CLINICIANS

• Co-prescribing Naloxone
• Continuing Education-Opioids
• Tools
• Standing Orders

Co-Prescribing Naloxone

On May 21, 2020, the Division of Consumer Affairs issued Administrative Order No. 2020-08 to promote access to the opioid antidote naloxone and reduce the number of overdose deaths during the COVID-19 emergency. Administrative Order (DCA 2020-08).The temporary rule requires prescribers to co-prescribe (i.e., concurrently prescribe) an opioid antidote (e.g., naloxone) to patients when continuously prescribing controlled dangerous substances for management of chronic pain under the following conditions:

1) If the patient has one or more prescriptions totaling 90 morphine milligram equivalents (MME) or more per day; or

2) If the patient is concurrently obtaining an opioid and a benzodiazepine.

Please click here to access FAQs for prescribers from the New Jersey Division of Consumer Affairs on mandatory co-prescribing. Co-Prescribing-Naloxone-to-Patients-with-Heightened-Risk-of-Opioid-Overdose-FAQ-Prescribers.pdf (njconsumeraffairs.gov)

 The Surgeon General advises that prescribers, substance use disorder treatment providers and pharmacists learn how to identify patients at high risk for overdose, follow the CDC Guideline for Prescribing Opioids for Chronic Pain, and utilize the Prescription Monitoring Program (PMP). U.S. Surgeon General’s Advisory on Naloxone and Opioid Overdose | HHS.gov Co-prescribing is also broadly supported by a multitude of U.S. health agencies, such as the FDA, the CDC and SAMHSA. The AMA Opioid Task Force encourages co-prescribing naloxone to a patient, family member or close friend of the patient, when clinically appropriate. The AMA released updated guidance to physicians for co-prescribing naloxone in August of 2017, and noted that the following factors may be helpful in determining whether to co-prescribe:

• Does the patient history or prescription monitoring program show that the patient is on a high opioid dose?
• Is the patient on a concomitant benzodiazepine prescription?
• Does the patient have a history of substance use disorder?
• Does the patient have an underlying mental health condition that might make him/her more susceptible to overdose?
• Does the patient have a medical condition, such as a respiratory disease, sleep apnea or other comorbidities, which might make him/her susceptible to opioid toxicity, respiratory distress or overdose?
• Might the patient be in a position to aid someone who is at risk of opioid overdose?

The AMA guidance offers additional suggestions on issues that may be discussed with the patient when determining whether to co-prescribe naloxone. AMA-Opioid-Task-Force-naloxone-one-pager-updated-August-2017-FINAL-1.pdf (end-opioid-epidemic.org)

Continuing Education on Opioid Prescription Drugs

Rowan University School of Osteopathic Medicine, in partnership with NJ CARES and the NJ Division of Consumer Affairs, offers this CME on opioids for health care professionals with prescribing authority, and other licensees. This is an enduring recorded course series consisting of six modules that uses a standardized, evidence-based opioid addiction prevention curriculum to train and inform New Jersey health care professionals on best practices in opioid prescribing and patient care in compliance with federal and state statutory and regulatory guidelines. The modules are designed to educate New Jersey health care professionals with prescribing authority, including physicians, physician assistants, dentists, podiatrists, optometrists, certified nurse midwives, and advanced practice nurses, as well as licensed pharmacists, psychologists, social workers, professional counselors, marriage and family therapists, and registered nurses and athletic trainers. 

Click here to register: http://bit.ly/njcaresmodules

Tools

Division of Consumer Affairs Waivers during the COVID-19 Public Health Emergency

COVID-19 Healthcare Licensees (njconsumeraffairs.gov)

Department of Health Executive Directive

Temporary Rule WAIVER/MODIFICATION OF N.J.A.C. 10:161B-l1.10 – ELIGIBILITY FOR TAKE-HOME MEDICATION adopted by THE COMMISSIONER OF THE DEPARTMENT OF HEALTH

05-08-2020_WaiverTakeHomeMedication_forOpioidTreatmentPrograms.pdf (nj.gov)

CDC Opioid Prescribing Guidelines

CDC Guideline for Prescribing Opioids for Chronic Pain | Drug Overdose | CDC Injury Center

Sample Pain Management agreement from the New Jersey State Board of Medical Examiners

Pain Treatment with Opioid Medications: Patient Agreement 

 Unsafe Storage of Opioids-Risks to Children

https://www.nj.gov/dcf/news/publications/Opioids.and.Children.Alert.pdf

Standing Orders