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As of Jan. 1, 2018, the dispensing of a controlled substance must be reported to the database no later than the close of the next business day. If a dispenser usually dispenses controlled substances in Florida but has no dispensing transactions to report for the preceding seven (7)-day period, the dispenser must report this information to E-FORCSE by filing a zero report, as described in the Dispenser’s Implementation Guide, which can be found at: https://flmd.us/dig. As many practitioners will be required under the new law to check the database for the first time, the following link will take you to the Department of Health’s website on accessing the E-FORCSE database: E-FORCSE Dispener Guide. You will need to establish an E-FORCSE account to log into the system. Access is granted to practitioners authorized to prescribe or dispense controlled substances so that they may look up, view and print controlled substance dispensing information on their specific patients. It should be noted that the DOH is required to issue a non-disciplinary citation to any prescriber or dispenser who fails to consult the database prior to prescribing or dispensing a controlled substance. For each subsequent offense, a practitioner is subject to discipline from their respective board. A practitioner who willfully and knowingly fails to report the dispensing of a controlled substance commits a misdemeanor of the first degree. This statute, enacted in 2011 as noted above, governs the prescribing of controlled substances in Florida for the treatment of “chronic nonmalignant pain.” HB 21 amends this statute to add a new section governing the prescribing of controlled substances for the treatment of “acute pain.” Acute pain is defined as “the normal, predicted, physiological, and time-limited response to an adverse chemical, thermal, or mechanical stimulus associated with surgery, trauma, or acute illness. After intense lobbying by the FMA and other groups, the Legislature exempted from this definition pain related to:• Cancer • A terminal condition (defined as a “progressive disease or medical or surgical condition that causes significant functional impairment, is not considered by a treating physician to be reversible without the administration of life-sustaining procedures, and will result in death within one year after diagnosis if the condition runs its normal course”) • Palliative care to provide relief of symptoms related to an incurable, progressive illness or injury; or• A traumatic injury with an Injury Severity Score of 9 or greater. The FMA expended a tremendous amount of effort attempting to add to this list pain related to major surgery. The governor’s office refused to accept this change and thus the exceptions to the definition of acute pain are limited to the four set forth above. This is important because of the limitation on controlled substance prescribing for acute pain contained in HB 21. The Florida Legislature, following the lead of the governor, set an arbitrary limit on the amount of opioids that could be prescribed for the treatment of acute pain. HB 21 provides that a prescription for a Schedule II opioid for the treatment of acute pain may not exceed a three-day supply. The legislation does allow a seven-day supply to be prescribed if: • More than a three-day supply is needed based on the professional judgment of the prescriber; • The prescriber indicates “ACUTE PAIN EXCEPTION” on the prescription; and • The prescriber documents in the medical records the acute medical condition and lack of alternative treatment options that justify deviation from the three-day supply limit. If a prescriber writes a prescription for a Schedule II opioid for the treatment of pain other than acute pain (i.e. for chronic non malignant pain, or for pain that is excluded from the definition of acute pain), the prescriber must indicate “NONACUTE PAIN” on the prescription. In addition, if the practitioner prescribes a Schedule II controlled substance for the treatment of pain related to a traumatic injury with a severity score of 9 or greater, the practitioner must concurrently prescribe an emergency opioid antagonist. Of note is the fact that the statute says a “Schedule II controlled substance” and not an “opioid drug listed as a Schedule II controlled substance.”
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