Section 216-RICR-20-20-4.3 - DefinitionsA. Wherever used in these regulations, the following terms shall be construed as follows: 1. "Act" means the R.I. Gen. Laws Chapter 21-28 entitled, "Uniform Controlled Substances Act."2. "Acute pain" means the normal, predicted physiological response to a noxious chemical, thermal, or mechanical stimulus and typically is associated with invasive procedures, trauma, and disease. Acute pain generally results from nociceptor activation due to damage to tissues. Acute pain typically resolves once the tissue damage is repaired. The duration of acute pain varies. For the purpose of this Part, acute pain shall not include chronic pain management, pain associated with a current cancer diagnosis, palliative care or nursing home care.3. "Addiction medicine physician" means a physician who is specifically trained in a wide range of prevention, evaluation and treatment modalities addressing substance use disorder in ambulatory care settings, acute care and long-term care facilities, psychiatric settings, and residential facilities.4. "Recovery from a substance use disorder" means a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential in areas of health, home, purpose and community, making informed, healthy choices that support physical and emotional wellbeing.5. "Chronic pain" means pain of greater than ninety (90) days duration, excluding pain requiring palliative care.6. "Common carrier" means any person who or which undertakes, whether directly or by any other arrangement, to transport property, or any class or classes of property, by motor vehicle between points within this state; for the general public for compensation, over the publicly used highways of this state, whether over regular or irregular routes, pursuant to R.I. Gen. Laws § 39-12-2.7. "Contract carrier" means any person who or which engages in transportation of property by motor vehicle, in intrastate commerce for compensation, under continuing contract with one (1) person, or an unlimited number of persons, for the furnishing of transportation services of a special and individual nature required by the shipper, and not generally provided by common carriers, pursuant to R.I. Gen. Laws § 39-12-2.8. "Controlled substance" means a drug, substance, or immediate precursor in Schedules I-V of R.I. Gen. Laws Chapter 21-28. The term shall not include distilled spirits, wine, or malt beverages, as those terms are defined or used in R.I. Gen. Laws Chapter 3-1, nor tobacco.9. "Department" means the Rhode Island Department of Health.10. "Director" means the Director of the Rhode Island Department of Health.11. "Distribute" means to deliver (other than by administering or dispensing) a controlled substance or an imitation controlled substance, and includes actual, constructive, or attempted transfer.12. "Distributor" means a person who so delivers a controlled substance, or an imitation controlled substance, pursuant to R.I. Gen. Laws § 21-28-1.02(18).13. "Electronic prescription" means a secure (encrypted and encoded) technology system that allows practitioners to create, sign, transmit, and file prescriptions from a computer or smart device to a pharmacy computer directly and electronically. Electronic prescriptions do not include handwritten, emailed, or faxed prescriptions or calling in prescriptions.14. "Hospice" means a model of care that focuses on relieving symptoms and supporting patients with a life expectancy of six (6) months or less. Hospice involves an interdisciplinary approach to provide health care, pain management, and emotional and spiritual support. The emphasis is on comfort, quality of life, and patient and family support. Hospice can be provided in the patient's home as well as freestanding hospice facilities, hospitals, nursing homes, or other long-term care facilities.15. "Initial prescription" means first prescription given to someone who is new to the prescription of opioids from your institution or office, and has not used opioids in the most recent thirty (30) calendar days.16. "Interstate carrier" means any person who or which operates motor vehicles for the transportation of property of others for compensation, over the publicly used highways of this state in interstate commerce, authorized or certified by the Interstate Commerce Commission, pursuant to R.I. Gen. Laws § 39-12-2.17. "Long acting and extended release opioids" - opioids intended for long acting or extended use have a half-life long enough that they are generally prescribed less than three (3) times a day. Examples of long acting and extended release opioids include, but are not limited to: Avinza (morphine sulfate) Extended-Release Capsules, Dolophine (methadone hydrochloride) Tablets, Duragesic (fentanyl transdermal system), Embeda (morphine sulfate and naltrexone hydrochloride) Extended-Release Capsules, Exalgo (hydromorphone HCl) Extended-Release Tablets, Kadian (morphine sulfate) Extended-Release Capsules, MS Contin (morphine sulfate) Extended-Release Tablets, Nucynta ER (tapentadol) extended-release tablets, Opana ER (oxymorphone hydrochloride) Extended-Release Tablets, Oxycontin (oxycodone hydrochloride) Extended-Release Tablets, Palladone (hydromorphone hydrochloride) Extended-Release Capsules) as well as other similar and future U.S. FDA-approved medications in this classification as defined by the U.S. FDA.18. "Medical record" means a record of a patient's medical information and treatment history maintained by physicians and other medical personnel, which includes, but is not limited to, information related to medical diagnosis, immunizations, allergies, x-rays, copies of laboratory reports, records of prescriptions, and other technical information used in assessing the patient's health condition, whether such information is maintained in a paper or electronic format.20. "Multidisciplinary pain clinic" means a clinic or office that provides comprehensive pain management provided by different health care disciplines including at least two (2) medical specialties and non-physician professionals. It shall include care provided by multiple available disciplines and treatment modalities in an integrated fashion.21. "Opioid induced hyperalgesia" means increased perception of pain out of proportion to what is expected, that results from the effects of opioids on the central nervous system (CNS).22. "Pain" means an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.23. "Pain medicine physician" means a physician whose usual course of practice is to treat patients who have acute and/or chronic pain as a condition.24. "Palliative care" means patient and family centered medical care that optimizes quality of life by anticipating, preventing, and treating suffering caused by advanced serious illness. Palliative care throughout the continuum of illness involves addressing physical, emotional, social and spiritual needs and facilitating patient autonomy, access to information, and choice. Palliative care includes, but is not limited to, discussions of the patient's goals for treatment; discussion of treatment options appropriate to the patient, including, where appropriate, hospice care; and comprehensive pain and symptom management.25. "Person" means any corporation, association, partnership, or one or more individuals.26. "Physical dependence" means a state of adaptation that is manifested by a drug-class-specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing the level of the drug in the blood.27. "Practitioner" means, for the purpose of this Part, a physician licensed pursuant to R.I. Gen. Laws Chapter 5-37, a physician assistant licensed pursuant to R.I. Gen. Laws Chapter 5-54; an Advanced Practice Registered Nurse (APRN) licensed pursuant to R.I. Gen. Laws Chapter 5-34; dentist; podiatrist; veterinarian; scientific investigator; or other person licensed, registered or permitted to prescribe, distribute, dispense, conduct research with respect to or to administer a controlled substance in the course of professional practice or research in Rhode Island.28. "Private carrier" means any person, other than a common carrier, or a contract carrier, or an interstate carrier, who or which transports in intrastate or interstate commerce by motor vehicle, property of which such person is the owner, lessee, or bailee, when such transportation is for the purpose of sales, lease, rent, or bailment, or in the furtherance of any commercial enterprise, pursuant to R.I. Gen. Laws § 39-12-2.29. "Substance use disorder" means a diagnosis provided by a licensed practitioner meeting the diagnostic criteria of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-5), or the coding of the International Statistical Classification of Diseases and Related Health Problems (ICD-10).30. "Tolerance" means a state of adaptation in which exposure to a substance induces changes that result in a diminution of one or more of the substance's effects over time.216 R.I. Code R. 216-RICR-20-20-4.3
Amended effective 1/2/2020