The Journal of the Arkansas Medical Society Issue 5 Volume 115 | Page 9

by CASEY L. PENN ASMB Regulation 2.4 Be Aware – Not Afraid – of New Rules Clarifying Excessive S ome AMS members are tired of hearing about Regulation 2.4, particularly the miscon- ceptions surrounding it. Others have yet to hear a word about it. From either position, or anywhere in between, the fact is that Arkansas State Medical Board’s recently adopted changes contain information that affects the physicians of Arkansas. The changes are relatively recent, so even at the risk of repeating ourselves, AMS is committed to sharing the latest developments. ing pain medications. “The rule discourages writing over 90, but it doesn’t prohibit it,” he said. “For those writing more than 50 MME per day for chronic pain, this rule establishes a list of things that must be documented in the medi- cal record.” So then, why the confusion? ASMB Attorney Kevin O’Dwyer believes physicians are simply misinterpreting the rule. “It’s true that Regulation 2.4 is a detailed set of rules,” said O’Dwyer, while also describing the rule as unambiguous and hard to misinterpret. During its April 2018 meet- ing, the ASMB adopted changes to Regulation 2, which states “Some physicians [and and governs the standard of patients] may be reading care expected of physicians things into it that just aren’t Kevin O’Dwyer in Arkansas, and specifically, there – like hard limits. It amendments made to section 2.4, which directs the prescribing of scheduled clearly does not set limits.* However, if you’re medications. Post-changes, the rule essentially going to go over 50 morphine equivalents, accomplishes two things: it defines once and you must demonstrate several things that for all what is “excessive” when prescribing are outlined in 2.4. It sets markers, but the narcotics, and it establishes some stipulations Board has always said that you must justify for prescribers to follow. why you’re prescribing. Historically, over- In a June 2018 commentary and again dur- prescribing was prescribing one pill without ing a Board of Trustees meeting in May, AMS justification. I think a lot of doctors are using Executive Director David Wroten touched on ap- 2.4 as reason to not prescribe or to explain to parent confusion related to “the Rule.” patients why they’re not going to prescribe. “There’s a lot of misinformation out there From what I’ve heard from doctors, it’s not about this issue,” Wroten explained, having wit- only 2.4. It’s the DEA, it’s fear of federal pros- nessed the April ASMB meeting. “No physicians ecution, it’s the PDMP, it’s somebody watch- testified against the regulations, but a room full ing your every prescription. These things of patients testified against it. Most were cata- cause more fear than 2.4, but 2.4 is new. strophic cases … These people were scared to “Patients have called me and said their death that they weren’t going to be able to get lawyer says this, or their doctor says this their pain medications that they had been on for all this time … What they testified – was ‘my … No lawyer has called me. No doctor has physicians said with the medical board regula- called me. I don’t know what the confusion is. tion, I can no longer write opioid prescriptions.’” It just says what it says.” Wroten went on to clarify that Regulation 2.4 does not prohibit physicians from prescrib- With that in mind, here’s a little bit of the rule itself: Regulation 2.4 as Effective August 8, 2018 (Source: armedicalboard.org) The prescribing of excessive amounts of controlled substances to a patient including the writing of an excessive number of prescriptions for an addicting or potentially harmful drug to a patient. “Excessive” is defined as the writing of any prescription in any amount without a de- tailed medical justification for the prescription in the patient record. A. Chronic Pain: If there is documented medical justification, “excessive” is defined pursu- ant to the Centers for Disease Control (CDC) guidelines for prescribing opioids for chronic > Continued on page 106. More Than Healthcare, Correct Care Solutions. WHO WE ARE CCS is a national public healthcare leader caring for underserved patients in correctional settings, psychiatric hospitals and residential treatment facilities. Opportunities for: Physician Locations throughout Arkansas Full-time, part-time and PRN available Comprehensive Benefits • 401K Tuition Reimbursement Competitive Compensation • So Much More... Empathy Compassion CALL TODAY OR APPLY ONLINE Chris Phillips [phone] or email [email protected] ccs.careers CCS IS PROUDLY AN EQUAL OPPORTUNITY EMPLOYER NUMBER 5 NOVEMBER 2018 • 105