The Ohio Board of Nursing, Medicine, Dentistry and Pharmacy promulgated rules for prescribing opioid analgesic.  The Board of Nursing rules address prescribing in Chapter 4723-9, Ohio Administrative Code (OAC), and the regulations for prescribing opioids for acute, sub-acute, and chronic pain, are specifically in Rule 4723-9-10, OAC.

• OAC 4723-9

The Exclusionary Formulary below was recommended by the Committee on Prescriptive Governance and adopted by the Board of Nursing in accordance with Sub. HB 216.  It identifies the drugs that CNS, CNP and CNMs are prohibited from prescribing.  The previous formulary that listed drugs with prescribing parameters is no longer in effect. CNS, CNP, and CNMs must prescribe pursuant to the standard care agreement with their collaborating physician, consistent with their APRNs national certification and according to state and federal law. 

The Committee on Prescriptive Governance (CPG) reviews new drugs to determine whether the drugs should be listed on the Exclusionary Formulary.  Download the PDF’s below to review the Exclusionary Formulary, view the flow chart for prescribing, and learn about the CPG review.

• Exclusionary Formulary, Adopted September, 2019
• New Drugs Reviewed by CPG 11/2018
• New Drugs Reviewed by CPG 9/2019

• APRN Prescribing Process Flowchart

Pharmacy Board Rule 4729-5-30, OAC and Nursing Board Rule 4723-9-10, OAC, require APRN prescribers (CNSs, CNMs, CNPs) to include, at minimum, the first four alphanumeric characters (ex. M16.5) of the ICD-10 medical diagnosis code on controlled substance prescriptions (sometimes referred to as the category and etiology). This information will be entered by the pharmacy into Ohio’s prescription monitoring program known as OARRS.

• Issuing a Valid Prescription – What Every Prescriber Needs to Know
• Requirements for Outpatient Opioid Prescriptions (for Pharmacists)
• Reporting Naltrexone Products to OARRS

The U.S Department of Justice and the Drug Enforcement Agency’s Diversion Control Division provides prescribers the resources needed for DEA Registration.  You can find it at the link below.

• Diversion Control Division Registration

• Ohio Automated Rx Reporting System (OARRS)
• OARRS Account Update and Delegate Reverification Workflow Process – New process requiring biannual verification of account details and delegates will ensure accuracy and security of OARRS data. See Announcement.

Take Charge Ohio is an initiative to help use pain medication safely to minimize the risk of drug misuse, dependency and addiction by offering prescribers and healthcare professionals resources and tools to educate patients on safe medication and pain management practices.  Visit http://www.takechargeohio.org/

Resolution Regarding NTSB Recommendations

The National Transportation Safety Board (NTSB) is the federal agency responsible for the investigation of accidents in aviation and other forms of transportation. Last year, the NTSB published a safety study that focused on toxicology tests of fatally injured pilots. As a result of the study, the NTSB issued two recommendations to the state of Ohio:

(1) Include in all state guidelines regarding prescribing controlled substances for pain a recommendation that health care providers discuss with patients the effect their medical condition and medication use may have on their ability to safely operate a vehicle in any mode of transportation. (I-14-1)

(2) Use existing newsletters or other routine forms of communication with licensed health care providers and pharmacists to highlight the importance of routinely discussing with patients the effect their diagnosed medical conditions or recommended drugs may have on their ability to safely operate a vehicle in any mode of transportation. (I-14-2)

The National Transportation Safety Board (NTSB) issued recommendations to the state of Ohio as a result of a NTSB safety study. As part of implementing the recommendations, the Board adopted a Resolution regarding prescribers and health care providers discussing with patients the effect their medical conditions and medication use may have on their ability to safely operate a vehicle in any mode of transportation.

• Download the Resolution