April 2024 
Opioid Prescribing

The Risk Management team is releasing the 2024 Practice Administrator’s Seminar. This year’s seminar addresses the evolving legal and risk landscape in relation to controlled substance prescribing. You can join them as they provide risk mitigation strategies from an operational perspective. The seminar will feature medical professional liability topics including proper screening and monitoring techniques, polypharmacy, medical record documentation, the process of considering nonpharmaceutical pain management strategies, and when to consult with or refer to other specialists. This seminar is set to be released later this year.

The current Practice Administrator Seminar is available until June 2024. This seminar addresses the baseline self-assessment, provides practical solutions to help evaluate common risks, and helps develop a process to keep a practice on track. The seminar is two hours and can be found here.

In 2023 ProAssurance partnered with Sure Med Compliance to offer the only digital health platform, called Perspectives in Care, scientifically validated to mitigate risk to both patient and provider in pain management settings. It can be difficult to balance treating a patient’s pain while also taking crucial steps to avoid misuse, abuse, dependence, and overdose of opioids. Providers must recognize “red flags” and signals of misuse. By delivering clinical insights that help influence safer prescribing decisions, Sure Med helps protect healthcare providers from liability and allow doctors to create safer exposures to controlled substances.

Sure Med recently announced its exclusive partnership with Curonix LLC, a medical technology company dedicated to easing chronic pain without the use of opioids, to collect clinical data from a nerve stimulating implanted device.

Pain Management Without Opioids

Curonix’s Freedom® Peripheral Nerve Stimulation (PNS) provides lasting chronic pain relief through a non-opioid, minimally invasive implanted technology. Paired with Sure Med’s digital health platform, Curonix will work with physicians and their teams to collect and analyze PNS data to expand the body of clinical evidence to further support PNS efficacy.

“Access to opioid sparing modalities is becoming increasingly limited,” says John Bowman, founder and CEO of Sure Med Compliance. “Coinciding with this industry challenge is another reduction by the DEA in aggregate production quotas of opioids. This scenario is creating an environment in which patients with chronic, intractable pain are forced to seek treatment using illegal means. Our goal in this partnership is to increase the commercial viability of products like Curonix’s Freedom stimulators, a product that has been shown to decrease pain, improve function, and decrease the amount of opioids needed to treat pain.”

Sure Med partners with forward-thinking companies like ProAssurance and Curonix to work toward solutions to help end the opioid overdose epidemic through greater compliance in pain management settings. More than 40,000 patients have already enrolled in Sure Med’s Perspectives in Care program.

It is available to ProAssurance insureds at no additional cost.

For more information, visit SureMedCompliance.com.

According to the Centers for Disease Control & Prevention, millions of Americans who suffer from pain are often prescribed opioids to treat their conditions. The result has been a growing problem of opioid use disorder and overdose.

Since the 1990s, when the amount of opioids prescribed to patients began to grow, the number of overdoses from prescription opioids has also increased. Even as the amount of opioids prescribed and sold for pain has increased, the amount of pain reported has not similarly changed and the number of deaths have increased dramatically.

In fact the number of drug overdose deaths involving prescription opioids in 2021 was nearly five times the number in 1999.

In 2021, 45 people died each day from a prescription opioid overdose, totaling nearly 17,000 deaths. Prescription opioids were involved in nearly 21% of all opioid overdose deaths in 2021. From 1999 to 2021, nearly 280,000 people died in the U.S. from overdoses involving prescription opioids.

A review of our closed claims over the past 10 years indicates that claims involving opioid therapy in chronic pain management patients generally involve overdose deaths. Allegations supporting negligence claims against physicians include excessive opioid prescribing; failure to refer the patient for pain management, addiction, or behavioral health treatment; failure to discover the patient was “doctor shopping”; failure to recognize suicide risk; and negligent tapering.

The Drug Enforcement Administration (DEA), in step with the Department of Health and Human Services (HHS), put forward two notices of proposed rulemaking in March 2023 seeking comments on proposals to allow prescribing of controlled medications via telemedicine. The proposals specifically covered instances where prescribing practitioners have never conducted an in-person medical evaluation of a patient. In May of that year after initial review of the comments, the DEA and HHS issued a temporary rule continuing certain exceptions granted in March 2020 as a result of the COVID-19 pandemic. The effective period for this rule was extended to November 11, 2023, and has been further extended to December 31, 2024.

These exceptions to the Ryan Haight Online Pharmacy Consumer Protection Act of 2008 were granted in order to prevent lapses in care during the pandemic. Their flexibilities authorize practitioners to prescribe schedule II-V controlled medications to patients via audio-video telemedicine appointments, without an in-person visit prerequisite. This includes the prescription of schedule III-V narcotic controlled medications that are approved by the Food and Drug Administration for the treatment of opioid use disorder, specifically for maintenance and withdrawal management.

The purpose of these temporary regulatory changes includes preventing the reduction of care access for patients who have not been able to establish a telemedicine relationship with their practitioner pending a final rule to address telemedicine more generally. Additionally, the extensions enable sufficient time for medical professionals and patients to prepare for any future regulations that might apply to prescribing controlled medications via telemedicine.

Read the full published Rule by the DEA and HHS: “Second Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications”