From the Guidelines
In Massachusetts, healthcare providers prescribing controlled substances must follow specific requirements, including registering with the Massachusetts Controlled Substances Registration (MCSR) and the federal Drug Enforcement Administration (DEA), and checking the Prescription Monitoring Program (PMP) before issuing the first prescription and periodically thereafter. For patients on long-term opioid therapy, you should see them at least every 3 months, though higher-risk patients may need more frequent visits, as recommended by the CDC guideline for prescribing opioids for chronic pain 1. Before prescribing opioids, you must discuss risks, benefits, and alternatives, and document this conversation. You should also establish treatment agreements for patients on long-term therapy, conduct risk assessments, and consider drug screening. These requirements aim to ensure appropriate prescribing while preventing misuse and diversion. The frequency of patient visits should be determined by clinical judgment based on the patient's stability, risk factors, and medication regimen, with more frequent monitoring for patients showing signs of misuse or those on higher doses, as suggested by the CDC guideline 1. Some key points to consider when evaluating patients on long-term opioid therapy include:
- Assessing benefits and harms of opioids within 1 to 4 weeks of starting long-term opioid therapy or of dose escalation 1
- Considering follow-up intervals within the lower end of this range when ER/LA opioids are started or increased or when total daily opioid dosage is ≥50 MME/day 1
- Strongly considering shorter follow-up intervals (within 3 days) when starting or increasing the dosage of methadone 1
- Regularly reassessing all patients receiving long-term opioid therapy, including patients who are new to the clinician but taking long-term therapy, at least every 3 months 1
- Reevaluating patients exposed to greater risk of opioid use disorder or overdose more frequently than every 3 months 1
From the Research
Controlled Substance Requirements for Massachusetts
- The provided studies do not specifically address the controlled substance requirements for Massachusetts.
- However, the studies discuss the management of chronic pain and opioid use disorder, which may be relevant to controlled substance requirements in general 2, 3, 4, 5.
Frequency of Patient Visits
- The studies do not provide a specific frequency for patient visits in Massachusetts or any other location.
- They do discuss the importance of ongoing care and monitoring for patients with chronic pain and opioid use disorder, suggesting that regular follow-up visits may be necessary 2, 3, 4, 5.
- The American Society of Interventional Pain Physicians (ASIPP) guidelines for the use of controlled substances in the management of chronic pain emphasize the need for systematic evaluation and ongoing care of patients with chronic or persistent pain, but do not specify a particular visit frequency 6.