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Opioid prescribing rule and guidelines

BWC's opioid rule for prescribers

The reimbursement of opioids in the treatment of pain for a work related injury or occupational disease rule applies to all BWC-certified prescribers and is designed to help prevent opioid dependence for Ohio's injured workers.

Patient education

•    Drug addiction affects all Ohioans
•    If opioids have not relieved your chronic pain
•    Is my pain medication making me worse?

At-risk patients

If you suspect your patient is at risk for dependency, addiction, or overdose, please consider these resources.
•    Ohio Department of Mental Health and Addiction Services
•    Prescribing resources 
•    BWC standard dose tapering schedules with appendix
•    Start Talking! Building a Drug-Free Future

Provider education and free CMEs

•    CDC opioid training for providers with an opportunity to earn free CE
•    Take Charge Ohio Laws, Rules & Guidelines

Best clinical practices

Prescribers are expected to comply with Ohio's best prescribing practices as outlined by the Ohio State Medical Board and reinforced by the Ohio Administrative Code (OAC). The rule reinforces important foundational elements of appropriate opioid utilization and customizes it for our population. Because injured workers have a vulnerability that differs from the general population, an additional level of opioid prescribing oversight is required by prescribers. The rule (OAC 4123-6-21.7-D) outlines the requirements needed for this necessary oversight. When prescribing opioids at or above an average daily dose of fifty MED per day, the prescriber must complete and document in the patient records: a validated risk assessment, not less than every three months; and urine drug screens, with frequency based upon results of the validated risk assessment and upon presence of aberrant behaviors or other indications of substance misuse abuse, substance use disorder, or diversion. 

Checkpoints: Tighter controls on duration and daily dose of opioid prescribing, as measured by milligrams of Morphine Equivalent Dose (MED). Pay attention to the duration of time an injured worker may be on opioids. For example, prescriber dose/duration checkpoints to review pain treatment plans are:
•    50 mg MED/Day for more than six weeks after injury or during the subacute injury phase,
•    80 mg MED/Day or for more than 42 to 84 days, and
•    80 to 120 mg MED/Day or for more than 12 weeks for the chronic pain phase.

Opioid treatment programs reimbursed

Be aware of red flags that may arise when treating the injured worker. BWC, through rule 4123-6-21.8 Reimbursement for Services to Assist in the Discontinuation of Medications, will reimburse for opioid treatment programs will reimburse for opioid treatment programs that include medication assisted treatment, behavioral and psychological counseling, and inpatient detoxification. If necessary, BWC will reimburse for up to 18 months if the injured worker follows the plan developed collaboratively with their provider. In addition, the injured worker may complete these programs without adding drug dependency as an allowed claim condition if the injured worker has an approved treatment plan.

Peer review of opioid prescribing is included as a part of utilization review for BWC prescribers as outlined in the rule. Although this process falls outside our progressive disciplinary process, it similarly could result in BWC decertifying a physician.



For more information about this rule, email BWC pharmacy benefits.
For more resources about opioid prescribing in Ohio, click on any one of the topics listed below.
•    Ohio's Opioid Prescribing Guidelines
•    Ohio Automated Rx Reporting System (OARRS)
•    Morphine Equivalent Dose table