Pharmacology
State-Specific Opioid Guidelines or Recommendations
State: California
Organization: California Medical Association (CMA)
Website: https://www.cdph.ca.gov/Programs/CCDPHP/DCDIC/SACB/CDPH%20Document%20Library/Prescription%20Drug%20Overdose%20Program/PrescribingGuidelines4.26.17Compliant.pdf
Development: The CMA Opioid Prescribing Guidelines were developed by a workgroup of experts in pain management, addiction medicine, and public health. The guidelines were based on a review of the latest scientific evidence and were informed by input from clinicians, patients, and other stakeholders. The guidelines were first published in 2016 and are updated regularly.
Overview: The CMA Opioid Prescribing Guidelines provide recommendations for the safe and effective use of opioids for the treatment of acute and chronic pain. The guidelines cover a wide range of topics, including when to initiate opioid therapy, how to choose the right opioid and dose, and how to monitor patients for adverse effects. The guidelines also include recommendations for discontinuing opioid therapy when it is no longer necessary.
Other State Resources
Organization: California Department of Public Health (CDPH)
Website: https://www.cdph.ca.gov/Programs/CCDPHP/DCDIC/SACB/Pages/Opioids.aspx
Overview: The CDPH is leading the state's response to the opioid epidemic. The CDPH website provides a variety of resources for clinicians, patients, and the public, including:
- Information on the opioid epidemic in California
- Resources for preventing and treating opioid use disorder
- Links to state and federal opioid prescribing guidelines
Use of Opioids for Pain Management
When is the use of opioids appropriate?
Opioids are appropriate for the treatment of:
- Acute pain, such as pain from surgery or injury, for a short period of time (3-7 days)
- Severe chronic pain that has not responded to other treatments
For what duration should opioids be prescribed?
Opioids should be prescribed for the shortest possible duration necessary to achieve pain relief. For acute pain, opioids should be prescribed for no more than 3-7 days. For chronic pain, opioids should be prescribed for the shortest possible duration that is effective, with regular re-evaluation of the need for continued use.
Reference:
- Centers for Disease Control and Prevention. (2022). CDC guideline for prescribing opioids for chronic pain — United States, 2022. https://www.cdc.gov/drugoverdose/pdf/Guidelines_At-A-Glance-508.pdf
State-Specific Laws on Controlled Substance Prescribing for the Nurse Practitioner
Law: California Business and Professions Code, Division 2, Chapter 4.5, Article 2, Section 2836.5
Provisions of the law:
- Advanced practice nurses (APNs) in California may prescribe all schedules of controlled substances, including opioids.
- APNs must complete a course in pain management and pharmacology before prescribing controlled substances.
- APNs must register with the California Prescription Drug Monitoring Program (PDMP) and check the PDMP before prescribing any controlled substance.
- APNs must maintain documentation of their pain management assessments and treatment plans for all patients who are prescribed controlled substances.
State Prescription Drug Monitoring Program (PDMP)
Name of the state's program: California Prescription Drug Monitoring Program (CURES)
Website: https://www.ojp.gov/ncjrs/virtual-library/abstracts/prescription-drug-monitoring-program-california-state-profile
Registration requirements and process:
- All prescribers in California must register with CURES.
- Registration is free and can be done online.
- Once registered, prescribers will be given a user ID and password to access the CURES database.
Standards and procedures for the access and review of database information:
- Prescribers must check CURES before prescribing any controlled substance to a new patient.
- Prescribers must also check CURES for all patients who are prescribed controlled substances on a regular basis.
- CURES data can be used to identify patients who are at risk for opioid misuse, overdose, and other adverse events.
State-Specific Laws on Medical Device Prescribing for the Nurse Practitioner
Law: California Business and Professions Code, Division 2, Chapter 6.5, Article 6, Section 3036
Provisions of the law:
- APNs in California may prescribe all types of medical devices, including durable medical equipment (DME).
- APNs must complete a course in pharmacology before prescribing DME.
- APNs must maintain documentation of their medical device assessments and treatment plans for all patients who are prescribed DME.
Conditions or limits on prescribing medical devices or DME:
- APNs may prescribe DME for any condition that is within their scope of practice.
- APNs may not