Indiana Opiate Prescribing Guidelines — MME limit 60/day ?

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In 2017, more than 6 million opioid prescriptions were dispensed to Indiana residents.[1]Improving the way opioids are prescribed through clinical practice guidelines can ensure patients have access to safer, more effective pain treatment, while reducing the number of people who misuse, abuse or overdose from these drugs. The following guidelines have been developed and published by experts in the field of pain management to guide clinicians on best practices when it comes to prescribing opioids. Each guideline is tailored to a specified clinical setting.

Chronic Pain – Indiana Pain Management Prescribing Final Rule
In 2014, the Indiana Medical Licensing Board adopted a final rule that regulates physicians engaged in the practice of pain management prescribing, pursuant to Indiana Administrative Code 844 IAC 5-6. These regulations address the main factors of safe and effective prescribing practices that include: patient assessment, non-opioid treatment options, patient information consent, patient follow-ups, INSPECT reports, drug monitoring tests, a daily high dose threshold and a treatment agreement.

Comparison of CDC Guidelines to Indiana Prescribing Rule

The variety of guidelines published by various institutions can often be difficult to compare and contrast. In response to this, the Indiana State Medical Association has compiled a document that compares CDC’s Guidelines for Prescribing Opioids for Chronic Pain with Indiana’s Pain Management Prescribing Final Rule. Although both sets of guidelines are aimed at improving the safety and effectiveness of opioid prescribing practices, the Indiana requirements are tailored more to the state of Indiana, while the CDC’s recommendations apply nationally. Physicians in Indiana may still apply the CDC’s recommendations in their opioid prescribing practices, even if those guidelines are not addressed in Indiana’s requirements.

Acute PainThe Indiana Guidelines for the Management of Acute Pain

The Indiana Guidelines for the Management of Acute Pain guidelines address safe, appropriate and effective opioid prescribing practices for outpatient management of acute pain. They may be applied to patients of all ages presenting acute pain, but they may not apply to acute pain resulting from a chronic condition.

Additional ResourcesCo-prescribing Naloxone to Patients at Risk of Overdose

Co-prescribing naloxone is encouraged by a broad range of stakeholders to help reverse the effects of an opioid overdose for high-risk patients. This resource provided by the American Medical Association (AMA) describes how to determine when it is clinically appropriate to co-prescribe naloxone and provides additional considerations, such as how to approach a patient you wish to co-prescribe naloxone to.

[1] Indiana State Department of Health, Division of Trauma and Injury Prevention, INSPECT.
Data retrieved from

Page last updated 11/27/2018

5 Responses

  1. I don’t know if it’s true or not but my pain management doc told me in Alabama it’s 50 MME. I think he is just trying to stay under the radar.

  2. This is the first time I’ve seen Tramadol specifically mentioned. How are they determining the MME of Tramadol to morphine? I don’t know of any science to make that determination.

  3. 60 MME (or any other legislated dose) is criminally stupid & insane, but it’s better than Oregon’s forced-to-zero.

  4. Knowledge is key, …and they don’t have it…

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