December 11, 2013 – Counting today there are five days until Indiana’s Emergency Pain Regulations go into effect (on December 15, 2013).

The Painful Truth (my opinion) today examines sections SIX, SEVEN, and EIGHT:

SECTION SIX (PROGRESS * COMPLIANCE * EXPECTATIONS)

This section deals with periodic scheduled visits.

1. “Stable” regimens need a “face to face” at least once every 4 months.
2. “If changes are prescribed by the physician” – face to face at least every 2 months.

At the visit:

1. Evaluate progress
2. Evaluate compliance
3. “Set clear expectations”

– “such as: attending physical therapy, counseling or other treatment options”

SECTION SEVEN (INSPECT reports – at the beginning and annually)

Must document in the chart if it is “consistent with the physician’s knowledge of the patient’s controlled substance use history.”

SECTION EIGHT (Drug monitoring test – in the beginning and annually)

There must also be a “confirmatory” test for these drug-monitoring tests.

If a test shows “inconsistent medication use” or “illicit substances” there must be documented a discussion, review, and revision of the treatment plan.

The Painful Truth notes that “confirmatory” is not defined in these regulations. However, this probably means that the specimen must be submitted for a more specific evaluation (e.g. gas chromatography – Still, one could argue that repeating the initial drug screen is a type of “confirmation.”).  Note that the regulations do not specify that every drug-monitoring test have a confirmatory test – rather, only the one at the “outset” and at the “annual” screen.

The Painful Truth submitted an opinion on drug-monitoring tests (October 2013).