1. (a) When opioids are started, the lowest effective dosage should be prescribed.
2. (b) APRNs should use caution when prescribing opioids at any dosage and carefully reassess evidence of individual benefits and risks when considering increasing dosage to greater than fifty (50) morphine milligram equivalents (MME) per day.
3. (c) APRNs should avoid increasing dosage to greater than ninety (90) MME per day or carefully justify a decision to titrate dosage to greater than ninety (90) MME per day.

4. (d) If opioids are prescribed at a level defined by the Centers for Disease Control and Prevention as excessive (greater than fifty (50) MME per day) the following shall be documented in the patient’s medical record:

   1. (1) Objective findings, which include, but are not limited to:

      1. (A) Imaging studies;
      2. (B) Lab testing and results;
      3. (C) Nerve conduction testing;
      4. (D) Biopsy; and
      5. (E) Any other test that would establish pain generating pathology;
   2. (2) Specific reasons for the need to prescribe greater than fifty (50) MME per day;
   3. (3) Documented alternative treatment plans as well as alternative therapies tried and failed prior to considering chronic opioid therapy;
   4. (4) Documented risk factor assessment detailing that the patient was informed of the risk and addictive nature of the prescribed drug;
   5. (5) Documented assessment of the potential for abuse and/or diversion of the prescribed drug;
   6. (6) Documented review of the Prescription Drug Monitoring Program report prior to issuing the prescription; and
   7. (7) A detailed clinical rationale for the prescribing.

Codification Notes: “APRN” means advanced practice registered nurse.