18 Va. Admin. Code § 150-20-174 - Prescribing of controlled substances for pain or chronic conditions
A. Evaluation of
the patient and need for prescribing a controlled substance for pain.
1. For the purposes of this section, a
controlled substance shall be a Schedules II through V drug, as set forth in
the Drug Control Act (§
54.1-3400 et seq. of the Code of
Virginia), which contains an opioid, to include tramadol and
buprenorphine.
2. Nonpharmacologic
and non-opioid treatment for pain shall be given consideration prior to
treatment with opioids. Prior to initiating treatment with a controlled
substance, as defined, the prescriber shall perform a history and physical
examination appropriate to the complaint and conduct an assessment of the
patient's history as part of the initial evaluation.
3. If a controlled substance is necessary for
treatment of pain, the veterinarian shall prescribe it in the lowest effective
dose appropriate to the size and species of the animal for the least amount of
time. The initial dose shall not exceed a 14-day supply.
B. If the prescribing is within the accepted
standard of care, a veterinarian may prescribe a controlled substance
containing an opioid for management of pain, terminal illnesses, or certain
chronic conditions, such as chronic heart failure, chronic bronchitis,
osteoarthritis, collapsing trachea, or related conditions.
1. For prescribing a controlled substance for
management of pain after the initial 14-day prescription, the patient shall be
seen and evaluated for the continued need for an opioid. For the prescribing of
a controlled substance for terminal illnesses or certain chronic conditions, it
is not required to see and reevaluate the patient for prescribing beyond 14
days.
2. For any prescribing of a
controlled substance beyond 14 days, the veterinarian shall develop a treatment
plan for the patient, which shall include measures to be used to determine
progress in treatment, further diagnostic evaluations or modalities that might
be necessary, and the extent to which the pain or condition is associated with
impairment.
3. For continued
prescribing of a controlled substance, the patient shall be seen and
reevaluated at least every six months, and the justification for such
prescribing documented in the patient record.
C. Prior to prescribing or dispensing a
controlled substance, the veterinarian shall document a discussion with the
owner about the responsibility for the security of the drug and proper disposal
of any unused drug.
D. Continuation
of treatment with controlled substances shall be supported by documentation of
continued benefit from the prescribing. If the patient's progress is
unsatisfactory, the veterinarian shall assess the appropriateness of continued
use of the current treatment plan and consider the use of other therapeutic
modalities.
E. The medical record
for prescribing controlled substances shall include signs or presentation of
the pain or condition, a presumptive diagnosis for the origin of the pain or
condition, an examination appropriate to the complaint, a treatment plan, and
the medication prescribed to include the date, type, dosage, and quantity
prescribed.
Notes
Statutory Authority: § 54.1-2400 of the Code of Virginia.
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