On February 13, 2019, the New York State Department of Health provided the following advisory to physicians:
Effective April 1, 2018, a written treatment plan in the patient’s medical record is required if a practitioner prescribes opioids for pain that has lasted for more than three months or past the time of normal tissue healing.
There are exceptions for patients being treated for:
- Cancer that is not in remission
- Hospice or other end-of-life care and
- Palliative care.
The treatment plan must follow generally accepted national professional or governmental guidelines, and shall include (but is not limited to) the documentation and discussion of the following clinical criteria within the medical record:
- Goals for pain management and functional improvement based on diagnosis, and a discussion on how opioid therapy would be tapered to lower dosages or tapered and discontinued if benefits do not outweigh risks;
- A review with the patient of the risks of and alternatives to opioid treatment; and
- An evaluation of risk factors for opioid-related harms.
Such documentation and discussion of the above clinical criteria shall be done, at a minimum, on an annual basis.
For an example of a generally accepted national governmental guideline for prescribing opioids for chronic pain from the Centers for Disease Control and Prevention (CDC), visit https://www.cdc.gov/media/modules/dpk/2016/dpk-pod/rr6501e1er-ebook.pdf.
Additionally, AAOS has developed a Pain Relief Toolkit that can be accessed online: https://aaos.org/Quality/PainReliefToolkit/?ssopc=1
