The Texas Medical Association has some suggestions for the Texas Medical Board (TMB) on how to implement the state’s new 10-day limit on opioid prescriptions for acute pain.
A letter to the board from TMA, the Texas College of Emergency Physicians, the Texas Orthopaedic Association, and the Texas Academy of Family Physicians addresses whether an in-person visit with a patient should be necessary to issue subsequent 10-day opioid prescriptions for acute pain after the initial scrip.
The letter, which followed a stakeholder meeting of TMB’s Opioid Workgroup on Feb. 18, says it should be up to the physician’s judgment whether a non-initial (i.e. second, third, or beyond) 10-day prescription for acute pain requires seeing a patient in-person. At the workgroup meeting, TMA’s letter noted, board representatives “expressed concern that a telephone call was not an appropriate means” to issue those follow-up prescriptions.
“The focus should not be on the means of contact, but instead should focus on a meaningful contact,” TMA’s Feb. 28 letter said. “What will be meaningful in one situation may not be in another. But all assessments for a subsequent opioid prescription should be meaningful, whether it is day 5 or day 11. And this should be left to the physician’s proper medical judgment based on the physician’s relationship with the patient and individual treatment plan, and in accordance with the standard of care.”
In certain situations, the law already allows a physician to use his or her medical judgment to assess via a telephone call whether a subsequent opioid prescription is appropriate to treat the patient’s acute pain, TMA told the board. And “limiting post-operative follow-up for a subsequent opioid prescription to treat acute pain to only an in-person visit or a synchronous audiovisual communication puts an unfair burden on the patient,” the letter added.
“As stated in the meeting, it may be inconvenient, painful, or even harmful for the patient, who has just undergone a painful procedure, to have to travel during his or her post-operative recovery to meet with his or her physician for an in-person visit. And to the extent the board limits telemedicine to just a synchronous audiovisual communication, it puts the burden on the patient to find a physician with this form of telecommunication support. Further, the synchronous audiovisual communication requirement may isolate rural patients who have limited to no broadband support.”
The 10-day limit on opioid prescriptions for acute pain is a product of House Bill 2174, which Texas lawmakers passed during the 2019 legislative session. TMB is in the process of making rules to accompany that law.
TMA’s letter to TMB also addressed the workgroup’s discussion around CME. HB 2174 requires prescribers to complete two hours of CME on prescribing and monitoring controlled substances in order to maintain their licenses. The board agreed to consider TMA’s recommendation to exempt from the CME those physicians whose licenses are up for renewal prior to the TMB rules being finalized.
Because the board is still drafting guidance on how to comply with the new law, “an exception is important to ensure these individuals are not found noncompliant due to the time gap in the law’s effective date and promulgation of corresponding rules,” TMA wrote.