(A) For the treatment of acute pain, the dentist shall comply with the following:
(1) Extended-release or long-acting opioid analgesics shall not be prescribed for treatment of acute pain;
(2) Before prescribing an opioid analgesic, the dentist shall first consider non-opioid treatment options. If opioid analgesics are required as determined by a patient history and clinical examination, the dentist shall prescribe for the minimum quantity and potency needed to treat the expected duration of pain, with a presumption that a three-day supply or less is frequently sufficient and that limiting the duration of opioid use to the necessary period will decrease the likelihood of subsequent chronic use or dependence.
(3) In all circumstances where opioid anangesics are prescribed for acute pain:
(a) Except as provided in paragraph (B) of this rule, the first opioid analgesic prescription for the treatment of an episode of acute pain shall be:
(i) For adults, not more than a seven-day supply with no refills;
(ii) For minors, not more than a five-day supply with no refills. A dentist shall comply with section 3719.061 of the Revised Code, including but not limited to obtaining the parent or guardian's written consent prior to prescribing an opioid analgesic to a minor;
(iii) The seven-day limit for adults and five-day limit for minors may be exceeded for pain that is expected to persist for longer than seven days based on the pathology causing the pain. In this circumstance, the reason that the limits are being exceeded and the reason that a non-opioid medication was not appropriate to treat the patient's conditions shall be documented in the patient's record; the number of days of the prescription shall not exceed the amount required to treat the expected duration of the pain as noted in paragraph (A)(2) of this rule; and
(iv) If a patient is allergic to or otherwise unable to tolerate the initial prescribed opioid medication, a prescription for a different, appropriate opioid may be issued at any time during the initial seven or five-day dosing period and shall be subject to all other provisions of this rule. The allergy and/or intolerance shall be documented in the patient's record. The patient or the minor patients, parent, guardian or other responsible adult must be provided education of the safe disposal of the unused medication.
(b) The patient, or a minor's parent or guardian, shall be advised of the benefits and risks of the opioid analgesic, including the potential for addiction, and the advice shall be documented in the patient's record; and
(c) The total morphine equivalent dose (MED) of a prescription for opioid analgesics for treatment of acute pain shall not exceed an average of thirty MED per day, except when all of the following apply:
(i) The patient has significant and prolonged acute pain related to one of the following conditions:
(a) Traumatic oro-facial tissue injury with major mandibular/ maxillary surgical procedures;
(b) Severe cellulitis of facial planes; or
(c) Severely impacted teeth with facial space infection necessitating surgical management.
(ii) The dentist determines that, for the seventy-two hour period following the procedure, it is absolutely necessary to exceed the 30 MED daily limit based on the patient's needs but may not exceed ninety MED per day.
(iii) The dentist has documented the reason for exceeding the thirty MED average in the patient record and why it is the lowest dose consistent with the patient's medical condition.
(iv) In circumstances when the thirty MED average is exceeded, the dose shall not exceed the dose required to treat the severity for the pain as noted in paragraph (A)(2) of this rule and furthermore, the dose will not exceed ninety MED per day within the initial seventy-two hour period as noted in paragraph (c)(ii) of this rule.
(d) Prescriptions which exceed the five or seven day supply or thirty MED average daily dose are subject to additional review by the board.
(e) All prescriptions for opioid analgesics for the treatment of acute pain shall comply with rules 4729-5-13 and 4729-5-30 of the Administrative Code and all other federal and state controlled substance laws, rules and regulations.
(B) The requirements of paragraph (A) of this rule apply to treatment of acute pain, and do not apply when an opioid analgesic is prescribed:
(1) To an individual who is a hospice patient or in a hospice care program;
(2) To an individual receiving palliative care;
(3) To an individual who has been diagnosed with a terminal condition;
(4) To an individual who has cancer or another condition associated with the individual's cancer or history of cancer; or
(5) To an individual undergoing medication-assisted treatment for a substance use disorder.
(C) This rule does not apply to prescriptions for opioid analgesics for the treatment of opioid addiction utilizing a schedule III, IV or V controlled substance narcotic that is approved by the federal drug administration for opioid detoxification or maintenance treatment.
(D) This rule does not apply to inpatient prescriptions as defined in rule 4729-17-01 of the Administrative Code.