RE – view               RE – vise                 RE – fer 

December 12, 2013 – Counting today there are four days until Indiana’s Emergency Pain Regulations go into effect (on Sunday, December 15, 2013).

The Painful Truth (my opinion) today examines section NINE.

SECTION NINE  – When the morphine equivalent dose (MED) is more than 60 mgm/day, it’s time to REVIEW, REVISE, & REFER

When the 60 mgm per day MED threshold is exceeded, the following must be done:

1. A face-to-face REVIEW of the treatment plan.
2. Document a REVISED ASSESSMENT & PLAN  – including risk of DEATH.
3. Consideration of REFERRAL to a “specialist.”

The Painful Truth notes that the main goal of the “revised” plan seems to be mitigation of risks (especially DEATH) associated with higher opioid dose regimens.

The Painful Truth notes that while the non-specific wording (i.e., “revised,” “consideration,” and “specialist”) allows application of a physician’s clinical judgment, it remains important that documentation adequately justify therapeutic decisions.

The Painful Truth recommends addressing the increased risks (including death) associated with MED greater than 60 mgm/day in a combined opioid INFORMED CONSENT & TREATMENT AGREEMENT (see section FIVE).

The Painful Truth has already examined the concept of a morphine equivalent threshold (see section TWO).