Hawai’i Providers: Mandatory Opioid Prescription Requirements under Act 66

Published on: June 19, 2018

MIEC’s member providers in Hawai’i who prescribe opioid pain medications should be aware of a new state law which just went into effect this month. This new law imposes more stringent requirements around chronic pain management, patients who are also taking anti-anxiety medication, and/or patient who are on large dosages of opioids. Specific elements of the law are discussed below.

Under Hawai’i Act 66 (17), Relating to Heath, as of July 1, 2018, all providers authorized to prescribe opioids in Hawai’i must adopt a written policy that includes the execution of a written informed consent document when prescribing opioids to a “qualifying opioid therapy patient,” defined as follows:

Under Hawai’i Act 66 a qualifying opioid therapy patient is:

• A patient requiring opioid treatment for more than three (3) months;
• A patient who is prescribed benzodiazepines and opioids together; or
• A patient who is prescribed a cumulative dosage of opioids that exceeds ninety (90) morphine milligram equivalents (MME) daily.

Pursuant to Act 66, the Department of Health has issued a template informed consent document for opioid therapy, which can be found & downloaded here.

Additionally, Act 66 places new restrictions on concurrent prescriptions for opioids and benzodiazepines, as follows:

Initial concurrent prescriptions for opioids and benzodiazepines shall not be for longer than seven (7) consecutive days unless a supply of longer than seven days is determined to be medically necessary for the treatment of:

1. Pain experienced while the patient is in post-operative care;
2. Chronic pain and pain management;
3. Substance abuse or opioid or opiate dependence;
4. Cancer;
5. Pain experienced while the patient is in palliative care; or
6. Pain experienced while the patient is in hospice care, provided that the practitioner documents both the condition being treated and that alternative treatment was not appropriate for that condition.

Finally, Act 66 allows for practitioners to authorize refills of concurrent prescriptions for opioids and benzodiazepines via telephone conference, but only where the practitioner deems such action to be medically necessary, and provided that the practitioner consults with the patient in person at least once every ninety (90) days for the duration of the concurrent prescription.

MIEC recommends that all of our Hawai’i members who prescribe opioids familiarize themselves with the full text of Act 66 and begin adhering to these new requirements effective July 1, 2018.

If you have any additional questions about the requirements of Act 66 or MIEC’s recommendations around opioid prescribing, please contact us at (800) 227-4527 or patientsafetyriskmgmt@miec.com.