On February 16, 2017 the Virginia Board of Medicine (“The Board”) adopted regulations entitled “Governing Opioid Prescribing for Pain and Prescribing of Buprenorphine.” The regulations were adopted under the Board’s emergency authority given that State Health Commissioner Marissa Levine declared on November 20, 2016 an opioid addiction crisis as a public health emergency. The regulations quickly advanced through the approval process by the Virginia Attorney General’s Office, the Virginia Department of Planning and Budget and were signed by the Governor on March 13, 2017. The regulations became effective March 15, 2017.
Coupled with these regulations, at least ten pieces of legislation were introduced during the 2017 Session of the Virginia General Assembly dealing with the prescribing of opioids and buprenorphine. This Advisory will provide an overview the legislation and new regulations regarding the treatment of acute pain, chronic pain and treatment with buprenorphine.
Two identical pieces of legislation passed by the 2017 General Assembly Session directed the Board to promulgate regulations on the treatment of acute pain and/or chronic pain with opioids and the prescription of buprenorphine. House Bill 2167, patroned by Delegate Todd Pillion (R, Dickenson) and Senate Bill 1180, patroned by Senator Ben Chafin (R, Bland) directed Board action.1 Both bills included emergency clauses making them effective upon signature of the Governor. The Governor signed HB 2167 on March 3, 2017 and signed SB 1180 on March 27, 2017. After the bills were filed, stakeholders stressed to the members of the General Assembly that it would be more appropriate to use the physician experts at the Board to address the issue of prescribing practices through regulations, as opposed to addressing by statute. The Board relied on expertise from a regulatory advisory panel, the Board’s legislative committee and the full Board, to revise and hone the regulations throughout January and February.
The regulations apply to Doctors of Medicine, Osteopathic Medicine, Podiatry and Physician Assistants.2 The Board of Nursing has adopted identical regulations that will govern Nurse Practitioners with prescriptive authority who are licensed through the Joint Boards of Medicine and Nursing. These regulations have been approved and are effective on May 8, 2017.
1 Both pieces of legislation also direct the Board of Dentistry to promulgate regulations for the prescribing of opioids for acute and chronic pain. The Board of Dentistry has already approved regulations that are proceeding through regulatory process to final approval.
2 18 VAC 85-21-10
With regard to exclusions, the regulations do not apply to the following:
- “The treatment of acute or chronic pain related to cancer, a patient in hospice care or a patient in palliative care;
- The treatment of acute or chronic pain during an inpatient hospital admission, in a nursing home or an assisted living facility that uses a sole source pharmacy; or
- A patient enrolled in a clinical trial as authorized by state or federal law.”3
The regulations define acute pain and chronic pain as follows:
Acute pain “shall mean pain that occurs within the normal course of a disease or condition or as the result of surgery for which controlled substances may be prescribed for no more than three months.” [emphasis added]4
Chronic pain “means non-malignant pain that goes beyond the normal course of a disease or condition for which controlled substances may be prescribed for a period greater than three months.” [emphasis added]5
To learn more about the how this will effect you and your practice click below.
This alert was originally written and published by the law firm Hancock, Daniel, Johnson & Nagle, PC and republished here with permission.
March 14, 2017 (original)
April 17, 2017 (updated)
May 3, 2017 (updated)