REVIEW
KENTUCKY’ S UPDATED Controlled Substances Regulations
James Patrick Murphy, MD, MMM
" We have strict statutes "- Wm. Shakespeare, Measure for Measure
The Kentucky Board of Medical Licensure( KBML) has updated its controlled substance prescribing regulations( REF 1). It is imperative that physicians become familiar with these new rules. Regulations are not the same as clinical guidelines or standards of care. Kentucky’ s regulations do not merely advise physicians on how they should act; they tell us how we shall act. While not a substitute for one’ s personal reading of the actual regulations, the following is an overview of salient aspects of these newly added rules.
Among the changes are four prominent dictates:( 1) A three-day limit on prescribing for acute conditions( 2) Steps to take with noncompliant patients( 3) What is expected when tapering medications( 4) When it is necessary to refer for substance abuse treatment
( 1) THREE-DAY LIMIT
Hopefully, by now you have heard of a new Kentucky law designed to impose a three-day limit on prescribing Schedule II pain medications for acute conditions( REF 2). Per protocol, this law,( titled House Bill 333) spawned important modifications to the KBML. These additions to the regulations were updated on November 15, 2017, and are available for viewing on the KBML website( REF 3).
Describing this new law, which only applies to Schedule II drugs as a“ limit” is somewhat misleading, as there are exemptions that allow physicians to prescribe for more than three days.
In addition to the previously published general exemptions found in the KBML controlled substances regulations( see below), the updated prescribing regulations offer a new exemption specific to the three-day limit for Schedule II medications. Simply stated, the three-day limit does not apply if the physician adequately documents these three particulars:
a. A description of the acute condition, b.
An assessment that more than three days is necessary c. Available alternative treatments are inadequate.
Thus, if one decides a patient needs more than three days of Schedule II pain medications, they can be prescribed, but the reasons must be clearly documented.
As mentioned above, the KBML updated prescribing regulations still contain the previously published general exemptions where the regulations( including the new rules about Schedule II drugs for acute pain) do not apply:
1. Hospice or end-of-life treatment
2. Hospital admissions as an inpatient, outpatient or observation patient
3. Cancer patients or pain related to cancer treatment
14 LOUISVILLE MEDICINE