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Non-Cancer Pain Management
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Click here to purchase the DVD set that includes NMNPC's approved independent learning CE programs:

Non-Cancer Pain Management
and
Bonus Pharmacology

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. Click here to purchase the approved CE program available in a DVD set from NMNPC.

♦ Register with the PMP now, 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 as part of "pharmacology day" at our 2013 annual conference in Santa Fe on April 12. The non-cancer pain management track included content on all topic areas required in the NMBON CE rule and we recorded those presentations. We have made these recordings available for purchase as an approved CE program that meets the requirements of the new rule in a DVD set: Non-Cancer Pain Management and Bonus Pharmacology. Participants in this CE activity may elect to take the post-test for the non-cancer pain management presentations only, the bonus pharmacology presentations only, or both. Go to our Online Storeto purchase the DVD.
    Non-Cancer Pain Management is approved for 5.0 contact hours of continuing education (which includes 5.0 hours of pharmacology) by the American Association of Nurse Practitioners. Program ID 1304153. This program was planned in accordance with AANP CE Standards and Policies and AANP Commercial Support Standards.

    Pharmacology Bonus is approved for 3.0 contact hours of continuing education (which includes 2.7 hours of pharmacology) by the American Association of Nurse Practitioners. Program ID 1304154. This program was planned in accordance with AANP CE Standards and Policies and AANP Commercial Support Standards.
  • 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 approved the course to fulfill 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.
  • We asked the NMBON whether they would officially recognize pain management CE courses that meet all the requirements of Rule 9 and they responded that they do not keep a listed of accepted CE. This means APNs will be personally responsible for verifying that their non-cancer pain management CE meets the requirements of Rule 9.
  • 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. Click here to purchase the approved CE program available in a DVD set from NMNPC.

♦ Register with the PMP now, 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.

 

 

 

 

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