Pain Management Resources and Opioid Use

• 2/1/2016: MME limitation was initially implemented at 300MME
• 10/1/2017: MME decreased from 300MME to 250MME
• 11/1/2018: MME decreased from 250MME to 200ME

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:

• Morphine Milligram Equivalents Policy

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:

• Morphine Equivalent Conversion Table

• Opioid Policy Update Frequently Asked Questions for Members
• Opioid Policy Update FAQs for Providers

Courtesy of National Safety Council on Acute Pain:

Prescription Drug Monitoring Program (PDMP): Health First Colorado strongly recommends using the PDMP when prescribing controlled substances. Signing up is incredibly easy.

Practice Guidelines:

• Colorado Department of Regulatory Agencies 2019 Revised Opioid Guidelines
• CDC guideline for prescribing opioids for chronic pain
• CDC Advises Against Misapplication of the Guideline for Prescribing Opioids for Chronic Pain
• Washington State Agency Medical Directors’ Group (AMDG)

Additional Information on the Tapering and Discontinuing of Opioids:

Disclaimer

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.co-dur@ucdenver.edu.

• VA Tapering and Discontinuing Opioids Fact Sheet

Additional Information:

• National Safety Council's: The Psychological and Physical Side Effects of Pain Medications
• Mathematics of Pain Relief
• Pharmacological Treatments for Neonatal Abstinence Syndrome
• Annals of Internal Medicine: Patient Outcomes in Dose Reduction or Discontinuation of Long-Term Opioid Therapy: A Systematic Review
• Colorado Drug Utilization Review (DUR) Newsletters
• National Safety Council's: Evidence for the Efficacy of Pain Medications (OTC vs. Opioids)

Courtesy of National Safety Council on Acute Pain:

• HB19-1287: Treatment For Opioids And Substance Use Disorders, concerning methods to increase access to treatment for behavioral health disorders, and, in connection therewith, making an appropriation.
• SB19-013: Medical Marijuana Condition Opiates Prescribed For, concerning the conditions for medical marijuana use for disabling medical conditions, and, in connection therewith, adding a condition for which a physician could prescribe an opioid to the list of disabling medical conditions for medical marijuana use.
• SB19-227: Harm Reduction Substance Use Disorders, concerning the identification of certain individuals with a substance use disorder; and making an appropriation.
• SB19-228: Substance Use Disorders Prevention Measures, concerning the safe use, storage, and disposal of antagonist drugs; and making an appropriation.
• HB18-1007: Substance Use Disorder Payment And Coverage, concerning payment issues related to substance use disorders.
• SB18-022: Clinical Practice For Opioid Prescribing, concerning clinical practice measures for safer opioid prescribing.
• SB18-168: Medicaid-assisted Treatment Through Pharmacies, concerning payment reform in the medical assistance program to provide access to medication-assisted treatment for the prevention of relapse for persons suffering from substance use disorders.
• HB18-1003: Opioid Misuse Prevention, concerning measures to prevent opioid misuse in Colorado, and, in connection therewith, making an appropriation.

Federal

• H.R.6: SUPPORT for Patients and Communities Act

Naloxone rescue product coverage is published in the Appendix P

• Nasal Narcan and Prefilled naloxone syringe with nasal atomizer are available without prior authorization.

Substance Abuse and Mental Health Services Administration (SAMHSA) Resources

• 5 Essential Steps to First Responders
• Safety Advice for Patients and Family Members

Additional Training and Resources:

• Get Naloxone Now: Online interactive trainings for community members/first responders on naloxone administration
• Prescribe to Prevent: Information for prescribers, pharmacists and community members
• How to Administer Nasal Spray Naloxone

• Find a Pharmacy that Provides Naloxone and Nasal Atomizers

• CDC Opioid Fact Sheet
• CDC Patient Information Page for Opioids
• American Hospital Association (AHA) - What you need to know
• American Academy of Family Physicians (AAFP) - Pain Management and Opioid Abuse Resources
• Medication Safe Use and Disposal Pamphlet
• List of Pain Relief Medications
• Please refer to the respective Regional Accountable Entity (RAE) for additional help connecting with care and information

• Pharmacological Coverage for Medication Assisted Treatment (MAT) can be found on the Appendix P
• Medicaid Behavioral Health Organizations Services
• Peer Assistance Services
• Substance Abuse and Mental Health Services Administration
• NIH National Institute on Drug Abuse
• The National Alliance for Advocates for Buprenorphine Treatment's Clinical Opiate Withdrawal Scale

• Screening, Brief Intervention and Referral to Treatment SBIRT Billing Manual 
• Behavioral Health Services
• Physical Therapy (PT) /Occupational Therapy (OT), massage in conjunction with PT/OT
• Colorado 1500 Specialty Manual (Mental Health Program)