844 IAC 5-6-8 - Drug monitoring testing
Authority: IC 25-22.5-2-7; IC 25-22.5-13-2
Affected: IC 25-1-9; IC 25-22.5
Sec. 8.
(a) At any
time the physician determines that it is medically necessary, whether at the
outset of an opioid treatment plan, or any time thereafter, a physician
prescribing opioids for a patient shall perform or order a drug monitoring
test, which must include a confirmatory test using a method selective enough to
differentiate individual drugs within a drug class, on the patient.
(b) In determining whether a drug monitoring
test under subsection (a) is medically necessary, the physician shall consider,
subject to the provisions of subsection (c), each of the following factors
where applicable and reasonably feasible:
(1)
Whether there is reason to believe a patient is not taking the prescribed
opioids or is diverting the opioids.
(2) Whether there has been no appreciable
impact on the patient's chronic pain despite being prescribed opioids for a
period of time that would generally have an impact.
(3) Whether there is reason to believe the
patient is taking or using controlled substances other than opioids or other
drugs or medications including illicit street drugs that might produce
significant polypharmacological effects or have other detrimental interaction
effects.
(4) Whether there is
reason to believe the patient is taking or using opioids in addition to the
opioids being prescribed by the physician and any other treating
physicians.
(5) Attempts by the
patient to obtain early refills of opioid containing prescriptions.
(6) The number of instances in which the
patient alleges that the patient's opioid containing prescription has been lost
or stolen.
(7) When the patient's
INSPECT report provides irregular or inconsistent information.
(8) When a previous drug monitoring test
conducted on the patient raised concerns about the patient's usage of
opioids.
(9) Necessity of verifying
that the patient no longer has substances in the patient's system that are not
appropriate under the patient's treatment plan.
(10) When the patient engages in apparent
aberrant behaviors or shows apparent intoxication.
(11) When the patient's opioid usage shows an
unauthorized dose escalation.
(12)
When the patient is reluctant to change medications or is demanding certain
medications.
(13) When the patient
refuses to participate in or cooperate with a full diagnostic workup or
examination.
(14) Whether a patient
has a history of substance abuse.
(15) When the patient has a health status
change (for example, pregnancy).
(16) Co-morbid psychiatric
diagnoses.
(17) Other evidence of
chronic opioid use, controlled substance abuse or misuse, illegal drug use or
addiction, or medication noncompliance.
(18) Any other factor the physician believes
is relevant to making an informed professional judgment about the medical
necessity of a prescription.
(c) It shall not be considered a violation of
this section for a physician to fail to conduct a review of all eighteen (18)
factors listed in subsection (b) if the physician reasonably determines
following a review of less than all of the factors listed in subsection (b)
that a drug monitoring test is medically necessary.
(d) Nothing about subsection (b) shall be
construed to prohibit the physician from performing or ordering a drug
monitoring test at any other time the physician considers
appropriate.
(e) If a test
performed under subsection (a), or conducted under subsection (d), reveals
inconsistent medication use patterns or the presence of illicit substances, a
review of the current treatment plan shall be required. Documentation of the
revised treatment plan and discussion with the patient must be recorded in the
patient's chart.
Notes
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