Subject of Possible Rule Making: Osteopathic physicians and surgeons general provision for opioid prescribing and tapering rules. The board of osteopathic medicine and surgery (board) is considering amending WAC 246-853-661 Exclusions, 246-853-730 Periodic review, and 246-853-755 Tapering requirements, to modernize the language, add clarity, and align rules with the Washington medical commission (WMC).

Reasons Why Rules on this Subject may be Needed and What They Might Accomplish: On November 3, 2022, the Centers for Disease Control and Prevention (CDC) released an update to their 2016 "Clinical Practice Guideline for Prescribing Opioids for Chronic Pain," entitled "CDC Clinical Practice Guideline for Prescribing Opioids for Pain" (guideline). The guideline expands its scope to include opioid prescribing for all pain (with certain exemptions). As such, the guideline more closely parallels the Washington state opioid prescribing rules developed in 2017-2018 and implemented in January of 2019, mandated by ESHB 1427 (chapter 297, Laws of 2017), and covering all Washington state opioid prescriber groups, including all allopathic physicians and physician assistants overseen by WMC. However, there are some differences.

WMC contracted with Gregory Terman, MD, who is a former pro tempore commissioner of WMC, as well as a professor of anesthesiology and pain medicine at the University of Washington in Seattle, to do a comprehensive comparison of WMC's opioid prescribing rules covering physicians (WAC 246-919-850 through 246-919-990) and physician assistants (WAC 246-918-800 through 246-918-835) to the guideline. Dr. Terman was also asked to recommend changes to WMC's opioid prescribing rules based on the differences found between WMC's opioid prescribing rules and the guideline. Dr. Terman provided WMC with a report, titled "Comparing and Contrasting the 2022 CDC Opioid Prescribing Guideline and the 2019 Washington State Prescribing Rules" (report). Based on the recommendations in the report, WMC voted to initiate rule making on the following items:

As a result, WMC filed a CR-101 under WSR 23-17-094 on August 16, 2023, to consider rule amendments to opioid prescribing rules for allopathic physicians based on recent updates to CDC opioid prescribing recommendations. The board works to remain consistent with WMC, as osteopathic physicians and allopathic physicians regularly provide care in the same settings. Maintaining consistency with WMC makes rules easier to apply standards in the complex health care regulatory environment and for licensees to understand.

The board is considering rule making to work with interested parties and the public to possibly revise the following WAC to address those three items: WAC 246-853-661 Exclusions, 246-853-730 Periodic review, and 246-853-755 Tapering requirements.

Rules on this subject may be needed to allow patients with sickle cell disease [to] receive the care they need in an efficient manner, provide osteopathic physicians and surgeons more clarity on when and how to taper patients to whom they prescribe opioids for chronic pain, and will provide rules that address how to work with patients that have an aberrant biological specimen test.

Interested parties can participate in the decision to adopt the new rule and formulation of the proposed rule before publication by contacting Becky McElhiney, P.O. Box 47852, Olympia, WA 98504-7852, phone 360-236-4766, fax 360-236-2901, TTY 711, email osteopathic@doh.wa.gov, website https://doh.wa.gov/licenses-permits-andcertificates/professions-new-renew-or-update/osteopathicphysician-and-surgeon.

Additional comments: Interested parties can participate in the drafting of the proposed rules. The board will be conducting rules workshops with interested parties and subject matter experts. The board will use existing GovDelivery lists and other known contact information to inform interested parties of opportunities to provide input on proposed rule language. To find out more information about our rule making, visit www.doh.wa.gov. To subscribe to GovDelivery, please visit https://public.govdelivery.com/accounts/WADOH/subscriber/new?topic_id=WADOH_153 and select "Osteopathic Board."