Healthcare Provider Frequently Asked Questions

When do the new opioid prescribing rules go into effect?
  • The new requirements for advanced registered nurse practitioners, osteopathic physicians, osteopathic physician assistants, and podiatric physicians become effective on November 1, 2018.
  • The requirements for allopathic physician assistants and medical doctors will become effective January 1, 2019.
  • Due to substantial changes in the proposed rules the Dental Commission is holding a hearing date of December 7, 2018 to potentially adopt the new requirements. We anticipate the Dental requirements will go into effect early 2019.
What are the main differences between the 2011 chronic pain management rules and the new opioid prescribing rules?

The new rules expand the 2011 rules to include treatment of acute non-operative, acute perioperative (post-surgical), and subacute pain. The new rules also cover other topics, such as patient notification, alternative treatments, co-prescribing and special populations.

Are there any exemptions to the new opioid prescribing rules?

Yes, they don't apply when treating patients with cancer-related pain, palliative, hospice, end-of -life care, inpatient and observation hospital patients, or procedural pre-medications.

Do I have to register for the Prescription Monitoring Program (PMP) if I work for an organization that has integrated the PMP data?

Yes. Any provider who intends to prescribe an opioid in Washington State must individually register with the Prescription Monitoring Program. This doesn't mean you have to maintain your registration if you can access PMP records via your system's electronic health record (EHR).

What continuing education is required if I prescribe opioids in Washington State?

Any provider who intends to prescribe an opioid in Washington State is required to adhere to the individual board or commission requirements of the profession. The rules typically require some continuing education in the opioid rules and in opioid prescribing best practices.

What type of continuing education will count toward meeting the opioid prescribing rule requirement?
Nursing
  • All ARNPs who prescribe opioids in Washington State must complete a one-time four-hour continuing education on best practices in prescribing opioids.
  • Continuing education hours count toward license renewal requirement and must be completed no later than the first full license renewal period beginning January 1, 2019.
Medical
  • See https://wmc.wa.gov/ for CE information for medical providers
Osteopathic
  • All osteopathic physicians and osteopathic physician assistants must complete a one-time one-hour continuing education on best practices in prescribing opioids and the current opioid prescribing rules.
  • Continuing education hours count toward license renewal requirement and must be complete after the first full license renewal period after January 1, 2019.
Dental
  • Dentists must complete a one-time three-hour continuing education on best practices in prescribing opioids and the new opioid requirements.
  • Continuing education hours count toward license renewal requirement and must be complete after the first full license renewal period after January 1, 2019.
Podiatry
  • All podiatric physicians must complete a one-time one-hour continuing education on best practices in prescribing opioids.
  • Continuing education hours count toward license renewal requirements for Category 1 and must be complete after the first full license renewal period after January 1, 2019.
Does the provider prescribing opioids have to be the person to check the PMP?

No. Providers may delegate mandatory PMP queries to an authorized healthcare designee, in line with the PMP requirements.

Am I able to check the PMP before the patient's appointment?

Yes. It may be advisable to run PMP checks before seeing that day's patients.

Who is considered an "authorized designee" for completing the required PMP checks and what is the responsibility associated with a "PMP query"?

An authorized healthcare designee is a current healthcare provider credentialed with the Washington State Department of Health. Any healthcare provider credentialed with the state may be a designee to perform PMP queries.

What methods may I use to conduct a pain management consultation?

You may use any available technology, including face-to-face. No specific methods must be used.

Will the continuing education be monitored?

The disciplinary authorities may conduct random audits on providers to ensure they meet CE requirements. You may be asked to provide copies of completed CE and should always retain these records.

If I took continuing education on pain management three years ago, do I have to take it again in the next three to four years?

Yes. The continuing education must be completed within the past two years for physicians, dentists, ARNPs and podiatrists. Osteopathic physicians must complete the CE every three years, which is the CE cycle for this profession.

How much continuing education is required, and how often, to be exempt from the mandatory consultation with a pain management specialist?

All professions included in the rules require 12 hours on chronic pain management within the past four years in order to be exempt from the consultation requirement. At least two of these hours must be dedicated to substance use disorder.

Are there mandatory continuing education requirements in the new opioid prescribing rules?

If you prescribe opioids, yes. Depending on your profession, there is mandatory, one-time continuing education requirement. Depending on your profession, the requirement is one to four hours. Check your profession's rules for the specific requirements.

Why is there a requirement to consult a pain specialist?

The consultation requirement is in the requirements. The purpose for the requirement is to make sure the care patients are receiving on higher doses of opioids is carefully supervised. The requirements described in rule include:

  • The dosage amount that must not be exceeded without a consultation;
  • The conditions under which the dosage may be exceeded without a consultation; and
  • Qualification requirements about providers specializing in pain management.
Are there provider exemptions for the consultation requirement?

Yes. The rules describe the specific criteria to be an exempt provider or to be considered a pain specialist.

For my patient who has been on a dosage regimen higher than 120 milligrams morphine equivalency dose, do I have to consult with a pain specialist?

Not necessarily. The rules provide exemptions for urgent or special circumstances. You must document adherence to all standards of practice defined in the rules for your profession.

Do I have to immediately begin to taper a high-dose chronic pain patient when a new patient relationship is established?
Not necessarily. If the patient is on a stable and non-escalating dose of opioids, has demonstrated compliance in previous written agreements for treatment, and has documented pain control, then you may have a 90-day exemption from the mandatory consultation requirements and tapering requirement. It is normally appropriate to initially maintain the patient's current opioid dose, and to evaluate whether tapering or adjustments should be made over time.
Do these rules affect all types of pain management?

They affect pain management using opioids medications.

What professions must comply with the rules?

Licensees of the:

  • Medical Commission
  • Nursing Commission
  • Podiatric Medical Board
  • Dental Commission
  • Board of Osteopathic Medicine and Surgery
  • Pharmacy Commission, as well as pharmacists and other healthcare practitioners.
What table should I use to determine the daily morphine equivalency dose (MED)?

The rules include a generally accepted definition for MED. The boards and commissions determined not to include a conversion table in the rules. Technology, knowledge and medication changes occur frequently. Conversion tables could quickly become outdated. The boards and commissions believe providers should be able to decide which conversion table to use. The Washington State Agency Medical Directors Group (AMDG) provides information on dosing guidelines. Please see the Resources webpage for more information.

If I prescribe above 120mg MED for a patient, do I need to consult a pain specialist?

The mandatory consultation threshold for adults is 120mg MED. A consultation with a pain specialist is required if the prescribed dosage amount exceeds 120mg MED orally per day, unless the consultation is exempted. The exemptions are listed in the rules. Please see your specific professions requirements for details.

Whom do I contact if I have questions?

Please see our contact us webpage for contact information.