National Credentialing Forum 2019 San Diego, CA February 7 2019 OkAMSS Fall Conference Oklahoma Board of Medical Licensure & Supervision Regulation of Opioid Drugs & Oklahoma Medical Marijuana Law National Credentialing Forum 2019 San Diego, CA February 7 2019 Ok Board of Medical Licensure & Supervision

OkAMSS Fall Conference Agenda Regulation of Opioid Drugs - SB 1446 We will review the ‘Opioid Best Practices’ Additional CME requirement for MDs Ramification of SB1446 on Physicians and mid-levels Oklahoma Medical Marijuana Law (SQ788) Physician Registration Board certification What's around the corner? February 7 2019 Ok Board of Medical Licensure & Supervision

Regulation of Opioid Drugs - SB 1446 Effective November 1, 2018 OkAMSS Fall Conference Regulation of Opioid Drugs - SB 1446 Effective November 1, 2018 CME: not less than one (1) hour of education in pain management or one (1) hour of education in opioid use or addiction each year preceding an application for renewal of a license, unless the licensee has demonstrated to the satisfaction of the Board that the licensee does not currently hold a valid federal Drug Enforcement Administration registration number. OBNDD to make Board referrals: of physicians if a patient receives one (1) or more prescriptions in quantities or frequency inconsistent with accepted standards of safe practice. PMP: Failure to check PMP is grounds for disciplinary action by licensing board. PMP must be checked at the initial prescription and then at least every 180 days. February 7 2019 Ok Board of Medical Licensure & Supervision

Acute Pain Effective November 1, 2018 - OkAMSS Fall Conference Acute Pain Effective November 1, 2018 - Initial Opioid Prescription w/new patient: Lowest effective dose No more than a 7 day supply Thorough physical medical exam Informed consent Specific treatment plan Check PMP Special attention for under 18 Special attention for pregnant patients Limit to lowest safe dose and 7 days February 7 2019 Ok Board of Medical Licensure & Supervision

Acute Pain Effective November 1, 2018 OkAMSS Fall Conference Acute Pain Effective November 1, 2018 Exception for major surgical procedure and/or “confined to home” status: The practitioner provides the subsequent prescription on the same day as the initial prescription; The practitioner provides written instruction on the subsequent prescription indicating the earliest date on which the prescription may be filled (i.e. “do not fill until” date); and The subsequent prescription is dispensed no more than five (5) days after the “do not fill until” date indicated on the prescription. February 7 2019 Ok Board of Medical Licensure & Supervision

Acute Pain Effective November 1, 2018 OkAMSS Fall Conference Acute Pain Effective November 1, 2018 IF the major surgical procedure and/or “confined to home” status conditions are NOT met: a second 7-day prescription may be issued, after consultation* (in person or by telephone), if practitioner determines prescription is necessary and appropriate. 7-day consultation should be performed by the physician; however, it does not appear to be so required. If a medication needs to be changed due to allergy, ineffective dose or other medical condition, document thoroughly in the record the need and rationale for change February 7 2019 Ok Board of Medical Licensure & Supervision

Chronic Pain Effective November 1, 2018 OkAMSS Fall Conference Chronic Pain Effective November 1, 2018 If continuing treatment for 3 months or more, practitioner shall: Review every 3 months - the course of treatment, any new information regarding etiology of pain and progress toward treatment objectives; Assess patient prior to every renewal to determine if the patient is experiencing dependency and document assessment; Periodically make reasonable efforts, unless clinically contraindicated to stop, decrease dosage or try other treatment modalities; Review PMP; Monitor compliance with pain management agreement. According to the A.G.’s office, the assessment may be performed by a mid-level PA/APRN. Face-to-face assessment is recommended, but not required February 7 2019 Ok Board of Medical Licensure & Supervision

OkAMSS Fall Conference Exceptions The pill limits do not apply to prescription for a patient who is currently in active treatment for cancer, receiving hospice care, palliative care or is a resident of a long-term care facility, or to any medications that are being prescribed for use in the treatment of substance abuse or opioid dependence February 7 2019 Ok Board of Medical Licensure & Supervision

OkAMSS Fall Conference Make sure to Bookmark: http://www.okmedicalboard.org/#pain-guidelines February 7 2019 Ok Board of Medical Licensure & Supervision

OkAMSS Fall Conference February 7 2019 Ok Board of Medical Licensure & Supervision

OkAMSS Fall Conference OK SQ 788 Medical Marijuana (MM) 1. There are no medical rules for marijuana! 2. There is no CME required by the law – CME programs are being developed 3. Physicians have to be *board certified in order to recommend MM. a. Board certification by ABMS, ABPS or approved by the OMB – list of approved Boards is on the website b. Health Department has a list of board certified physicians c. Recommend NOT prescribe – avoids federal law Schedule I 4. Physicians interested in this topic should visit the OMMA Website as an excellent resource: http://omma.ok.gov/ *fully expect this item to be discussed next legislative session February 7 2019 Ok Board of Medical Licensure & Supervision

OkAMSS Fall Conference  IMPORTANT:  The Oklahoma Medical Marijuana Authority (OMMA) Food Safety Standards Board is the authority entrusted to carry out the requirements of this Law. Please direct all calls and inquiries to OMMA at: Oklahoma Medical Marijuana Authority  Phone: (405) 522-6662  Email: omma@ok.gov  Website: omma.ok.gov Guidance for Recommending Physicians Physician Registration Form February 7 2019 Ok Board of Medical Licensure & Supervision

What's around the corner? OkAMSS Fall Conference What's around the corner? Physical Therapy Licensure Compact - HB 3336 Effective: 11-1-2018 MD Licensure Compact Occupational Therapy Practice Act -Telemedicine/Telehealth/Tele-rehab Medical Board Practice Act – Allied Licensure Application Electronic Circularization, Admin fine, other… Supervision Form (form 5) – Online workflow process Blockchain – e-Wallet Card February 7 2019 Ok Board of Medical Licensure & Supervision

OkAMSS Fall Conference February 7 2019 QUESTIONS? 405-962-1400 Ext. 118 Reji T. Varghese Deputy Executive Director varghese@okmedicalboard.org Ok Board of Medical Licensure & Supervision