20 Miss. Code. R. 2-IX

Current through December 10, 2024

Section 20-2-IX - Opioid Abuse Disorder

A.DSM V Opioid Use Disorder Criteria

Opioid Use Disorder is specified instead of Substance Use Disorder if opioids are the drugs of abuse. A minimum of 2-3 criteria is required for a mild substance use disorder diagnosis, while 4-5 criteria is moderate, and 6-7 criteria is severe (APA, 2013):

1. taking the opioid in larger amounts and for longer than intended;

2. wanting to cut down or quit but not being able to do it;

3. spending a lot of time obtaining the opioid;

4. repeatedly unable to carry out major obligations at work, school, or home due to opioid use;

5. continued use despite persistent or recurring social or interpersonal problems caused or made worse by opioid use;

6. stopping or reducing important social, occupational or recreational activities due to opioid use;

7. recurrent use of opioids in physically hazardous situations;

8. consistent use of opioids despite acknowledgment of persistent or recurrent physical or psychological difficulties from using opioids;

9. tolerance as defined by either a need for markedly increased amounts to achieve intoxication or desired effect or markedly diminished effect with continued use of the same amount. (criterion does not apply when used appropriately under medical supervision); and

10. withdrawal manifesting as either characteristic syndrome or the substance is used to avoid withdrawal (criterion does not apply when used appropriately under medical supervision).

B.Mississippi Board of Medical Licensure

Once a physician recognizes that a patient has an addiction issue, per the Mississippi Board of Medical Licensure, the following applies:

No physician shall prescribe any controlled substance or other drug having addiction forming or addiction sustaining liability to a patient who is a drug addict for the purpose of detoxification treatment' or maintenance treatment' and no physician shall administer or dispense any narcotic controlled substance for the purpose of detoxification treatment' or maintenance treatment' unless they are properly registered in accordance with Section 303(g) 21 U.S.C. 823(g). Nothing in this paragraph shall prohibit a physician from administering narcotic drugs to a person for the purpose of relieving acute withdrawal symptoms when necessary while arrangements are being made for referral for treatment. Not more than one (1) day's medication may be administered to the person or for the person's use at one time. Such emergency treatment may be carried out for not more than three (3) days. US-CODE-2011-title21/pdf/USCODE-2011-title 21-chap13-subchapl-part C-Sec823 states that a physician must be separately registered to treat substance abuse.

C.Treatment for Addiction

1. If an opioid abuse disorder manifests itself and is directly related to the use of controlled substances that were prescribed for a workers' compensation injury, the treatment for that addiction shall be compensable.

a. Treatment for addiction, including use of appropriate medications and psychotherapy, will be covered for one year unless the clinician documents that care beyond one year is medically necessary.

b. Not all patients who are addicted will require formal detoxification. Patients on lower doses of controlled substances often will not go through withdrawal. If, however, the patient is on a large dose which will cause withdrawal symptoms, then a detoxification program is appropriate.

¹ Chou R, Deyo R, Devine B, et al. The effectiveness and risks of long-term opioid treatment of chronic pain. Evidence Report/Technology Assessment No. 218 AHRQ Publication No 14-E005-EF. Rockville, MD: Agency for Healthcare Research and Quality; 2014

¹ Daubresse M, Chang HY, Yu Y, et al. Ambulatory diagnosis and treatment of nonmalignant pain in the United States .2000-2010. Med Care 2013;51:870-8

¹ Paulozzi LJ, Mack KA, Hockenberry JM. Vital signs: variation among states in prescribing of opioid pain relievers and benzodiazepines-United States, 2012. MMWR Morb Mortal Wkly Rep 2014;63:563-8

¹ Levy B, Paulozzi L, Mack KA, Jones CM. Trends in opioid analgesic-prescribing rates by specialty, US. 2007-2012. Am J Prev Med 2015;49:409-13

¹ CDC. Multiple cause of death data on CDC WONDER. Atlanta, Ga: US Department of Health and Human Services, CDC; 2016

¹ Kaplovitch E, Gomes T, Camacho X, Dhalla IA, Mamdani MM, Juurlink DN. Sex differences in dose escalation and overdose death during chronic opioid therapy: a population-based cohort study. PLoS One 2015;10:e0134550

¹ Franklin GM, Stover BD, Turner JA, Fulton-Kehoe D, Wickizer TM. Early opioid prescription and subsequent disability among workers with back injuries: The Disability Risk Identification Study Cohort. Spine 2008;33:199B204

20 Miss. Code. R. 2-IX

Adopted 6/14/2017