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Non-Cancer Pain Management
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NMNPC recorded 5 presentations on non-cancer pain management  offered at our 2015 annual conference. As noted below, CE covering non-cancer pain management is required for license renewal. We'll offer an independent learning CE program on DVD (currently in production) for those unable to attend the conference and will post purchase information here when the program is available in June. If you have questions before then, please email us at contact@NMNPC.org. 

What You Need to Know

Questions and misunderstandings surrounded the provision in the amended Pain Relief Act requiring non-cancer pain management continuing education (CE) for nurse practitioners and other providers. Other provisions in the amended Act also raised questions. In response, NMNPC actively sought answers to some of the questions raised by our members and other advanced practice nurses (APNs). You'll find that information on this page. To summarize up front, we suggest that to understand and meet the new requirements APNs should:

♦ Read the amendment to the Pain Relief Act (it's short).

♦ Become familiar with the requirements in the amended nursing Rule 9 (became effective November 20, 2012).

♦ Obtain the required pain management CE before applying for license renewal. (You will be able to purchase an independent learning CE program in a DVD set covering the required content from NMNPC in June, 2015. When the program is available, NMNPC will post purchase information here.)
♦ Be sure your PMP registration is active before applying for renewal of a controlled substance license.

♦ Learn how to participate in PMP inquiry and reporting by reviewing the instructions and manual.

♦ Become familiar with the new Board of Pharmacy rules on prescribing controlled substances.
To jump directly to more information, click on the links below:

Background Summary

  • During the 2012 New Mexico legislative session, legislators passed Senate Bill 215, amending the 1999 Pain Relief Act.
  • The amendment created the Prescription Drug Misuse and Overdose Prevention and Pain Management Advisory Council (hereafter called the Advisory Council). The Advisory Council:
    ♦ Includes representatives from statewide professional organizations (including NMNPC) and other health care stakeholders.

    ♦ Meets at least quarterly and is administratively attached to the Department of Health (DOH).

    ♦ Reviews prescription drug misuse, overdose prevention, and current pain management practices in New Mexico.

    ♦ Reviews prescription drug misuse, overdose prevention, pain management standards, and educational efforts at the national level.
  • The amendment directs licensing boards to require non-cancer pain management continuing education (CE).
    ♦ Each board must develop CE rules for the health care providers under the board's jurisdiction who hold a federal Drug Enforcement Administration (DEA) registration and licensure to prescribe opioids (Controlled Substance License).

    ♦ Some affected boards (including the New Mexico Board of Nursing - NMBON) have already developed the CE rules and others are currently working to do so.

    ♦ A June 2012 letter sent by the New Mexico Medical Board (NMMB) to physicians and physician assistants addressed the CE issue. Some NPs attended meetings held by hospitals and clinics to discuss that letter, getting the impression that it applied to them. This was only partly accurate - the amended Act is applicable to NPs, but NPs are under the rules of the NMBON, not the NMMB rule discussed in their letter.
  • Some rules developed (or being developed) by affected boards require licensees to register and participate in the New Mexico Board of Pharmacy Prescription Monitoring Program (PMP).
  • The amendment to the Act has resulted in action by the Board of Pharmacy to institute new rules (now in effect) governing controlled substance prescribing.

What Are the Board of Nursing Requirements?

  • The New Mexio Board of Nursing (NMBON) has adopted an amended Rules Part 9: Management of Chronic Pain With Controlled Substances.
  • The amended Rule 9 took effect on November 20, 2012 and applies to all advanced practice nurses (APNs) licensed by the NMBON who hold DEA registration and are licensed to prescribe opioids (Controlled Substance License).
  • Changes in Rule 9 include:
    New governing rules replaced guidelines for how the NMBON will determine whether a health care practitioner’s prescriptive practices are consistent with the appropriate treatment of pain.

    ♦ Requirements that all APNs must now register with the Board of Pharmacy PMP and become regular participants in PMP inquiry and reporting activities.

    ♦ A new requirement for 5 hours of non-cancer pain management CE to be included in the current 15 hours of pharmacology CE needed every 2 years.

    Identification of specific topic areas required for the 5 hours of newly-required CE:
    Review of the rule (16.12.9 NMAC - Rule 9)) for management of non-cancer pain.

    Understanding of the pharmacology and risks of controlled substances.

    Basic awareness of the problems of abuse, addiction and diversion.

    Awareness of state and federal regulations for the prescription of controlled substances.
  • According to communication from the NMBON, they expect any APN renewing a license after November 20, 2012 to comply with the new CE requirement, but will require the APN to submit evidence of the CE only if audited.

Are CE Courses That Comply With Rule 9 Available?

  • NMNPC included a 5 hour track at our 2015 annual conference on April 29. This non-cancer pain management track included content on all topic areas required in the NMBON CE rule and we recorded those presentations. We will make these recordings available for purchase in a DVD set. The DVD set will be available in June.
  • The NMBON website includes a link to a pain management course developed by the UNM Pain Consultation and Treatment Center in collaboration with the UNM Office of Continuing Medical Education. Although the NMMB recognized the course as fulfilling their CE requirement, it's not clear if the course includes the required content on the nursing Rule 9 applicable to APNs in New Mexico. However, to the best of our knowledge, the NMBON will accept this course as meeting the nursing rule requirement if APNs also read Rule 9. A communication recieved from the NMBON stated that APNs must be able to justify how non-approved CE enhanced nursing practice. In order to comply with the requirement for the specific content on Rule 9, we believe APNs will need to justify how reading Rule 9 (a non-approved CE activity) enhanced nursing practice.
  • The NMBON recognized the pain management CE course NMNPC developed in 2013 as meeting the requirements of Rule 9 and we will ask them to again recognize our new CE course currently in production (available in June).
  • Other CE courses are available online through various organizations; many would require combining two or more courses to meet all the requirements of Rule 9. We encourage anyone making course choices to compare the content to the list of CE topics listed in Rule 9 to verify that those courses include all the required content. Also keep in mind that most of these courses would not include content on Rule 9 because it is specific to New Mexico. In those cases, the information above regarding reading Rule 9 would be applicable.

What About the PMP and New Board of Pharmacy Rules?

  • All APNs with DEA and controlled substance licensure must register with the PMP. There is a link on the right of this page to the PMP registration site.
  • There are instructions and a manual for the PMP available that can help APNs understand how to meet the Rule 9 requirement to become a regular participant in PMP inquiry and reporting. For example, once registered with the PMP, APNs will have the ability to obtain and review a prescription monitoring report from the PMP prior to prescribing a controlled substance to an individual (one new requirement included in Rule 9). These reports can provide information on whether the individual is receiving opiates from multiple prescribers, has been getting opiates for more than 12 consecutive weeks, is on more than one controlled substance, or has evidence of early refills, for example.
  • The New Mexico Board of Pharmacy (NMBOP) made changes to the PMP and the Controlled Substances rules, published in the New Mexico Register on August 15, 2012 and now in effect. These changes apply to practitioners holding controlled substance registrations with the NMBOP.
  • APNs already registered with the PMP can renew their controlled substance registrations but the NMBOP will not issue renewals until they verify practitioners' PMP registration. APNs not yet registered with the PMP should register now to meet the requirement of Rule 9 and to be able to apply for controlled substance renewal.
  • The NMBOP does not require practitioners who issue controlled substance prescriptions to patients or administer controlled substances in the practice setting to report these activities to the PMP.
  • The NMBOP does require reporting to the PMP under certain circumstances for practitioners who dispense controlled substances directly to their patients.
  • There are changes in the NMBOP rules governing new telephone prescriptions for any schedule III, IV, or V opiate.

What is the Bottom Line?

In the interests of patient safety and appropriate practice, all APNs who prescribe controlled substances should understand the new requirements of the amended Pain Relief Act and comply with those requirements. To assist in understanding and meeting the requirements:

♦ Read the amendment to the Pain Relief Act (it's short).

♦ Become familiar with the requirements in the amended nursing Rule 9 (became effective November 20, 2012).

♦ Obtain the required pain management CE before applying for license renewal. (You will be able to purchase an independent learning CE program in a DVD set covering the required content from NMNPC in June, 2015. When the program is available, NMNPC will post purchase information here.)

♦ Be sure your PMP registration is active before applying for renewal of a controlled substance license.

♦ Learn how to participate in PMP inquiry and reporting by reviewing the instructions and manual.

♦ Become familiar with the new Board of Pharmacy rules on prescribing controlled substances.

For further details and information, use the links on the right of this page to access relevant documents, websites, and courses.

DISCLAIMER: After careful study of the relevant documents and communication with the New Mexico Board of Nursing, the information on this page is accurate to the best of our knowledge. However, please note that all authority for determining how the New Mexico Board of Nursing interprets and implements Rule 9 rests with that Board and we urge APNs with further questions or concerns to contact the Board directly.

 

 

 

 

Documents

Websites

Pain Management CE Course

  • NMNPC is developing an updated DVD independent learning activity on non-cancer pain management that will be available for purchase in June, 2015.

Advisory Council Reports

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