January 18, 2019, Wisconsin Medical Society Medigram
The State of Wisconsin Medical Examining Board modified the Opioid Prescribing Guideline at its monthly meeting in Madison on Wednesday. Expressing a desire to be less proscriptive in the “Discontinuing Opioid Therapy” section of the guideline, the Board has removed specific clinical suggestions for situations when opioid therapy leads to evidence of addiction risk or is proving ineffective.
The section’s first two subsections have been shortened, while the third section remains the same:
Discontinuing Opioid Therapy
- If lack of efficacy of opioid therapy is determined, safe discontinuation of opioid therapy should be performed.
- If evidence of increased risk develops, safe discontinuation of opioid therapy should be considered.
- If evidence emerges that indicates that the opioids put a patient at the risk of imminent danger (overdose, addiction, etc.), or that they are being diverted, opioids should be immediately discontinued and the patient should be treated for withdrawal, if needed. Exceptions to abrupt opioid discontinuation include patients with unstable angina and pregnant patients. These patients should be weaned from the opioid medications in a gradual manner with close follow-up.
The Board also added a new general provision near the top of the overall guideline:
2. It is best practice for a practitioner to consider guidelines within their specialty when prescribing opioids.
The remaining guideline provisions were renumbered to reflect this addition. The new guideline became effective upon Wednesday’s vote approving the changes.
In other action, the MEB elected its leaders for 2019. They are the same as in 2018, with Ken Simons, MD, reelected chair, Tim Westlake, MD, as vice chair and Mary Jo Capodice, DO, as secretary.