TMB Sets Rules on Acute-Pain Scrip Limit, Opioid CME
By Joey Berlin


Texas’ pain management requirements underwent several important changes by law in the past year. Now, the Texas Medical Board (TMB) has issued rules clarifying what prescribers must do to comply with those laws.

During July, TMB finalized its definitions for different categories of pain; laid out rules for required checks of the state’s prescription monitoring program (PMP); and set the CME requirement for physicians to school themselves on opioids and pain management.

Final rules the board adopted July 10 were written to accompany state law, enacted during 2019, that limits acute-pain prescriptions for opioids to 10 days. TMB amended its existing definitions for acute and chronic pain, and also created a new definition for “post-surgical, post-procedure, persistent non-chronic pain.”

Those definitions now each include a stated time element from the date of the initial opioid prescription:

  • Acute pain: Pain that is time-limited to no more than 30 days from the date of the initial prescription;
  • Chronic pain: Pain that exists for more than 91 days from the date of the initial prescription; and
  • Post-surgical, post-procedure, persistent non-chronic pain: Pain lasting 31-90 days from the date of the initial prescription.

Under those definitions, the 10-day limit will apply only to opioid prescriptions for acute pain, according to the Texas Medical Association Office of the General Counsel.

Other rules TMB adopted July 10 accompany the state’s mandate for prescribers to check the PMP before writing any prescription for opioids, barbiturates, benzodiazepines, or carisoprodol. For patients taking their medication home, TMB’s rules state the PMP check must occur before the patient leaves the outpatient setting. For inpatient stays, the PMP check must occur upon discharge.

Checks must be documented in the patient’s medical record.

Exceptions to the mandated PMP check include prescriptions for hospice care, cancer care, and treatment for sickle-cell disease (the exception needs to be documented in the patient’s record), and if a prescriber tries to access the PMP but can’t because of circumstances out of the prescriber’s control.

TMA helped TMB arrive at its final opioid CME requirements,  adopted July 3. TMB now requires physicians to take two hours of CME “in topics related to pain management, and the prescription of opioids and other controlled substances.” The board also will require a course on human trafficking prevention approved by the Texas Health and Human Services Commission. Both requirements will be part of the 24 credits in the study of medical ethics and/or professional responsibility CME that physicians must take every 24 months.

In written comments during the rulemaking process, TMA and others successfully persuaded the board to require just two hours of CME on pain management and opioids; TMB was originally considering a six-hour opioid CME requirement.

However, the board did not take TMA’s request to require only prescribers and direct-care physicians take the pain-management CME. TMB also rejected TMA’s recommendation to allow extra opioid-CME credit to roll over to the next renewal period.


Last Updated On

July 31, 2020

Originally Published On

July 31, 2020

Related Content

Opioids | Pain management