In an effort to combat the opioid crisis that has been plaguing our state, the Legislature passed ESHB 1427 during the 2017 legislative session, which requires the Medical Quality Assurance Commission, Board of Osteopathic Medicine and Surgery, Nursing Care Quality Assurance Commission, Dental Quality Assurance Commission, and the Podiatric Medical Board to adopt rules establishing requirements for prescribing opioid drugs by January 1, 2019. In developing the rules, the disciplining authorities considered the Agency Medical Directors’ Group and Centers for Disease Control guidelines and consulted with the Department of Health (DOH), the University of Washington, and professional associations. 

The end goal was for all the boards and commission to adopt the same set of rules. In an effort to promote coordinated and consistent rules across the professions, each board and commission identified in the bill sent representatives to form the Opioid Prescribing Task Force. The Task Force held seven stakeholder meetings across the state, taking testimony from providers, technical experts, and stakeholders, including chronic pain patients. At their last meeting on March 14, the Task Force developed the final 1427 Conceptual Rules draft (version 7.1). The draft was then disseminated to the different commissions and boards to undergo their individual rule-making processes. The Dental Quality Assurance Commission’s (DQAC) proposed version of opioid prescribing rules is now available for stakeholder comment. You can view the entire rule draft online.

View the Draft

Some of the highlights of the proposed rule include:

Patient Notification, Secure Storage and Disposal 
(WAC 246-817-907)
Dentists will be required to provide information to patients educating them on the risks associated with the use of opioids and document such notification in the patient record. Upon the first issuance of an opioid prescription as well as the transition from acute nonoperative pain or acute perioperative pain to subacute pain, dentists will also be required to notify patients about the safe and secure storage of opioid prescriptions and the proper disposal of unused opioid medication, including the availability of recognized drug take-back programs. This requirement can be satisfied with a document provided by the Department of Health. 

Continuing Education Requirements 
(WAC 246-817-909) 
In order to prescribe an opioid in Washington state, a dentist must complete a one-time continuing education (CE) requirement regarding best practices in the prescribing of opioids and DQAC’s opioid prescribing rules. The CE must be at least three hours in length and can count toward CE requirements for license renewal. 

Diagnosis Identified on Prescriptions
(WAC 246-817-911)
Prescribers will be required to include the diagnosis, indication for use, or the ICD code on all opioid prescriptions.

Prescribing Limits

• Acute Nonoperative Pain & Acute Perioperative Pain (WAC 246-817-913)
  Dentists will be limited to writing a seven-day supply, unless there is clinical documentation in the patient record to justify the need for a higher quantity.
• Subacute Pain (WAC 246-817-916) 
  Dentists will be limited to writing a fourteen-day supply, unless there is clinical documentation in the patient record to justify the need for a higher quantity.

Prescription Monitoring Program (PMP) Requirements 
(WAC 246-817-980)
Under the proposed rule, dentists who prescribe opioids would be required to register to access the PMP and would be required to query the PMP prior to every prescription of an opioid. However, the PMP query requirement will not apply in situations when the PMP or the EMR cannot be accessed due to a technological or electrical failure. Dentists will be able to delegate PMP queries to an authorized designee. 

Send your Comments to DQAC

WSDA fully understands the impact this rule can have on your practice and how you care for your patients. That is why we have advocated and continue to advocate for the adoption of sensible and pragmatic rules, and will continue to push back on onerous requirements.

Please consider submitting any comments, concerns, or suggested changes regarding these proposed rule changes to DQAC by emailing DQAC’s Program Manager at jennifer.santiago@doh.wa.gov.

You may also submit comments on the Agency Rules comment page through August 31, 2018.

Public Hearing

DQAC will also hold a public hearing regarding the proposed rules.

Public Hearing on Proposed Opioid Rules
September 7, 2018
9:35 a.m.
Department of Health, Point Plaza East, Room 152/153
310 Israel Rd. SE
Tumwater, WA 98501

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Questions?

Please contact WSDA Director of Government Affairs Mellani McAleenan at mellani@wsda.org or Government Affairs Associate Emily Lovell at emily@wsda.org with any questions or concerns regarding these proposed rules.