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Fewer members using opioids - those who are, are using less
The Department of Health Care Policy and Financing (the Department) has implemented and plans to continue to implement policies designed to impact the opioid overdose epidemic. The objective of this page is to provide a central source for Department opioid policy information, resources regarding pain management and opioid prescribing for the provider, member pain management resources, and additional related information. The Department is following the lead of the Colorado Consortium for Prescription Drug Abuse Prevention in reducing the misuse of prescription opioids. In order to support this Governor-assigned task force the currently implemented policies describing limitations on morphine milligram equivalents (MME), short acting opioid pill quantities, early interruption of opioid dosing escalations, and dental provider specific policies are briefly listed:
Through these policies, the Department is attempting to reduce potentially inappropriate opioid utilization, high risk/high dose prescribing, and reduce unnecessary escalation to higher dose opioid utilization. Recognizing there are special needs and necessity for individual assessment for many members, the Department provides provider-provider consults with a pain management specialist free of charge to the provider and member and are available by request (firstname.lastname@example.org). Compassionate pain management and opioid safety are important to the Department and the consult service provides an additional expert evaluation of safety and efficacy of members' pain management regimens.
The Department strongly encourages the provider use the Prescription Drug Monitoring Program when prescribing controlled substances to all members.
Courtesy of National Safety Council on Acute Pain:
The Department continues to advance toward its goal of 120 MME without a specific time mentioned in the policy. The policy document initially identifying the MME limitations can be found here:
MME for opioid prescriptions are counted in a cumulative manner. If a single prescription for an opioid exceeds the MME limit, then it will require prior authorization. If multiple different opioid prescriptions are provided, then the MME for each will be added until the prescription that exceeds the MME limit will require prior authorization. The morphine equivalence calculator the Department bases their calculations on can be found here:
Prescription Drug Monitoring Program (PDMP): Health First Colorado strongly recommends using the PDMP when precribing controlled substances. Signing up is incredibly easy.
Additional Information on the Tapering and Discontinuing of Opioids:
HCPF is not recommending this calculator to be used as a reference for converting a patient from one opioid to another, conversion is a complex process and we recommend consulting a specialist. The reference calculator is provided as it is the source of opioid milligram equivalents quantification used by HCPF. Please exercise great caution when converting patients from one opioid to another as issues of cross-tolerance and agent pharmacokinetics can create a potentially life-threatening situation. If a telephone consult is needed with a pain management physician (free of charge for Medicaid members), please email SSPPS.email@example.com.
Naloxone rescue product coverage is published in the Appendix P
Substance Abuse and Mental Health Services Administration (SAMHSA) Resources
Additional Training and Resources: