News & Insights

Opioid Rules: Unused, Unlocked and Undisposed in Louisiana

October 27, 2017

By Karen Duncan, RN, Attorney at Law


Opioid Rules: Unused, Unlocked and Undisposed in Louisiana

Prescribed opioids are disappearing from Louisiana homes. Hospice patients – the sickest of the sick –often get their medical pain care at home. When they die, unused painkillers sometimes go missing. For family members struggling with addiction, stealing the leftover drugs is hard to resist.

Even caregivers themselves occasionally pocket controlled substances left unlocked and unprotected in the house. Recently, a Louisiana hospice nurse was arrested for stealing morphine, oxycodone, and hydrocodone from a deceased patient’s home. Similar thefts have been reported in Alabama, Michigan and Missouri. It is likely that most hospice opioid diversion isn’t reported at all.

Unused hospice opioids are only part of the problem. Excessively prescribed postoperative painkillers are a major contributor to the epidemic of abuse. Unused, unlocked, and undisposed postoperative prescription opioids create a reservoir for illegal diversion. In a recently published meta-analysis of unused surgical painkiller use, 67 to 92 percent of the patients reported unused opioids.

What’s more, it isn’t easy to properly dispose of leftover drugs. The DEA Controlled Substances Act and the Disposal Act strictly controls how drugs, including opioids, are disposed. Hospice workers are not allowed to discard the drugs for the hospice patient. Drugs should not be flushed down the toilet as they will eventually end up in the drinking water. In most cases, the patient or the patient’s family must make a special trip to an authorized DEA collection receptacle where the drugs will eventually be incinerated.

Several states, including Louisiana, have taken steps to reduce excess opioid prescribing and shrink the pool of unused drugs.

New Louisiana Laws

  • 7-Day Opioid Supply. In certain circumstances, the prescriber cannot prescribe more than a 7-day supply of opioids for outpatient use. This 7-day limitation applies to:
    • Prescribing opioids for the first time to an adult patient with an acute condition
    • Prescribing opioids for a minor at any time
      • The prescriber must educate the minor patient’s parent or guardian about the risks of opioid use and why the prescription is necessary.

Risk Management Tip: Document any patient education in the medical record. If the minor is mature, educate the minor patient as well as his or her parent or guardian about relevant risks.

  • Exception to the 7-Day Supply Rule. The rule leaves room for professional medical judgment. When making an exception:
    • Document that an alternative non-opioid is not appropriate and that the opioid is necessary:
      • to treat an adult’s or a minor’s acute medical condition, or
      • for chronic pain management, pain associated with a cancer diagnosis, or
      • for palliative care, or
      • for the treatment of substance abuse or opioid dependence
    • Inform the patient of the risks of opioid dependence.

Risk Management Tip: Tell the patient that the pharmacy may fill less than the full quantity if the patient chooses.

  • Continuing Education For Prescribing Controlled Substances. These new laws are intended to proactively curb opioid abuse in Louisiana:
    • Each prescriber must obtain three credit hours of education on drug diversion, the best practices for opioid prescribing, and addiction treatment.
    • This new education requirement is a one-time prerequisite, upon initial licensure or renewal.
    • This new education requirement is included in the credit hours already required by the LSBME, not in addition to the existing requirements.
    • This new education requirement becomes effective January 1, 2018.
    • The LSBME will develop a prescriber form for those who do not prescribe opioids to request exemption from these education requirements.

Risk Management Tip: The LSBME has published a notice of intent to provide additional explanatory rules and guidelines. Refer to Title 46 of the Louisiana Register October 20, 2017, page 2022. Comments on the proposed Rule should be submitted by November 20, 2017.

  • The Prescription Monitoring Program (PMP). Upon initial application or renewal of a controlled dangerous substance license by the Board of Pharmacy (a CDS license), an opioid prescriber shall automatically be registered in the Louisiana PMP.

Enrolled PMP prescribers should:

Licensing boards may treat reports of failure to comply with these PMP requirements as notification of a complaint against the prescriber.

  • Document PMP compliance. Note the PMP query and the reasons why opioids were or were not prescribed.  
  • If you are unfamiliar with the PMP or you need more information, visit the Louisiana Board of Pharmacy FAQ page or call the Board at 225.925.4767.
    • Through the PMP, prescribers may appoint delegates who can query the PMP for them.

A prescriber does not have to query the PMP when:

  • no more than a single 7-day supply of opioid is prescribed or administered, or
  • the patient is in hospice or is terminally ill, or
  • the patient has cancer-related chronic or intractable pain, or
  • the opioid is administered or ordered in a hospital, or
  • the PMP system is down or inaccessible
    • Prescriber must query the PMP when accessibility has been restored, and document the reasons for the delayed query.

Risk Management Tip: If you are already registered and using the PMP, you may be able to receive Merit Based Incentive Payment System (MIPS) credit. For assistance with the Quality Payment Program, contact LAMMICO Practice Management Specialist, Natalie Cohen, at ncohen@lammico.com or 504.841.5211.

Risk Management Tip: Prescribers may authorize Naloxone (Narcan) to family members of opioid users to reverse overdoses. For more information on the Naloxone standing orders, please click here.

 

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