The podiatric physician shall comply with the requirements in this section when prescribing opioid analgesics for subacute pain and shall document completion of these requirements in the patient record:

1. (1) Prior to prescribing an opioid for subacute pain, the podiatric physician shall:

   1. (a) Conduct an appropriate history and physical examination or review and update the patient's existing history and examination taken during the acute nonoperative or acute perioperative phase;
   2. (b) Evaluate the nature and intensity of the pain;
   3. (c) Inquire about other medications the patient is prescribed or is taking, including type, dosage, and quantity prescribed;
   4. (d) Conduct, or cause his or her authorized designee to conduct, a query of the PMP in accordance with provisions of WAC 246-922-790 and document the review and any concerns in the patient record;
   5. (e) Screen and document the patient's potential for high-risk behavior and adverse events related to opioid therapy. If the podiatric physician determines the patient is high-risk, consider lower dose therapy, shorter intervals between prescriptions, more frequent visits, increased biological specimen testing, and prescribing rescue naloxone;
   6. (f) Obtain a biological specimen test if the patient's function is deteriorating or if pain is escalating;
   7. (g) Screen or refer the patient for further consultation for psychosocial factors which may be impairing recovery including, but not limited to, depression or anxiety.

2. (2) The podiatric physician treating a patient for subacute pain with opioids shall ensure that, at a minimum, the following are documented in the patient record:

   1. (a) The presence of one or more recognized diagnoses or indications for the use of opioid pain medication;
   2. (b) The observed or reported improvement in function or pain control forming the basis to continue prescribing opioid analgesics beyond the acute pain episode;
   3. (c) The result of any queries of the PMP and any concerns the podiatric physician may have;
   4. (d) All medications the patient is known to be prescribed or taking;
   5. (e) An appropriate pain treatment plan, including the consideration of, or attempts to use, nonpharmacological modalities and nonopioid therapy;
   6. (f) Results of any aberrant biological specimen testing results and the risk-benefit analysis if opioids are to be continued;
   7. (g) Results of screening or referral for further consultation for psychosocial factors which may be impairing recovery including, but not limited to, depression or anxiety;
   8. (h) Results of screening for the patient's level of risk for aberrant behavior and adverse events related to opioid therapy;
   9. (i) The risk-benefit analysis conducted if opioids and any of the medications listed in WAC 246-922-775(1) are prescribed concurrently; and
   10. (j) All other required components of the patient record, as established in statute or rule.

3. (3) Follow-up visits for pain control must include objectives or metrics to be used to determine treatment success if opioids are to be continued. This may include:

   1. (a) Change in pain level;
   2. (b) Change in physical function;
   3. (c) Change in psychosocial function; and
   4. (d) Additional planned diagnostic evaluations or other treatments.

[Statutory Authority: RCW 18.22.005, 18.22.015, 18.22.800, and 2017 c 297. WSR 18-20-085, § 246-922-705, filed 10/1/18, effective 11/1/18.]