Rhode Island sets limits and safeguards for opioid prescriptions

Practitioners must follow specific safeguards when prescribing opioids for acute pain and for minors. For adults with acute pain, an initial opioid prescription must use the lowest effective dose of an immediate-release opioid and cannot exceed a seven-day supply. For minors, an opioid prescription cannot exceed 20 doses unless an exception applies. For acute pain, opioid treatment may start only if non-opioid therapies do not work or a clinical assessment finds that the benefits of opioid treatment outweigh its risks. For a minor, a practitioner may prescribe more than 20 doses for specified conditions when professional medical judgment supports it; the reason and why a non-opioid option failed or was not appropriate must be recorded. Before prescribing an opioid to a minor, the practitioner must discuss risks and alternatives with the patient or, when required, the parent or guardian, document the discussion, offer naloxone, and follow consent rules. The act says it takes effect upon passage.

Practitioners may prescribe controlled medicines for documented ongoing pain and certain other conditions, while following patient safeguards. These provisions cover documented chronic or severe ongoing pain, cancer-related pain, sickle cell pain, palliative or end-of-life care, and other conditions allowed by health department rules. Concern about substance use disorder alone is not a reason to withhold treatment, but practitioners must check prescription records, verify methadone or buprenorphine use, refer to a specialist when appropriate, and make a written treatment agreement under health department rules. Practitioners may not prescribe when they know or should know that a patient will use the medicine for a nonmedical purpose or divert it to others. A practitioner or pharmacist may deny a prescription based on clinical judgment. The act says it takes effect upon passage.

The act repeals the separate chapter on intractable pain treatment and includes pain-treatment provisions in the Uniform Controlled Substances Act. This applies to Rhode Island's chapter on intractable pain treatment and the controlled-substances provisions covering practitioners and patients receiving pain treatment. The act says it takes effect upon passage.