Submitted by: Shaun Horak, PA-C, NAPA Liaison,
Nebraska Patient Safety Coalition
There have been legislative efforts to decrease the risk of opioid-related misuse and deaths nationwide and our state. In 2016, opioid pain relievers, such as oxycodone or hydrocodone, contributed to 38 of 128 (30%) drug overdose deaths in Nebraska. In February 2016, the Nebraska Legislature passed LB 471, a bill to improve Nebraska’s Prescription Drug Monitoring Program (PDMP). The Nebraska PDMP is a no-cost service to providers administered in collaboration between the Nebraska Department of Health and Human Services (DHHS) and the Nebraska Health Information Initiative (NEHII), a medication query functionality available to all prescribers and dispensers in Nebraska.
The Nebraska PDMP is authorized to monitor the care and treatment of patient medications, provide information to improve our patients’ health and safety and help prevent the misuse of prescribed controlled substances. Beginning January 1, 2017, all controlled substances dispensed in Nebraska were to be reported by the pharmacies to the PDMP. The responsibilities of providers, which include all licensed PAs, include mandatory enrollment in the PDMP. There have been some additional bills passed to expand on LB 471 and further define providers’ regulations and requirements.
LB 931 prohibits practitioners from prescribing more than a seven–day supply of opiates for patients younger than 18 years of age for outpatient use for an acute condition. However, exceptions to the seven-day cap exist for patients with a cancer diagnosis, palliative care or another severe medical diagnosis, so long as the practitioner documents such a condition. Additionally, suppose the practitioner has not previously prescribed an opiate for such a patient. In that case, the practitioner must discuss the risks associated with opiates and why the prescription is necessary. This law became effective on July 19, 2018.
LB 933 requires practitioners to notify patients of the risk of addiction, overdose, why the prescription is necessary and alternative available treatment options when prescribing opioids or other controlled substances, listed as Schedule II on the Uniform Controlled Substances Act. The mandated notification must occur when the substance is initially prescribed and again before the third prescription.
LB 788 was amended into LB 731, which was signed by the Governor on April 19, 2018. These CME requirements are effective beginning in 2021 for PA license renewals. This law requires practitioners who prescribe controlled substances to earn a minimum of three hours of Category 1 continuing medical education biennially regarding prescribing opiates. The continuing education may include, but is not limited to, education regarding prescribing and administering opiates, the risks and indicators regarding the development of addiction to opiates and emergency opiate situations. One half-hour of the three mandated hours of education must cover the Nebraska PDMP. This half-hour PDMP requirement can be satisfied by watching the free PDMP video on the Nebraska DHHS website and completing the training acknowledgment form. It is the practitioner’s sole responsibility to make sure they meet licensing and CME requirements should an audit be done.