More than seven years have passed since Michigan legislation aimed at combating the state’s opioid crisis took effect.
Although subsequent guidance by state and federal agencies have provided some clarity regarding the laws, rules and standard of care that impact prescribing controlled substances for patients (particularly for opioids), many physicians continue to engage in certain practices that place them at risk of legal and other scrutiny, such as a medical malpractice claim, licensing investigation, post-payment audit, etc. This article discusses some common prescribing practice risks for Michigan physicians and best practices to consider.
Licensing and Registrations
To prescribe controlled substances to patients in Michigan, in addition to their health profession license, physicians must have a Michigan controlled substance license and a registration with the U.S. Drug Enforcement Agency. To dispense controlled substances, physicians must additionally have a Michigan drug control license, unless an exception applies. State licensing laws consider the location of the patient at the time of treatment, regardless of the patient’s domicile. For example, Michigan’s licensing laws generally apply to treatment rendered to patients located in Michigan at the time of treatment, whether in-person or via telehealth. Thus, physicians should use caution before prescribing medications, including controlled substances, to patients who are not located in Michigan at the time of prescribing, including “snowbirds” and patients who are temporarily out of state due to travel or school.
MAPS Registration and Queries
Michigan law requires physicians who prescribe controlled substances to be registered with the Michigan Automated Prescription System (MAPS). As part of this registration, physicians must designate their primary practice specialty. Physicians who engage in a multi-disciplinary practice should select the practice specialty through which they primarily prescribe controlled substances. This is important because physicians are ranked within the MAPS system based on their controlled substances prescribing practices in comparison to peers within their primary specialty. If a physician’s prescribing practice ranks too high within their specialty, this can trigger an investigation by LARA into the physician’s prescribing practices, even if no complaint has been made against the physician.
In addition to registering with MAPS, Michigan law requires physicians to obtain and review a MAPS report if prescribing a controlled substance in a quantity which exceeds a 3-day supply (unless an exception applies) or if prescribing buprenorphine or a drug containing buprenorphine or methadone to a patient in a substance use disorder program. However, it is advisable for physicians to chart not only that they reviewed the patient’s MAPS report, but also how the information in the MAPS report influenced their medical decision-making. This is particularly important for patients with a higher overdose risk score, multiple controlled substance prescriptions and/or prescribers, and other unusual or higher-risk information on their MAPS report.
Documentation Practices
When prescribing controlled substances to a patient, regardless of the type, dose or quantity, physicians must engage in good clinical charting and documentation to evidence the rendering of care to the patient. It is important that the clinical chart and medical record evidence not only clinical data, but also the physician’s medical decision-making process resulting in the prescribing of the controlled substance. This can include discussion of the patient’s diagnosis, symptoms or changes in symptoms, alternative treatments or medications considered/attempted, as well as a plan for further monitoring and evaluation of the efficacy of the controlled substance. Michigan law additionally requires physicians to ask the patient about other controlled substances the patient may be using and to record the patient’s response. If a patient is being treated with multiple controlled substances by multiple providers (e.g., pain specialist and psychiatry), consider documenting any coordination of care necessary to minimize patient risk with co-prescribed medications, such as opioids and benzodiazepines or stimulants, which have a higher risk of overdose and other adverse outcomes.
When prescribing an opioid to a patient, physicians must discuss and provide the patient with certain statutorily required information and obtain a signed acknowledgement from the patient or the patient’s parent/guardian/authorized adult (if the patient is a minor) on the MDHHS-5730 Opioid Start Talking Form and include the signed form in the patient’s medical record.
Physicians should use caution when using an electronic medical record’s carry-forward method to document controlled substance prescribing, particularly for patients who use controlled substances longer-term. Each patient visit should include updated information regarding observations made and the decision-making process for maintaining or adjusting the patient’s medications.
Prescribing Limitations
Physicians should be mindful of certain controlled substance prescribing limitations. For example, if prescribing a schedule 2 controlled substance, the physician may issue more than one prescription not to exceed a 90-day supply in total. If prescribing an opioid to a minor and the MDHHS-5730 is signed by an “authorized adult,” physicians must limit the prescription to no more than a 72-hour supply. Additionally, if a patient is being treated for “acute pain,” a physician may not prescribe the patient more than a 7-day supply of an opioid within a 7-day period.
Moreover, physicians who regularly prescribe higher doses of controlled substances, including but not limited to opioids, benzodiazepines or stimulants, or who co-prescribe these medications, should use additional caution to ensure thorough documentation of medical decision-making and monitoring, as these prescribing practices often create a higher risk of adverse patient outcomes and investigation by state and federal agencies.
Delegation and Supervision
Michigan law permits physicians assistants to independently prescribe controlled substances in accordance with the terms of a practice agreement with a participating physician. Similarly, physicians are permitted to delegate the prescribing of schedule 2 to 5 controlled substances to a nurse practitioner, nurse midwife, or clinical nurse specialist pursuant to a written authorization which meets certain requirements and must be reviewed annually. Physicians are responsible for ensuring compliance with the terms of a practice agreement, collaborative agreement or other written authorization, as well as complying with (and documenting evidence of) applicable supervision obligations for prescribing by delegation, including (1) continuous availability of direct communication in person or by telecommunication, (2) the availability on a regularly scheduled basis to review the practice of the supervised individual, to provide consultation, review records and to further educate the supervised individual in the performance of their functions, and (3) providing predetermined procedures and drug protocol. A physician’s failure to comply with these requirements could result in disciplinary action against the physician’s medical license for negligent delegation and supervision.
Conclusion
Physicians who regularly prescribe controlled substances should review their prescribing practices and protocols to ensure compliance with applicable laws, rules and the standard of care. It is advisable to engage the assistance of experienced legal counsel for this purpose.
This article originally appeared in the Third Quarter 2025 edition(goes to new website) of the Detroit Medical News. Republished With Permission.
