South Carolina Boards Issue Revised Pain Management Guidelines

December 15, 2017 by Robyn W. Madden

In the not so distant past, pain management guidelines focused, in part, upon patient reported pain.  In the past several years, there’s been a shift towards more conservative pain management. 

In March 2014, Governor Haley issued Executive Order 2014-22 creating the Governor’s Prescription Drug Abuse Prevention Council (PDAP).  Later that same year, South Carolina Norco was changed to a Schedule II narcotic; the pain management guidelines were revised a second time. 

Two years later, the South Carolina Department of Health and Environmental Control (“SCDHEC”) noted that nearly five million Opioid prescriptions were filled in South Carolina, at a time when only 4.961 million people resided in South Carolina. That same year, the CDC published the CDC Guideline for Prescribing Opioids for Chronic Pain.

Not surprisingly, the South Carolina Boards of Medical Examiners, Nursing, Dentistry, and Pharmacy recently adopted revised pain management guidelines which directly address prescribing opioids for pain management.   

Defending Your Practice When Managing Patient Pain

A licensed practitioner with prescriptive authority in South Carolina continues to hold the discretion to decide when and whether to prescribe controlled substances, including opioids.  As evidenced by recent legislation, including mandatory review of SCRIPTS before prescribing schedule II medication, practitioners prescribing pain medication will be subject to increased scrutiny related to chart review.

The best defense to a question of whether a patient’s medication is appropriately prescribed and patient care is appropriately managed is through documentation and a complete medical record.  The revised South Carolina pain management guidelines reflect that failure to verify a patient’s history through SCRIPTS, failing to follow the pain management guidelines, and/or failing to adequately document the patient’s plan of care may result in an LLR investigation and subsequent disciplinary action.  If you receive notice that your practice has been called into question, we offer a no-cost consultation to discuss the LLR investigation process and possible defense.  Our team will aggressively defend your right to continued practice.  803.227.4254.

The new SC LLR Pain Management Guidelines reiterate the importance of SCRIPTS and promote alternative therapy when considering pain management, including physical therapy, exercise, and cognitive behavioral therapy.

Things to consider before prescribing Opioids under the new SC LLR pain management guidelines include:

• Is the patient suffering from acute or chronic pain?
• Setting goals for pain and function. Be realistic. Clarify expectations and consider when medication should be discontinued (before it is prescribed). Continue pain medication only if there is clinically meaningful pain improvement and function outweighing risk to patient safety.
• Discussing all known risks and benefits and the patient’s responsibility for pain management. Discuss alternative medications and alternative therapies.
• Carefully considering which medications to prescribe, the appropriate dose, the duration of the script, when to follow up with the patient, and when to taper or discontinue meds before prescribing medication.
• Evaluating the pros and cons of prescription pain management with each patient within 1 to 4 weeks of starting opioid therapy.
• Considering, and planning for, additional risks including age, other medical conditions, mental health conditions, substance use disorder.
• Avoid prescribing opioids and benzodiazepines concurrently.

Picking Up Where Another Practitioner Left Off?

Patients who present to your practice with a prescription from another provider must be reassessed. Failure to assess and consider whether pain medication is indicated as set forth above, or failure to appropriately document, may result in disciplinary action by the appropriate licensing board.

Immediate Release Opioids are Preferred for Acute Pain

When prescribing opioids for acute pain following a proper patient  assessment, the guidelines suggest use of immediate release opioids, at the lowest dose, for the shortest possible duration in conjunction with drug testing.  In many instances, a prescription of three days or less is suggested.

Are Opioids Necessary?

The revised South Carolina pain management guidelines stress the importance of use of alternative medication and alternative therapy when dealing with chronic pain.  When dealing with chronic pain, medication should only be continued if expected benefits for pain and function outweigh the all risks to patient safety.  The new pain management guidelines also indicate that continued use of opioids for pain management should be combined with nonpharmacologic therapy and nonopioid pharmacologic therapy when appropriate. Importantly, chronic pain may not be treated through telemedicine without prior authorization from the South Carolina Board of Medical Examiners. 

Faced with justifying your pain management practices under the revised South Carolina Pain Management guidelines or need to defend an allegation of substandard care? Our South Carolina Professional License Defense Attorneys are here to help.  803.227.4254.