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New Emergency Room Rules Adopted for Opiate Prescriptions In New Hampshire

In response to the growing opioid crisis in New Hampshire, the state Board of Medicine has adopted emergency room rules for the prescribing of opiate painkillers. During the meeting that was conducted on November 4th, the board rejected the majority of the changes that were provided by Gov. Maggie Hassan but has begun a thorough review of the current rules for opioid prescriptions.

They have high hopes that they will receive input from the community so that they can offer more detailed updates by April of 2016. While a draft proposal of additional emergency rules were declined, the released press notice recognized that there is an immediate need for change due to rampant opiate abuse.

These newly implemented emergency room rules will require physicians who prescribe opioids to offer extensive educational overviews to acute pain patients about the risks associated with their prescriptions as well as providing up to date information about the disposal of unused pills. These patients will also receive modified informed consent of their painkillers while undergoing a risk assessment, a toxicology screening and have to sign a written pain agreement. Finally, the emergency rules have adopted federal guidelines regarding the best practices for prescribing opioids.

These new guidelines are the results of state officials cracking down harder on the over-prescribing of painkillers, citing evidence linking prescription drug abuse with heroin use and addiction. Because the Board of Medicine is responsible for the licensing and disciplining of physicians in New Hampshire, the board have been receiving requests from Hassan regarding the need for specific updates to these rules.

She has asked that licensed providers be required to attend continuing education classes regarding pain management and the prescription of opioids in addition to other safeguards to the research that links heroin and opiate prescription abuse. Included in her requests were changes to the current language in the patient consent form that claims that the chances of pain medication addiction was low, something that the state attorney general's office has been investigating.

Board member Dr. John Wheeler stated that he considers the verbiage in the governor’s proposal was tedious, citing the need for "more of a differential between acute and chronic [pain]." While the language minimizing the addictive risks of painkillers was adjusted, there was little support for Hassan's proposed changes. There was particular backlash against the suggestion that the emergency room supply of painkillers was limited to a three day supply, due to the amount of patients that are seen in the ER who require pain medication. Dr. Michelle Nathan states that forty percent of the patients she sees in one shift end up receiving a prescription for painkillers, stating that such proposed restrictions were "highly subjective." While she recognizes that opioid abuse is on the rise, she is opposed to a rapid push through of new regulations.

In fact, there is concern about whether prescribers will have difficulty adjusting to the emergency regulations that have been put in effect due to the lack of public notice. Dr. Travis Harker, who is the former president for the New Hampshire Medical Society, suggests that this is only one step in a larger struggle against drug addiction.

These emergency rules will roll out and take effect by the end of this week as the board reaches out to physicians. Hopefully these new changes will help cut back on the abuse.


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