In This Issue:

• SB1446 Opioid Prescribing Best Practices
• Additional Opioid Prescribing Resources
• Medical Marijuana: To Recommend, or not to Recommend, that is the Question
• BOARD ACTIONS - January-September 2018
• Upcoming Renewals

From your Medical Board

SB1446 Opioid Prescribing Best Practices

Oklahoma Senate Bill 1446 – Best Practices for an Act Regulating the Prescribing of Opioid Drugs

Effective November 1, 2018

Continuing Medical Education: Physicians are required to complete one (1) hour of CME in pain management per year.

OBNDD: May provide licensing boards with unsolicited referrals of physicians if a patient receives one (1) or more prescriptions in quantities or frequency inconsistent with accepted standards of safe practice. 63 O.S. §2-309D(M)

Prescription Monitoring Program – 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. 63 O.S. §2-309D(G)(2)(a), 63 O.S. §2-309D(G)(4)

Acute Pain Prescription Limits: For acute pain, practitioner shall not issue an initial prescription for an opioid drug in a quantity exceeding seven (7) day supply. Prescription shall be for the lowest effective dose of immediate-release opioid drug. 63 O.S. §2-309I(A).  Following the initial seven (7) days, a second 7-day prescription may be issued, after consultation (in person or by telephone), if practitioner determines prescription is necessary and appropriate, documents the rationale for the prescription and determines and documents it does not present undue risk of abuse, addiction or diversion. * For best practice, the 7-day consultation should be performed by the physician; however, it does not appear to be 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.

Chronic Pain Prescriptions: If continuing treatment for three months or more, practitioner shall: (1) review every three months the course of treatment, any new information regarding etiology of pain and progress toward treatment objectives; (2) assess patient prior to every renewal to determine if patient is experiencing dependency and document assessment; (3) periodically make reasonable efforts, unless clinically contraindicated to stop, decrease dosage or try other treatment modalities; (4) review PMP; (5) monitor compliance with pain management agreement. 63 O.S. §2-309I(F).*Assessment may be performed by a mid-level PA/APRN. Face-to-face assessment is recommended but not required.

Morphine Milligram Equivalent - MME: the law references 100 MME as a safe patient threshold. If you choose to prescribe greater than 100 MME, document the rationale thoroughly.

Prior to Initial Prescription for Pain a Prescription for a Schedule II or any Opioid: Practitioner shall: (1) take and document a thorough medical history; (2) conduct and document a physical exam; (3) develop a treatment plan; (4) access the PMP; (5) limit supply to no more than seven days; (6) if under 18, enter into a Patient-Provider Agreement [Pain Management Agreement] with parent or guardian; (7) if pregnant, enter Patient-Provider Agreement [Pain Management Agreement] with patient. 63 O.S. §2-309I(B)

Informed Consent & Risk Discussions: Prior to initial prescription and again prior to third prescription, practitioner must discuss risks including: (1) risks of addiction and overdose, dangers of taking opioids with alcohol, benzodiazepines and other CNS depressants; (2) reason the prescription is necessary; (3) alternative treatment available; (4) risks can include fatal respiratory depression. Practitioner shall document the discussion in the medical record. 63 O.S. §2-309I(D)

Patient-Provider Agreement [Pain Management Agreement]: Practitioner shall enter into a Patient-Provider Agreement [Pain Management Agreement] with a patient: (1) at the time of the third prescription for opioid or Schedule II drug; (2) If patient requires more than three months of pain management; (3) if patient is prescribed benzodiazepines and opioids together; (4) if patient requires more than 100 mg morphine milligram equivalents (MME); (5)  If patient is pregnant; or (6) with the parent or guardian if the patient is a minor. 63 O.S. §2-309I(I); 63 O.S. §2-309I(B)(6),(7)

Excluded: The requirements of SB 1446 do not apply to patients receiving active treatment of cancer, hospice, palliative care, or residents of a long-term care facility. 63 O.S. §2-309I(G)

Written Policy: Any provider authorized to prescribe opioids shall adopt and maintain a written policy regarding the same. 63 O.S. §2-309I (I)

Disclaimer:  This Best Practices document is subject to change without notice and is made available to facilitate understanding of SB1446.  This is not intended to be an official interpretation or commentary on the intent of the law.

Revision 10/25/2018

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Additional Opioid Prescribing Resources

Additional Opioid Prescribing Resources are available on the OSBMLS Website, including documents required by SB 1446: (click to open now)

• A Sample Written Opioid Policy.  
• A Sample Patient-Provider Agreement.

For additional information 

Click here to view the Pain Guidelines section of the OSBMLS Website

we will update this website with relevant information as it becomes available.

Medical Marijuana: To Recommend, or not to Recommend, that is the Question

 “To Recommend, or not to Recommend, that is the Question”

1.     Oklahoma physician must have an active full [currently] unrestricted medical license.

2.     The physician must be board certified by a national accrediting body recognized by the Oklahoma Medical Board.

[the following are currently recognized by the OMB]

·     AMERICAN BOARD OF MEDICAL SPECIALTIES

·     AMERICAN BOARD PHYSICIAN SPECIALTIES

·     AMERICAN BOARD OF COSMETIC SURGERY

·     AMERICAN BOARD OF FACIAL PLASTIC/RECONSTRUCTIVE SURGERY

·     AMERICAN BOARD OF SLEEP MEDICINE

·     AMERICAN BOARD OF ENVIRONMENTAL MEDICINE

·     AMERICAN BOARD OF ELECTROENCEPHALOGRAPHY/NEUROPHYSIOLOGY

3.     How do I sign up to recommend?

Contact:

•     Oklahoma Medical Marijuana Authority

•     Phone: (405) 522-OMMA (6662)

•     Email: omma@ok.gov

•     Website: omma.ok.gov

Adult Patient Application Information

Minor Patient Application Information; 

Temporary Patient Application Information 

Caregiver Application Information       

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BOARD ACTIONS - January-September 2018

Click on licensee name link for details. Some actions are not final until approved by the Oklahoma Attorney General.

Rhiannon K. Alig, RC, Lic #4190

Enid, Formal reprimand, $1500 fine

George S. Cohlmia, MD, Lic #15023

Tulsa, Complaint Citation

Sara A. Collier, MD, Lic #31042

Oklahoma City, Complaint Citation

Hung H. Dang, MD, Lic. #23467

Des Moines, Complaint Citation

Azuka C. Egbuniwe, MD, Lic. #28751

Augusta, Complaint Citation

Jeri L. Ellis, MD, Lic. #20048

Shawnee, Prescription restrictions, practice restrictions

Walter J. Exon, MD, Lic. #10770

Tulsa, Revoked License

James F. Fleckenstein, MD, Lic. #23288

Tulsa, Case Stayed

James M. Gilbert, MD, Lic. #9487

Bethany, Complaint Citation

Cynthia D. Goodman, MD, Lic. #17502

Dallas,TX  Surrendered License

Mark N. Hill, MD, Lic #31681

Durant, Formal Reprimand, Fine, CE

Jimmie E Howell, Jr., RC, Lic. #117

Collinsville, Surrendered License

Sharif S. Ismail, MD, Lic. #22720

Lawton, Complaint Citation

Richard J. Johns II, PT, Lic. #4424

Henryetta, Complaint Citation

Scott G. Lilly, MD, Lic. #21684

Tulsa, Modification of suspension dated 9/1/17

Gary L. Loveless, LPED, Lic. #31

Oklahoma City, Revoked License.

Gary L. Loveless, LPO, Lic. #23

Oklahoma City, One year probation, and 30 CEUs, ethics course  

Linda Lucio, MD, Lic. #18290

Oklahoma City, Probation

Kimberlee R. Mixon, PA, Lic. #1288

Tulsa, Indefinite probation

Albert T. Nguyen, MD, Lic. #28578

Oklahoma City, 30-day suspension, formal reprimand, fine, prohibited from supervising mid-level practitioners for 6 months, CME

Kelton H. Oliver, MD, Lic #18031

Anchorage, AK Reprimand and Probation

Gilbert R. Parks, MD, Lic. #25246

Oklahoma City, Surrendered License

Lee C. Rittenhouse, MD, Lic #12365

Crescent, Complaint Citation

Dwayne L. Roush, MD, Lic #19836

Yukon, Suspension dated June 1, 2017 remains in full force and continued 60 days. CDS restrictions

Gerald A. Snider, MD, Lic #9483

Tulsa, License Revoked

Staci S. Sparks, OT, Lic #638

Midwest City, dismissed- licensee deceased

Jason T Stansill, MD, Lic #22433

Sallisaw, 5 years probation, return to work restrictions

Brad A Starkey, MD, Lic #19484

Broken Arrow, Indefinite probation

Melita L. Tate, MD, Lic #21826

Tulsa, Formal Reprimand, fine, no telemedicine for 1 year

Ricardo R Villareal, TA, Lic #942

Oklahoma City, 90-day suspension, $3500 fine, CEUs

Richard J. Wedel, MD, Lic #23316

Norman, Complaint Citation

William D. Wright, MD, Lic #16990

Edmond,  Immediate Summary Suspension

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Upcoming Renewals

Registered Electrologists

Nov 1 - Dec 31

Prosthetists/Orthotists and Assistants

Nov 1 - Dec 31

Physical Therapists and Assistants

Dec 1 - Jan 31

Licensed Pedorthists

Dec 1 - Jan 31

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Valuable resources available on Medical Board Website:

• Prescription Monitoring Program
• License Search 
• Laws & Rules 
• A Woman’s Right to Know 
• Renew & Update License 
• Doctors Lounge 
• Board Contact 
• CME 
• Medical Board Home Page