PAIN ON THE SUNCOAST:
LEGISLATING RESPONSIBLE PRESCRIBING
By Fabian A. Ramos, MD, FIPP, DABA, DABIPP, DABPM,
International Pain Medicine, Fellow of Interventional Pain Practice
MAY 2018 | SARASOTA SCENE 85
insider
Board Certified – American Board of Interventional Pain Physicians,
American Board of Pain Medicine, American Board of Anesthesiology
It is important to understand the
difference between acute and chronic
pain. Acute pain will subside. Chronic
pain is ongoing and often debilitating.
One may experience acute pain after a
dental procedure, minor injury or surgery.
With the new legislation, those suffering
from acute pain will be limited to
prescription dosages as mentioned above.
In a prior step to combat opioid abuse,
the Florida legislature created E-FORCSE
in 2009 to encourage safer prescribing.
or opioid, your pharmacist is required to
log this data into E-FORCSE. Although the
information has been available, it has not
been mandatory for all physicians to refer
to this database prior to writing a
prescription for a controlled substance.
When the legislation is enacted, this will
be mandated by law.
Another element of responsible
dissemination of controlled substances by
physicians relates to MME (Morphine
Milligram Equivalent) per day. This affects
those suffering from both acute and
chronic pain. The effective milligram
dosages has be lowered with the new
legislation; another necessary step in
of addiction and overdose.
Will these new requirements be easy to
implement? No.
Will this new legislation be convenient
Will these new requirements save lives?
Yes.
InHEALTH
Scott signed Florida House Bill 21 at the
allocating more than $65 million to
problem – an epidemic that ravages our
population. According to a report recently
released by the Florida Department of
Law Enforcement, 5,725 people
overdosed in 2016, an increase of nearly
35 percent from 2015. Of those,
substances that are not prescribed by
doctors, such as heroin and carfentanyl,
accounted for 406 and 754, respectively.
These harrowing numbers pointed to the
urgency of prescription reform.
HB 21 goes into effect on July 1, 2018, to
enact measures that help regulate acute
and chronic pain prescriptions of opioids
by imposing three main components:
1. Opioid prescriptions written to treat
acute pain will be limited to only a
three-, seven-, or 10-day opioid
prescription when deemed medically
necessary.
2. Mandatory physician review of the
E-FORCSE (Electronic Florida Online
Reporting of Controlled Substances
Evaluation) database to determine a
patient’s current prescribed medications
prior to writing new prescriptions for
controlled substances.
3. Authorized physicians are required to
complete a board-approved, two-hour
continuing education course on
prescribing controlled substances.
With HB 21, the State of Florida is
epidemic and urge a conservative
approach to pain management that
focuses on other modalities and
interventional procedures.
Prescribing opioids should be a last
resort. For example, in a practice
over 10,000 patients, only 18
percent of the patients are
prescribed opioids – and only when
deemed absolutely necessary, such
as a patient who is diagnosed with
intractable pain.
There has been a renaissance over
the past two decades with the
closure of many “pill mills” on the
Suncoast. As a result, Manatee
that in the last six months of 2017,
there was a 75 percent decrease in
overdoses and deaths, and an 85
percent decrease thus far in 2018.
When HB 21 is enacted this
summer, we expect an even greater
decrease in negative opioid-related
consequences.
Fabian A. Ramos, MD, FIPP,
DABA, DABIPP, DABPM
Ramos Center for
Interventional & Functional Pain Medicine
100 3rd Avenue West, Bradenton
5741 Bee Ridge Rd., Sarasota
941.708.9555