georgia Prescription Drug Monitoring Program 

•  Georgia PDMP Delegate Training

•  PDMP: Sign Up Page

(Contact DPH at pdmpsupport@dph.ga.gov or 404.463.1517 if questions.)

 

• The following prescriptions require a prior check of the patient’s record in the PDMP

• Link to HB 249

• Link to list of common benzodiazepine and non-benzodiazepine sleeping pills with their brand names- Please note that the HB 249 requirement does NOT apply to NON-benzodiazepine sleeping aid

 

 

 

5. Other Educational Resources

 

 

AMA

•  AMA: End the Epidemic

 

Surgeon General 

•   Turn The Tide

 

CDC Resources

• CDC Vital Signs: Opioid Prescribing- Where you live matters

•  CDC Guideline for Prescribing Opioids for Chronic Pain

 

 

References

 

1. Burger, J. Uncovered: The Holy Grail of Opioid Prescription Durations After Surgery. Outpatient Surgery. \\http://www.outpatientsurgery.net/newsletter/eweekly/2017/10/03/uncovered-the-holy-grail-of-opioid-prescription-durations-after-surgery. Published October 2, 2017. Accessed October 4, 2017. 

2.     CDC Guideline for Prescribing Opioids for Chronic Pain. Centers for Disease Control and Prevention Website. https://www.cdc.gov/drugoverdose/prescribing/guideline.html. Updated March 15, 2017.

3.     CDC Releases Guideline for Prescribing Opioids for Chronic Pain. Centers for Disease Control Website. https://www.cdc.gov/media/dpk/prescription-drug-overdose/opioid-prescription-guidelines/dpk-opioid-prescription-guidelines.html. Updated March 23, 2016.

4.     Dowell D, Haegerich TM. Changing the Conversation About Opioid Tapering. Ann Intern Med. 2017;167:208–209. doi: 10.7326/M17-1402

5.     Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain – United States, 2016. MMWR Recomm Rep 2016;65(No. RR-1):1-49. doi: http://dx.doi.org/10.15585/mmwr.rr6501e1

6.     Dunn KM, Saunders KW, Rutter CM, et al. Overdose and prescribed opioids: Associations among chronic non-cancer pain patients. Annals of internal medicine. 2010;152(2):85-92. doi:10.1059/0003-4819-152-2-201001190-00006

7.     Five Best Practices When Prescribing Opioids. American College of Physicians Website. https://www.acponline.org/system/files/documents/about_acp/chapters/.../opioid1.pdf.

8.     Frank JW, Lovejoy TI, Becker WC, Morasco BJ, Koenig CJ, Hoffecker L, et al. Patient Outcomes in Dose Reduction or Discontinuation of Long-Term Opioid Therapy: A Systematic Review. Ann Intern Med. 2017;167:181–191. doi: 10.7326/M17-0598

9.     Gostin LO, Hodge JG, Noe SA. Reframing the Opioid Epidemic as a National Emergency. JAMA. Published online August 23, 2017. doi:10.1001/jama.2017.13358

10.     Gottlieb S, Woodcock J. Marshaling FDA Benefit-Risk Expertise to Address the Current Opioid Abuse Epidemic. JAMA. 2017;318(5):421–422. doi:10.1001/jama.2017.9205

11.  Guideline for Prescribing Opioids for Chronic Pain. Centers for Disease Control and Prevention Website. https://www.cdc.gov/drugoverdose/pdf/guidelines_factsheet-a.pdf.

12.  Kirschner N, Ginsburg J, Sulmasy LS, for the Health and Public Policy Committee of the American College of Physicians. Prescription Drug Abuse: Executive Summary of a Policy Position Paper From the American College of Physicians. Ann Intern Med. 2014;160:198–200. doi: 10.7326/M13-2209

13.  Lagisetty P, Bohnert A. Annals for Hospitalists Inpatient Notes - The Opioid Epidemic—What's a Hospitalist to Do?. Ann Intern Med. 2017;167:HO2–HO3. doi: 10.7326/M17-1564

14.  Larochelle MR, Liebschutz JM, Zhang F, Ross-Degnan D, Wharam JF. Opioid Prescribing After Nonfatal Overdose and Association With Repeated Overdose: A Cohort Study. Ann Intern Med. 2016;164:1–9. doi: 10.7326/M15-0038

15.  Lasser KE. Prescription Opioid Use Among U.S. Adults: Our Brave New World. Ann Intern Med. [Epub ahead of print 1 August 2017] doi: 10.7326/M17-1559

16.  Menchine M, et al. 202 Do State Prescription Drug Monitoring Programs Reduce Opioid Consumption?. Annals of Emergency Medicine. 2016;68(4): S79. doi: http://dx.doi.org/10.1016/j.annemergmed.2016.08.216

17.  Opioid Pain Medicines. American College of Physicians Website. https://www.acponline.org/system/files/documents/patients_families/products/health_tips/opi_en.pdf.

18.  Opioid Prescribing. Centers for Disease Control and Prevention Website. https://www.cdc.gov/vitalsigns/opioids/index.html. Updated July 6, 2017.

19.  Opioid Prescribing: Where you live matters. Centers for Disease Control and Prevention Website. https://www.cdc.gov/vitalsigns/pdf/2017-07-vitalsigns.pdf. Published July 6, 2017.

20.  Opioids. American College of Physicians Website. https://www.acponline.org/practice-resources/patient-education/online-resources/opioids.

21.  Prescribing Opioids for Chronic Pain. Turn the Tide Rx Website. http://turnthetiderx.org/wp-content/uploads/2016/06/TurnTheTide_PocketGuide_Final.pdf.

22.  Prescription Opioid Use, Misuse, and Use Disorders in U.S. Adults. Ann Intern Med. [Epub ahead of print 1 August 2017] doi: 10.7326/P17-9042

23.  Schuchat A, Houry D, Guy GP. New Data on Opioid Use and Prescribing in the United States. JAMA.2017;318(5):425–426. doi:10.1001/jama.2017.8913

24.  Young HW, et al. 209 Assessing Risk of Opioid Abuse Among the Emergency Medicine Population. Annals of Emergency Medicine. 2016;68(4):S81-82. doi: http://dx.doi.org/10.1016/j.annemergmed.2016.08.223