A Guide to State Opioid Prescribing Policies

Pain Policy and Regulation: Idaho

Idaho Laws

The Idaho law defines the following conduct as unprofessional, and the Board of Medicine lists many additional conduct items as unprofessional in its rules. The full statute is available at: http://www3.state.id.us/cgi-bin/newidst?sctid=540180014.K

• Prescribing or furnishing narcotic or hallucinogenic drugs to persons who are addicted to drugs to maintain their addiction and level of usage without attempting to treat the primary condition requiring the use of narcotics.
• Prescribing or furnishing narcotic, hypnotic, hallucinogenic, stimulating or dangerous drugs for other than treatment of any disease, injury, or medical condition.
• The direct promotion to a patient by a physician of the sale of drugs, devices, appliances, or goods that are unnecessary and not medically indicated.
• Abandonment of a patient.
• Failure to supervise the activities of externs, interns, residents, nurse practitioners, certified nurse-midwives, clinical nurse specialists, or physician assistants.

Idaho Pharmacy-related Forms

The state has numerous forms relating to controlled substances and pharmacy registration and practice. These forms are available at: http://bop.accessidaho.org/forms/index.html

Prescriptions

The full statute is available at: http://www3.state.id.us/idstat/TOC/37027JTOC.html

• Schedule II prescriptions MUST be written. Idaho law allows for the emergency issuance of a schedule II prescription via oral format, so long as the pharmacist promptly reduces it to writing. You cannot refill a schedule II controlled substance prescription.
• Schedule III and IV prescriptions shall not be dispensed without a written or oral prescription of a practitioner unless the practitioner (other than a pharmacy) is dispensing directly to the ultimate user.
• Schedule III and IV prescriptions shall not be filled or refilled more than six (6) months after the date thereof or refilled more than five (5) times, unless renewed by the practitioner.
• Schedule V controlled substances shall not be distributed or dispensed for other than a medical purpose.
• Form and Content of Prescriptions. Schedule II controlled substance prescriptions shall be dated as of and signed on the day when issued and must bear the full name and address of the patient, the drug name, strength, dosage form, quantity prescribed, directions for use, and the name, address, and registration number of the practitioner. A prescription should be signed in the same manner as a check or legal document. Ink or indelible pencil must be used and the prescription forms must be signed manually. An agent may prepare the prescription for signature, but the prescribing practitioner is ultimately responsible for ensuring that the prescriptions comply with federal and state law.
• Corresponding Responsibility of Pharmacist. A corresponding liability rests upon the pharmacist who fills a prescription not prepared in the form prescribed by law.
• Schedule II Prescriptions in a Nursing Home, Hospital, or Hospice. Schedule II orders for patients in properly licensed hospitals, nursing homes, or extended care facilities that use a unit dose distribution system shall be written into the patient's record and signed by the practitioner, with proper dating and drug information. A direct copy of this order must be given to the pharmacist within 72 hours. These records shall be kept for 3 years and must remain available for inspection.
• Idaho Prescription Tracking Program. The state has a prescription tracking program. The statute is available at: http://www3.state.id.us/cgi-bin/newidst?sctid=370270030A.K

Idaho Guidelines for the Use of Controlled Substances to Treat Pain

The Board has adopted the following criteria when evaluating the physician's treatment of pain, including the use of controlled substances. The full document is available at: http://www.bom.state.id.us/licensees/opiods.html

• Evaluation of the Patient. A medical history and physical examination must be obtained, evaluated, and documented in the medical record. The medical record should document the nature and intensity of the pain, current and past treatments for pain, underlying or coexisting diseases or conditions, the effect of the pain on physical and psychological function, and history of substance abuse. The medical record also should document the presence of one or more recognized medical indications for the use of a controlled substance.
• Treatment Plan. The written treatment plan should state objectives that will be used to determine treatment success, such as pain relief and improved physical and psychosocial function, and should indicate whether any further diagnostic evaluations or other treatments are planned. After treatment begins, the physician should adjust drug therapy to the individual medical needs of each patient. Other treatment modalities or a rehabilitation program may be necessary depending on the cause of the pain and the extent to which the pain is associated with physical and psychosocial impairment.
• Informed Consent and Agreement for Treatment. The physician should discuss the risks and benefits of the use of controlled substances with the patient, persons designated by the patient, or with the patient's surrogate or guardian if the patient is without medical decision-making capacity. The patient should receive prescriptions from one physician and one pharmacy whenever possible. If the patient is at high risk for medication abuse or has a history of substance abuse, the physician should consider the use of a written agreement between physician and patient outlining patient responsibilities, including urine/serum medication levels screening when requested; number and frequency of all prescription refills; and reasons for which drug therapy may be discontinued (eg, violation of agreement).
• Periodic Review. The physician should periodically review the course of pain treatment and any new information about the cause of the pain or the patient's state of health. Continuation or modification of controlled substances for pain management therapy depends on the physician's evaluation of progress toward treatment objectives. Satisfactory response to treatment may be indicated by the patient's decreased pain, increased level of function, or improved quality of life. Objective evidence of improved or diminished function should be monitored and information from family members or other caregivers should be considered in determining the patient's response to treatment. If the patient's progress is unsatisfactory, the physician should assess the appropriateness of continued use of the current treatment plan and consider the use of other therapeutic modalities.
• Consultation. The physician should be willing to refer the patient as necessary for additional evaluation and treatment to achieve treatment objectives. Special attention should be given to those patients with pain who are at risk for medication misuse, abuse, or diversion. The management of pain in patients with a history of substance abuse or with a comorbid psychiatric disorder may require extra care, monitoring, documentation, and consultation with or referral to an expert in the management of such patients.
• Medical Records. The physician should keep accurate and complete records to include: the medical history and physical examination; diagnostic, therapeutic, and laboratory results; evaluations and consultations; treatment objectives; discussion of risks and benefits; informed consent; treatments; medications (including date, type, dosage, and quantity prescribed); instructions and agreements; and periodic reviews. Records should remain current and be maintained in an accessible manner readily available for review.
• Compliance With Controlled Substances Laws and Regulations. To prescribe, dispense, or administer controlled substances, the physician must be licensed in the state and comply with applicable federal and state regulations. Physicians are referred to the Practitioner's Manual of the U.S. Drug Enforcement Administration and relevant documents issued by the state medical board for specific rules governing controlled substances as well as applicable state regulations.

Definitions Used by the Idaho Board of Medicine Relating to Prescribing Controlled Medications to Treat Pain

The following definitions are used:

• Acute Pain. Acute pain is the normal, predicted physiologic response to a noxious chemical, thermal, or mechanical stimulus and typically is associated with invasive procedures, trauma, and disease. It is generally time-limited.
• Addiction. Addiction is a primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include the following: impaired control over drug use, craving, compulsive use, and continued use despite harm. Physical dependence and tolerance are normal physiologic consequences of extended opioid therapy for pain and are not the same as addiction.
• Chronic Pain. Chronic pain is a state in which pain persists beyond the usual course of an acute disease or healing of an injury, or that may or may not be associated with an acute or chronic pathologic process that causes continuous or intermittent pain over months or years.
• Pain. An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.
• Physical Dependence. Physical dependence is a state of adaptation that is manifested by drug class-specific signs and symptoms that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist. Physical dependence, by itself, does not equate with addiction.
• Pseudoaddiction. The iatrogenic syndrome resulting from the misinterpretation of relief-seeking behaviors as though they are drug-seeking behaviors that are commonly seen with addiction. The relief-seeking behaviors resolve upon institution of effective analgesic therapy.
• Substance Abuse. Substance abuse is the use of any substance(s) for nontherapeutic purposes or use of medication for purposes other than those for which it is prescribed.
• Tolerance. Tolerance is a physiologic state resulting from regular use of a drug in which an increased dosage is needed to produce a specific effect, or a reduced effect is observed with a constant dose over time. Tolerance may or may not be evident during opioid treatment and does not equate with addiction.

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Author Information

Jennifer Bolen, JD, Founder, The Legal Side of Pain, Lenoir City, Tennessee http://www.legalsideofpain.com

Disclosure: Jennifer Bolen, JD, has disclosed that she has received grants for educational activities from King Pharmaceuticals and Cephalon. Ms. Bolen has also disclosed that she has served as an advisor or consultant to King Pharmaceuticals, Abbott Labs, PriCara, Calloway Labs, Millennium Labs, and Cephalon. Ms. Bolen has also disclosed that she serves as a speaker for King Pharmaceuticals, Abbott Labs, PriCara, Calloway Labs, Millennium Labs, and Cephalon.