Pain Management

Pain Management Updates

Updated CDC Guidelines

The CDC updated their Clinical Practice Guideline for Prescribing Opioids for Pain. The Oregon Medical Board is in the process of updating the OMB's Statement of Philosophy on Pain Management.

DEA Removes Waiver Requirement to Prescribe Buprenorphine

On December 29, 2022, Congress signed the Consolidated Appropriations Act of 2023, thus removing the federal requirement for practitioners to submit a Notice of Intent (have a waiver) to prescribe medications, such as buprenorphine, for the treatment of opioid use disorder (OUD).

All DEA registrants should be aware of the following:

A DATA-Waiver registration is no longer required to treat patients with buprenorphine for opioid use disorder.
Going forward, all prescriptions for buprenorphine only require a standard DEA registration number. The previously used DATA-Waiver registration numbers are no longer needed for any prescription.
There are no longer any limits or patient caps on the number of patients a prescriber may treat for opioid use disorder with buprenorphine.
The Act does not impact existing state laws or regulations that may be applicable.

The Consolidated Appropriations Act also introduced new training requirements for all prescribers. Section 1263 requires new or renewing DEA registrants, starting June 27, 2023, to have at least one of the following:

A total of eight hours of training from certain organizations on opioid or other substance use disorders for practitioners renewing or newly applying for a registration from the DEA to prescribe any Schedule II-V controlled medications;
Board certification in addiction medicine or addiction psychiatry from the American Board of Medical Specialties, American Board of Addiction Medicine, or the American Osteopathic Association; or
Graduation within five years and status in good standing from medical, advanced practice nursing, or physician assistant school in the United States that included successful completion of an opioid or other substance use disorder curriculum of at least eight hours.

Visit SAMHSA.gov or DEAdiversion.usdoj.gov, or see the DEA’s Training Requirements document to learn more.

Pain Management Required Course and Updated Resources

All Oregon Medical Board licensees must complete the Oregon Pain Management Commission's (OPMC) continuing education course Changing the Conversation About Pain," at initial licensure and every two years . The course now includes topics such as health equity. See the Continuing Education page for details.

Additionally, a workgroup comprised of representatives of the OPMC, Oregon Health Authority (OHA) Public Health, and Providence Health & Safety, as well as six clinical experts, have developed the Pain Education Toolkit, which offers patient and provider educational resources on topics such as sleep, nutrition, and medications.

Visit OregonPainGuidance.org/paineducationtoolkit to access the toolkit. A clinician-focused version is also available at OregonPainGuidance.org/paineducationtoolkitforclinicians.

Prescription Drug Monitoring Program (PDMP)

All Oregon-licensed physicians and PAs who have a DEA number are required to register for the PDMP. Register at oregon.pmpaware.net by selecting "Create an Account." For more information, please review OAR 847-010-0120 and OAR 333-023-0825. For questions, contact the PDMP at 866-205-1222 or pdmp.health@state.or.us.

ATTENTION: The Oregon Health Authority adopted temporary rules to align with requirements in 42 U.S.C. 1396w-3a. The temporary rules require Oregon Health Plan (OHP) enrolled providers and Coordinated Care Organization (CCO) contracted providers to check the PDMP before prescribing controlled substances to covered individuals. See OAR 410-120-1260(13) and OAR 410-141-3855(15) for details.

CDC Advises Against Misapplication of the Guideline for Prescribing Opioids for Chronic Pain

Authors of the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain are advising against misapplication of the guideline that can risk patient health and safety, raising awareness of the following issues:

Misapplication of recommendations to populations outside of the Guideline's scope. The Guideline is intended for primary care clinicians treating chronic pain for patients 18 and older. Examples of misapplication include applying the Guideline to patients in active cancer treatment, patients experiencing acute sickle cell crises, or patients experiencing post-surgical pain.
Misapplication of the Guideline's dosage recommendation that results in hard limits or “cutting off" opioids. The Guideline states, “When opioids are started, clinicians should prescribe the lowest effective dosage. Clinicians should… avoid increasing dosage to ≥90 MME/day or carefully justify a decision to titrate dosage to ≥90 MME/day." The recommendation statement does not suggest discontinuation of opioids already prescribed at higher dosages.
The Guideline does not support abrupt tapering or sudden discontinuation of opioids. These practices can result in severe opioid withdrawal symptoms including pain and psychological distress, and some patients might seek other sources of opioids. In addition, policies that mandate hard limits conflict with the Guideline's emphasis on individualized assessment of the benefits and risks of opioids given the specific circumstances and unique needs of each patient.
Misapplication of the Guideline's dosage recommendation to patients receiving or starting medication-assisted treatment for opioid use disorder. The Guideline's recommendation about dosage applies to use of opioids in the management of chronic pain, not to the use of medication-assisted treatment for opioid use disorder. The Guideline strongly recommends offering medication-assisted treatment for patients with opioid use disorder.

More information about the CDC Guideline for Prescribing Opioids for Chronic Pain and how appropriately apply it to patient care, visit the CDC's website.

In July 2020, the Food and Drug Administration provided guidance directing health care professionals to discuss naloxone, a potentially life-saving medication that can reverse drug overdoses, with all patients when prescribing opioid pain relievers or medicines to treat opioid use disorder. See the FDA's website for additional information.

Oregon Medical Board Information

Statement of Philosophy: Pain Management
The Material Risk Notice Form
Continuing Education Requirements for Pain Management
Prescription Drug Monitoring Program
Medical Marijuana

Oregon Opioid Prescribing Guidelines

The Oregon Medical Board endorsed these guidelines in January 2020.

Oregon Acute Opioid Prescribing Guidelines

The Oregon Medical Board endorsed these guidelines in January 2019.

Oregon Chronic Opioid Prescribing Guidelines

The Oregon Medical Board endorsed these guidelines in January 2017.

Additional Resources

BRAVO! A Collaborative Approach to Opioid Tapering – This booklet provides primary care providers with guidelines and tools to support them as they work with patients on long term opioid therapy. It is also intended to provide materials for academic detailing on tapering.
The Oregon Pain Guidance website provides pain management guidance and tools for healthcare professionals as well as patients and families.
The Oregon Prescription Drug Monitoring Program (PDMP) assists healthcare professionals in providing better patient care.
COPE (Collaborative Opioid Prescribing Education) Course – The University of Washington's free, online, interactive course promotes a shared decision-making approach between providers and patients.
The Federation of State Medical Boards' Opioids and Pain Management webpage offers numerous resources on state, federal, and FSMB opioid policies.

Note: The National Transportation Safety Board reminds health care providers to discuss with patients the effects that their medical conditions and medications may have on their ability to safely operate a vehicle in any mode of transportation.

Medication Assisted Treatment (MAT) for Opioid Addiction – Physician Assistants and Nurse Practitioners are now included among the healthcare professionals who may provide MAT for opioid addiction. More information is available on the Substance Abuse and Mental Health Services Administration (SAMHSA) website. All MAT providers must complete training and be granted a waiver by the DEA. The required 24-hour continuing education training is free and available through the Providers' Clinical Support System. For details about training requirements and exemptions, please see these FAQs.