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