Rico, and the District of Columbia, require prescribers of
controlled substances to obtain a state-issued controlled
dangerous substance (CDS) license (see Figure 1, page 35).
This mandate allows the states to monitor a practitioner’s
prescribing practices of controlled substances.
Massachusetts deserves special mention for leading
opioid prescribing policy changes at the state level by requiring that prescribers complete training in pain management
and addiction, among other requirements.36 Physicians must
adhere to specific documentation requirements if a patient is
prescribed more than a seven-day supply of opioids. Patients
may request a partially filled prescription at the pharmacy,
and the pharmacist is expected to explain the implications
of this prescription to the consumer. For Schedule II opioids,
physicians must document that they discussed the risks of
opioids with their patients. When prescribing extended-release, long-acting opioids, the prescriber and the patient
must enter into a written pain management agreement.
Policymakers in Massachusetts also established a benchmarking mechanism for prescribers to monitor and compare
their opioid prescribing patterns against similar specialty
or practice types. These data allow the Board of Registration in Medicine to investigate and notify physicians who
deviate from their peers.36
The previous U.S. Surgeon General, Vivek Murthy, MD,
sent an open letter in August 2016 to U. S. physicians asking
them to “treat pain safely and effectively” by correctly identifying and appropriately treating patients for opioid use
disorder, calling on health care providers to “shape how
the rest of the country sees addiction by talking about and
treating it as a chronic illness, not a moral failing.”
37 As prescribers of pain medications for acute postoperative pain,
surgeons have been working to reduce the consequences
of the opioid epidemic, both before and after the Surgeon
General’s call for action.
An example of a surgeon who is leading the charge in
reversing the opioid epidemic is DuPage County Coroner
Richard A. Jorgensen, MD, FACS. In 2013, he created the
DuPage Narcan Program, the first overdose prevention program of its kind in Illinois.
38 The use of naloxone (Narcan)
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