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Part 2 Combatting the Opioid Epidemic: What You Need to Know as a Physician

This article is a continuation of last month’s article discussing new legislation regarding the prescription of opioids. The new legislation incorporated a number of bills, two of which will be discussed below. The first provision of the new legislation that will be discussed below details steps for prescribing opioids to adults and minors. The second provision discussed below details certain restrictions on the quantity of opioids that may be prescribed.

The first provision to be discussed is House Bill 4408, which takes effect on June 1, 2018. House Bill 4408 details what must occur prior to a physician prescribing an opioid. This provision has slightly different rules for minors and adults. The pertinent parts are as follows:

When dealing with minor patients, prior to the first prescription of an opioid or other controlled substance, a physician must discuss the following:

(1) risks of addiction and overdose;

(2) increased risk of addiction for patients suffering from mental disorders and/or substance abuse disorders;

(3) dangers of taking an opioid with a benzodiazepine, alcohol, or other central nervous system depressant; and

(4) any other information contained in the controlled substance’s patient counseling information section of the label.

Additionally, the minor’s parent or guardian must sign a “start talking consent form” which should include the name, quantity, and number of refills of the opioid being prescribed, a statement that the medication has a potential for abuse, and a statement certifying the physician has discussed the addictive nature of the substance with the minor patient and his/her parent/guardian. The minor patient’s parent or guardian must sign the consent on behalf of the minor.

When dealing with adult patients, prior to the prescription of an opioid, the physician shall discuss the dangers of addiction, proper disposal of unused medication, and that the delivery of a controlled substance is a felony. If the patient is a female in the reproductive stage, the physician must also discuss the short and long-term effects of exposing a fetus to a controlled substance.

The patient must also sign a consent form indicating the above information was discussed. The Michigan Department of Health and Human Services has a general consent form that may be used.

Notably, House Bill 4408 provides for several scenarios which will trigger an investigation by LARA. As such, there is a high probability that if consent forms are not utilized by physicians, and physicians do not discuss the addictive nature of opioids and other controlled substances, LARA will launch an investigation.

Another important provision of the new opioid legislation, Senate Bill 274, becomes effective on July 1, 2018. This bill limits the quantity of opioids which may be prescribed for patients suffering from acute pain. Acute pain is defined as: “pain that is the normal, psychological response to a noxious chemical or a thermal or mechanical stimulus and is typically associated with invasive procedures, trauma, and disease and usually lasts for a limited amount of time.” If a patient is suffering from acute pain, the physician cannot prescribe more than a 7-day supply of an opioid to the patient within a 7-day period.

Prior to the newly enacted legislation surrounding opioid prescriptions, investigations by LARA had been consistently increasing. Given the above legislation, especially considering the fact that it specifically provides LARA authority to investigate violations, it is very likely that LARA will continue to actively investigate the prescription of controlled substances, especially opioids. Please reference the full text of House Bill 4408 and Senate Bill 274, which can be found on the Michigan Legislature website, for more information in regards to the above two provisions.

If you have been contacted by LARA for an interview, if you have been served with an Administrative Complaint, or if you have any questions or concerns regarding LARA or the information contained within this article, please contact the author, Megan R. Mulder of Cline, Cline & Griffin, P.C. at or by calling the office at 810-232-3141.

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