DEPARTMENT OF HEALTH

(Podiatric Medical Board)

[Filed January 17, 2020, 9:27 a.m., effective February 17, 2020]

Effective Date of Rule: Thirty-one days after filing.

Purpose: WAC 246-922-675 (podiatric physicians) Patient notification, secure storage, and disposal. The podiatric medical board (board) adopted amendments to establish patient notification, documentation, counseling requirements, and right to refuse an opioid prescription or order for any reason, when prescribing opioid drugs, as directed by SSB 5380 (chapter 314, Laws of 2019), codified as RCW 18.22.810.

Citation of Rules Affected by this Order: Amending WAC 246-922-675.

Statutory Authority for Adoption: RCW 18.22.005 and 18.22.015.

Other Authority: RCW 18.22.810.

Adopted under notice filed as WSR 19-21-159 on October 22, 2019.

A final cost-benefit analysis is available by contacting Susan Gragg, P.O. Box 47852, Olympia, WA 98504-7852, phone 360-236-4941, fax 360-236-2901, TTY 360-833-6388 or 711, email podiatric@doh.wa.gov, website www.doh.wa.gov.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 1, Repealed 0.

Number of Sections Adopted at the Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's own Initiative: New 0, Amended 0, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

Number of Sections Adopted using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 1, Repealed 0.

Date Adopted: December 5, 2019.

AMENDATORY SECTION(Amending WSR 18-20-085, filed 10/1/18, effective 11/1/18)

WAC 246-922-675Patient notification, secure storage, and disposal.

(1) The podiatric physician shall provide information to the patient educating them of risks associated with the use of opioids, including the risk of dependence and overdose, as appropriate to the medical condition, the type of patient, and the phase of treatment. The podiatric physician shall document such notification in the patient record.

(2) Patient notification must occur, at a minimum, at the following points of treatment:

(a) The first issuance of a prescription for an opioid; and

(b) The transition between phases of treatment, as follows:

(i) Acute nonoperative pain or acute perioperative pain to subacute pain; and

(ii) Subacute pain to chronic pain.

(3) Patient notification must also include information regarding:

(a) Pain management alternatives to opioid medications as stated in WAC 246-922-680;

(b) The safe and secure storage of opioid prescriptions; ((and

(b)))(c) The proper disposal of unused opioid medications including, but not limited to, the availability of recognized drug take-back programs; and

(d) The patient's right to refuse an opioid prescription or order for any reason. In accordance with RCW 18.22.810, if a patient indicates a desire not to receive an opioid, the podiatric physician must document the patient's request and avoid prescribing or ordering opioids, unless the request is revoked by the patient.

(4) ((The patient notification requirements in this section shall be deemed fulfilled by providing board-approved patient education information.))If a patient is under eighteen years old or is not competent, the discussion required in subsections (1) through (3) of this section must include the patient's parent, guardian, or the person identified in RCW 7.70.065, unless otherwise provided in law.

(5) As required in RCW 69.50.317 of the Uniform Controlled Substances Act, any practitioner who writes the first prescription for an opioid during the course of treatment to any patient must discuss a written copy of the warning language provided by the department under RCW 43.70.765.

(6) This section does not apply to:

(a) Opioid prescriptions issued for the treatment of pain associated with terminal cancer or other terminal diseases, or for palliative, hospice, or other end-of-life care or where the practitioner determines the health, well-being, or care of the patient would be compromised by the requirements of this section and documents such basis for the determination in the patient's health care record; or

(b) Administration of an opioid in an inpatient or outpatient treatment setting.

(7) To fulfill the requirements in this section, a podiatric physician may designate any individual who holds a credential issued by a disciplining authority under RCW 18.130.040 to provide the notification.