18 Va. Admin. Code § 105-20-48 - Prescribing an opioid for acute pain
A. Nonpharmacologic and non-opioid treatment
for pain shall be given consideration prior to treatment with opioids. If an
opioid is considered necessary for the treatment of acute pain, a TPA-certified
optometrist shall follow the regulations for prescribing and treating with
opioids.
B. Prior to initiating
treatment with a controlled substance containing an opioid for a complaint of
acute pain, a TPA-certified optometrist shall perform a health history and
physical examination appropriate to the complaint, query the Prescription
Monitoring Program as set forth in §
54.1-2522.1 of the Code of
Virginia, and conduct an assessment of the patient's history and risk of
substance abuse.
C. Initiation of
opioid treatment for all patients with acute pain shall include the following:
1. A prescription for an opioid shall be a
short-acting opioid in the lowest effective dose for the fewest number of days,
not to exceed seven days as determined by the manufacturer's directions for
use, unless extenuating circumstances are clearly documented in the patient
record.
2. A TPA-certified
optometrist shall carefully consider and document in the patient record the
reasons to exceed 50 MME per day.
3. A prescription for naloxone should be
considered for any patient when any risk factor of prior overdose, substance
misuse, or concomitant use of benzodiazepine is present.
D. If another prescription for an opioid is
to be written beyond seven days, a TPA-certified optometrist shall:
1. Reevaluate the patient and document in the
patient record the continued need for an opioid prescription; and
2. Check the patient's prescription history
in the Prescription Monitoring Program.
E. The patient record shall include a
description of the pain, a presumptive diagnosis for the origin of the pain, an
examination appropriate to the complaint, a treatment plan, and the medication
prescribed (including date, type, dosage, strength, and quantity
prescribed).
F. Due to a higher
risk of fatal overdose when opioids are prescribed for a patient also taking
benzodiazepines, sedative hypnotics, tramadol, or carisoprodol, a TPA-certified
optometrist shall only co-prescribe these substances when there are extenuating
circumstances and shall document in the patient recorda tapering plan to
achieve the lowest possible effective doses if these medications are
prescribed.
Notes
Statutory Authority: § 54.1-2400 of the Code of Virginia.
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.