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State-by-State Summary of Opioid Prescribing

Regulations and Guidelines

This document was developed by and used by permission from:

Corey Davis, JD

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N/A

N/A

N/A

Pending

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CT Emergency Department

N/A

-Guidelines for the Use of

Controlled Substances for the

Treatment of Pain;

-DE Emergency Department

Opioid Prescribing Guidelines

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N/A

N/A

Joint Policy Statement

on the Use of

Controlled Substances

for the Treatment of

Pain

N/A

Guidelines for the Use

of Controlled

Treatment

N/A

N/A

MD Emergency Department

Opioid Prescribing Guidelines

Policies and

Emergency Department Opioid

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Joint Statement on

Pain Management

N/A

Guidelines for the Use

of Controlled

Substances for the

Treatment of Pain

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6

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Legislature in November 2016.

For more information, see http://dhss.alaska.gov/AKOpioidTaskForce/Pages/default.aspx.

Arizona

Advisory Guidelines: Arizona Opioid Prescribing Guidelines

Released in November 2014, these are a “voluntary consensus set of guidelines that

promote best practices for prescribing opioids for acute and chronic pain.” The guidelines

were endorsed by a number of state organizations, including the Arizona Medical

8

Association, the Arizona Hospital and Healthcare Association, and the Arizona Nurses

Association.

Summary of guidelines:

severity warrants that choice, and non-opioid pain medications or therapies do not

provide adequate pain relief.

opioid tolerant patients, and limited situations.

potential for misuse.

opioids and periodically if renewing opioid prescriptions.

substance use, psychiatric comorbidities, and functional status should be performed

before initiating opioid treatment for chronic pain.

perform risk stratification before initiating opioid treatment.

past records when possible.

pain conditions, serious co-morbidities including mental illness, a history or

evidence of current drug addiction or abuse, patients who are pregnant or

breastfeeding.

point if the risks outweigh the benefits or if dangerous or illegal behaviors are

demonstrated.

related adverse events increase with doses >50-100 mg of morphine equivalent

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dose per day (MEDD) and reaching these doses should trigger a re-evaluation of

therapy.

Link to guidelines: http://www.azdhs.gov/documents/audiences/clinicians/clinical-

guidelines-recommendations/prescribing-guidelines/az-opiod-prescribing-guidelines.pdf

Arkansas

Requirements with the force of law: Ark. Code Ann. § 20-7-703 (2015).

This law requires Arkansas hospitals with an emergency department to adopt guidelines

concerning prescribing of opioids in the emergency department. The guidelines must

address treatment of chronic pain and acute pain; limits on amounts or duration of opioid

prescriptions; and identification of situations where opioid prescriptions should be

discouraged or prohibited.

Link to the statute: http://law.justia.com/codes/arkansas/2015/title-20/subtitle-

Hospital Association, and the Arkansas Medical Society, among others.

Specific guidelines:

of acute exacerbations of chronic pain is discouraged.

controlled substances that were lost, destroyed or stolen.

for patients in a methadone treatment program.

addiction, along with information about proper storage and disposal to those

receiving a prescription.

determine if a patient has an emergency medical condition. The law does not

require physicians to use opioid analgesics to treat pain.

Such an evaluation should be completed before a decision is made as to whether to

prescribe an opioid analgesic.

relative risk for medication misuse or abuse should be part of the initial evaluation

and should be completed prior to a decision as to whether to prescribe opioid

analgesics.

patient is receiving prescriptions from any other physicians.

Link to guidelines:

https://bom.idaho.gov/BOMPortal/BOM/PDF%20FORMS/ModelPolicyUseofOpioidAnalge

sicsinTreatmentofChronicPain.pdf

For more information, see:

https://www.idmed.org/idaho/assets/files/AM2016/DuBose_Addt.pdf

Illinois

No data found.

Indiana

Requirements with the force of law: 844 Ind. Admin. Code 5-6-3 (2014)

In September 2014, the Indiana Medical Licensing Board adopted a rule that regulates

physicians engaged in the practice of pain management prescribing.

Summary of requirements:

equivalent dose of more than 60mg per day for more than three consecutive

months; or

form.

treatment plan and patient evaluation must be scheduled, including consideration of

a referral to a specialist.

develop a revised assessment and treatment plan for ongoing treatment, if the

physician continues to provide ongoing opioid treatment.

For the language of the rule, see http://www.ismanet.org/pdf/legal/FinalRule102516.pdf

For a summary of the rule, see

http://www.ismanet.org/pdf/legal/IndianaPainManagementPrescribingFinalRuleSummar

y.pdf

For the language of the amendment, see

https://medicalboard.iowa.gov/iowa_code/proposed%20rules/pdf/ARC%202535C%20-

%20Chapter%2013_CDC%20Guidelines%20for%20Prescribing.pdf

For more information, see

http://www.medicalboard.iowa.gov/Board%20News/2016/Press%20release%20-

%20Board%20adds%20CDC%20guideline%20on%20opioid%20prescribing%20to%20lis

t%20of%20resources%20for%20physicians%20who%20treat%20chronic%20pain%20-

%20%20August%2029%202016.pdf

Kansas

Quasi-regulatory guidelines: Joint Policy Statement of the Boards of Healing Arts, Nursing

and Pharmacy on the Use of Controlled Substances for the Treatment of Pain

In June 2002, the Kansas Boards of Healing Arts, Nursing, and Pharmacy issued a joint

Kentucky

Requirements with the force of law: 201 Ky. Admin Regs. 9:260 (2013)

In 2013, the Kentucky Board of Medical Licensure adopted new Professional Standards for

the Prescribing or Dispensing of Controlled Substances in different situations. Some of

these requirements include:

including a history of present illness

fentanyl patches, or methadone) for acute pain that is not directly related to and

close in time to a specific surgical procedure;

complaint is for time-limited use, and that the patient should discontinue the use of

the controlled substance when the condition requiring the controlled substance use

has resolved; and

controlled substance.

Similar requirements were adopted for opioid prescribing in other situations, including

Link to statute summary:

http://kbml.ky.gov/hb1/Documents/Summary%20of%20201%20KAR%209_260.pdf

Quasi-regulatory guidelines: Guidelines for the Use of Controlled Substances in Pain

Treatment

The Kentucky Board of Medical Licensure issues advisory guidelines for prescribing

opioids to treat acute pain. Recommendations include performing a patient evaluation

Requirements with the force of law: Ky. Rev. Stat. Ann. § 218A.205(3)(b) (2017)

In 2017, Kentucky enacted an act to limit prescriptions of opioid prescriptions to a three-

day supply. The act prohibits practitioners from issuing a prescription for a Schedule II

substance for more than three days if the prescription is intended to treat pain as an acute

medical condition. The following exceptions apply:

patient’s pain as an acute medical condition and the practitioner documents the

condition and the lack of alternative options;

setting;

licensing board in consultation with the Kentucky Office of Drug Control Policy

Link to the enacted act:

http://www.lrc.ky.gov/recorddocuments/bill/17RS/HB333/bill.pdf

Louisiana

Requirements with the force of law: La. Stat. Ann. § 40:978 (2015)

In 2015, Louisiana amended its controlled substances statute to limit opioid prescriptions

Link to the amended statute: http://law.justia.com/codes/louisiana/2014/code-

revisedstatutes/title-40/rs-40-978

Maine

Requirements with the force of law: 02-373 Me. Code R. 21 § II (2012)

Link to the regulations:

https://www1.maine.gov/osteo/administrative/chaptertwentyone.pdf

Requirements with the force of law: 32 Maine Rev. Stat. Ann. § 3300-F (2016)

In 2016, the Main Legislature amended the state’s statute related to professional licensing

to adopt the following limitations on prescribers’ practices: a licensed physician whose

scope of practice includes prescribing opioid medication may not prescribe:

of 100 morphine milligram equivalents (MME) of opioid medication per day;

opioid medication to a patient under treatment for chronic pain.

opioid medication to a patient under treatment for acute pain.

Exceptions to these requirements include 1) when prescribing opioid medication for pain

associated with active and aftercare cancer treatment, palliative care, end-of-life and

hospice care, and medication-assisted treatment (MAT); and 2) when directly ordering or

administering benzodiazepine or opioid medication to a person in an emergency room

setting, an inpatient hospital setting, a long-term care facility, or a residential care facility.

The legislature also added a provision to the state’s Controlled Substances Prescription

Monitoring Act that requires, upon initial prescription of a benzodiazepine or an opioid

medication to a person and every 90 days for as long as that prescription is renewed, a

prescriber to check prescription monitoring information for records related to that person.

This provision takes effect on January 1, 2017.

Link to the statute: https://legislature.maine.gov/legis/statutes/22/title22sec7253.html

Prescription Drug Monitoring Program (PDMP) before writing an opioid

prescription.

other providers and hospitals that are treating the patients by using CRISP,

Maryland’s health information exchange.

the patient’s primary opioid prescriber or primary care provider of the visit and the

medication prescribed.

or controlled-release opioids, such as OxyContin®, fentanyl patches, and

methadone.

opioid analgesics for serious acute pain, lasting no more than three days.

Link to the guidelines: http://www.mhaonline.org/docs/default-

source/Resources/Opioid-Resources-for-Hospitals/maryland-emergency-department-

opioid-prescribing-guidelines.pdf?sfvrsn=2

Requirements with the force of law: Md. Code Ann., Health Occ. § 1-223 (2017)

Since 2017, Maryland provides that, “on treatment for pain, a health care provider, based

Link to the enacted bill: http://mgaleg.maryland.gov/2017RS/bills/hb/hb1432T.pdf

Massachusetts

Quasi-regulatory guidelines: Prescribing Practices Policies and Guidelines

In 2015, the Massachusetts Board of Registration in Medicine amended its prescribing

guidelines to address the opioid epidemic. The Board adopted the Massachusetts Medical

Society’s Opioid Therapy and Physician Communication Guidelines. The guidelines include

directions for opioid therapy for acute pain and chronic pain.

performance effects of these prescriptions.

the effects and safety of opioid treatment on pain intensity, function, and quality of

life. In most instances, the trial should begin with a short-acting opioid medication.

level of pain control and to avoid excessive side effects.

low dosage sequential prescription approaches considered.

Summary of guidelines for chronic pain:

soon as possible after the 90-day threshold is reached.

consider the use of appropriate baseline urine drug testing if the risk assessment or

Link to the MMS’s guidelines: http://www.massmed.org/Advocacy/Key-Issues/Opioid-

Abuse/Opioid-Therapy-and-Physician-Communication-Guidelines-(pdf)/

Advisory Guidelines: Massachusetts Hospital Association Guidelines for Emergency

Department Opioid Management

The MHA Substance Use Disorder Prevention and Treatment Task Force developed opioid

prescribing guidelines to be used in emergency departments in the state. The guidelines

include:

substance misuse that includes services for brief intervention and referrals to

or controlled-release opioids, such as OxyContin®, fentanyl patches, and

before prescribing opioids, obtaining informed consent from the patient for opioid

treatment, requiring a written agreement outlining patient responsibilities if the patient is

determined to be at high risk for medication abuse or to have a history of substance abuse,

conduct periodic review of the opioid treatment, and maintain a complete medical record

of the patient’s treatment

Link to the guidelines:

https://www.michigan.gov/documents/mdch_MI_guidelines_91795_7.pdf

Link to the guidelines:

https://mn.gov/boards/assets/Joint%20Statement%20on%20Pain%20Management%20

Advisory Guidelines: New Mexico Hospital Association-Recommended Opioid Risk-

Reduction Strategies and Prescribing Guidelines in New Mexico Emergency Departments

The NMHA Behavioral Health Task Force developed opioid prescribing guidelines to be

used in emergency departments in the state. The guidelines include:

abuse that includes services for brief intervention and referrals to treatment

programs for patients who are at risk for developing, or who actively have,

primary opioid prescriber or primary care provider when prescriptions for acute

exacerbations of chronic pain are made.

nasal naloxone and provide education to at-risk patients (e.g., patients on high

dose/quantity narcotic prescriptions, patients with accidental prescription or illicit

narcotic overdoses, etc.) and their families/friends.

Link to the guidelines: http://nmhanet.org/files/Documents/Emergency-Medicine-

Controlled-Substance-Administration-and-Prescribing-Guidelines.pdf

previous twelve months shall only be required when drugs are prescribed for a period

greater than 10 days). Moreover, during the continuous use of opioids by established

patients a PMP report shall be requested and reviewed a minimum of once every six

months.

Link to the statute: http://164.64.110.239/nmac/parts/title16/16.010.0014.htm

New York

Advisory Guidelines: NYC Emergency Department Discharge Opioid Prescribing Guidelines

In 2013, the New York City Department of Health and Mental Hygiene released guidelines

the management of pain.

patients require no more than three days.

Controlled Substance Information (CSI) on Dispensed Prescriptions Program for

information on patients’ controlled substance prescription history.

such as the risks of overdose and dependence/ addiction, as well as safe storage and

proper disposal of unused medications.

Link to the guidelines: https://www1.nyc.gov/assets/doh/downloads/pdf/basas/opioid-

prescribing-guidelines.pdf

Requirements with the force of law: N.Y. Pub. Health § 3334-a(2) (2013)

Since 2013, the State of New York requires physicians to access the state’s prescription

Link to the statute: http://law.justia.com/codes/new-york/2015/pbh/article-33/title-

4/3343-a/

Requirements with the force of law: N.Y. Pub. Health § 3331(5) (2016)

In 2016, the New York Legislature amended the state’s controlled substances statute to

include a provision that limits the doses of opioids physicians are allowed to prescribe.

Opioid prescriptions are limited to seven days for first time users for treatment of acute

Link to the enacted act:

http://assembly.state.ny.us/leg/?default_fld=&leg_video=&bn=A10727&term=&Summary

=Y&Actions=Y&Memo=Y&Text=Y

North Carolina

Quasi-regulatory guidelines: Policy for the Use of Opiates for the Treatment of Pain

In June 2014, the North Carolina Medical Board issued guidelines for the use of opioids in

and first line pharmacotherapy with over the counter medications, non-steroidal

anti-inflammatory drugs, and acetaminophen should be considered before initiating

opioid therapy.

patient as a therapeutic trial or test for a defined period of time (usually no more

than 90 days) and with specified evaluation points.

readily available to patients who are identified as being at risk of an opiate overdose

information about the etiology of the pain or the patient’s overall health and level of

activities.

as well as in detecting the use of non-prescribed drugs.

Link to the guidelines:

http://www.ncmedboard.org/images/uploads/other_pdfs/Policy_for_the_Use_of_Opiates_f

or_the_Treatment_of_Pain_June_4_2014.pdf

The North Dakota Department of Human Services issued tips for safe opioid prescribing

practices in their Medicaid Pharmacy Program Quarterly Newsletter. Some of the

recommendations include:

Link to the recommendations:

http://www.hidesigns.com/assets/files/ndmedicaid/newsletters/ND%20newsletter1_rev.

pdf

Ohio

Advisory Guidelines: Ohio Emergency and Acute Care Facility Opioids and Other Controlled

prescribed in emergency/acute care facilities only when appropriate based on the

patient’s presenting symptoms, clinical examination, and risk for addiction.

pain will typically NOT be given in injection (IM or IV) form.

has either previously presented with the same problem or received an OOCS

prescription from another provider within the last month.

treatment program.

patches, and methadone).

prescription for OOCS, the emergency clinician or facility:

prescription monitoring programs, per state rules.

available), or an appropriate sub‐specialty service.

of the emergency clinician with regard to appropriate use of prescriptions for

OOCS.

day supply.

should be provided with detailed information about the addictive nature of these

medications, the potential dangers of misuse and the appropriate storage and

disposal of these medications at home.

Link to the guidelines: http://www.healthy.ohio.gov/-

Specific guidelines:

Providers should exercise the same caution with tramadol as with opioids.

chronic pain. Providers should also avoid prescribing benzodiazepines with opioids.

equal to or greater than 80 mg MED for longer than three continuous months should

information on the potential adverse effects of long-term opioid therapy.

of treatment.

Link to the guidelines:

http://mha.ohio.gov/Portals/0/assets/Initiatives/GCOAT/Guidelines-Chronic-Pain.pdf

Requirements with the force of law: Ohio Admin. Code 4731-11-11 (2015)

Link to the statute: http://codes.ohio.gov/oac/4731-11-11v1

Advisory Guidelines: Ohio Guideline for the Management of Acute Pain Outside of

Emergency Departments

In 2016, the Ohio Opiate Action Team issued recommendations for the prescribing of

opioids for treatment of acute pain outside of emergency rooms.

Specific guidelines:

should be made, when appropriate, to facilitate the use of an evidence-based

approach to treatment.

psychosocial environment, personal or family history of substance use disorder).

morphine equivalence chart should be used if needed.

patient, rather than a default number of pills.

medication, including unused or leftover medication.

Link to the guidelines:

http://mha.ohio.gov/Portals/0/assets/Initiatives/GCOAT/Guidelines-Acute-Pain-

20160119.pdf

Link to the Ohio Guidelines Factsheet:

http://mha.ohio.gov/Portals/0/assets/Initiatives/GCOAT/20160112-GCOAT-Prescribing-

Guidelines-Summary.pdf

exceed an average of 30 MED per day;

provide a specific reason in the patient’s medical record.

controlled substance prescription, which will be entered into Ohio’s PDMP, OARRS.

The new limits do not apply to opiates prescribed for cancer, palliative care, end-

oflife/hospice care or medication-assisted treatment for addiction.

20on%20Prescription%20Opiates%20Will%20Save%20Lives%20and%20Fight%20Addic

tion.pdf

Link to FAQ on the new rules:

http://www.pharmacy.ohio.gov/Documents/Pubs/Special/ControlledSubstances/New%2

0Limits%20on%20Prescription%20Opiates%20for%20Acute%20Pain%20-

%20Frequently%20Asked%20Questions.pdf

Link to the statute: http://law.justia.com/codes/oklahoma/2015/title-63/section-63-2-

302/

Advisory Guidelines: Oklahoma Emergency Department (ED) and Urgent Care Clinic (UCC)

Opioid Prescribing Guidelines

In 2013, an interdisciplinary group of health care practitioners in Oklahoma, that included

the Oklahoma Board of Nursing, the Oklahoma State Medical Association, the Oklahoma

Department of Mental health and Substance Abuse Services, among others, published a set

except in special circumstances. Most patients require opioids for no more than

three days of pain control, with a maximum of 30 pills in most cases.

prior to prescribing opioid medication.

care provider provide all opioid prescriptions. When an exception occurs and

another provider deems it necessary to prescribe opioids, Oklahoma PMP data

should be reviewed, and only enough pills prescribed, if indicated, to last until the

office of the patient’s primary opioid prescriber opens.

the office of the patient’s primary opioid prescriber opens.

exacerbations of chronic pain is discouraged, except in special circumstances.

benzodiazepines and/or other opioids.

In September 2014, an interdisciplinary group of health care practitioners in Oklahoma,

that included the Oklahoma Board of Nursing, the Oklahoma State Medical Association, the

Oklahoma Department of Mental health and Substance Abuse Services, among others,

published a set of recommendations for physicians and other providers prescribing opioids

for treating acute and chronic pain in office-based settings.

Specific guidelines for treating acute pain:

pain warrants that choice and after determining that other non-opioid pain

dispensed should be no more than the number of doses needed based on the usual

duration of pain severe enough to require opioids for that condition.

counseled to store the medications securely and never to share with others.

extended release oxycodone, and morphine) are rarely indicated for treatment of

acute pain.

potential for abuse, if persistent pain suggests the need to continue opioids. Health

Specific guidelines for treating chronic pain:

before initiating opioid treatment.

for chronic pain.

the patient is clinically stable and judged to be compliant with therapy, it is

recommended that the health care provider check the Oklahoma PMP more

frequently.

face-to-face visits during which treatment goals, analgesia, activity, adverse effects,

and aberrant behaviors are monitored. The Oklahoma PMP should be queried at

least once per year for patients receiving opioid treatment for chronic pain.

aberrant, dangerous, or illegal behaviors are demonstrated.

counseled to store the medications securely and never to share with others.

Link to the guidelines:

https://www.ok.gov/health2/documents/UP_Oklahoma_Office_Based_Guidelines.pdf

Requirements with the force of law: Opioid Analgesic Quantity Limits

In November 2014, the Oklahoma Health Care Authority (OHCA), which administers the

state’s Medicaid program, implemented a quantity limit on coverage of short-acting opioid

prescription. Chronic opioid analgesic quantity limits apply to short-acting opioid therapies

Link to the language of the approved bill:

http://webserver.rilin.state.ri.us/BillText/BillText16/SenateText16/S2823Aaa.pdf

South Carolina

Quasi-regulatory Guidelines: Pain Management Guidelines

Requirements with the force of law: Required Use of the South Carolina Reporting &

Identification Prescription Tracking System (SCRIPTS)

Since April 1, 2016, the South Carolina Department of Health and Human Services

(SCDHHS) requires that providers verify Medicaid members' controlled substance

prescription history before issuing prescriptions for opioids. Failure to consult the South

Carolina Reporting and Identification Prescription Tracking System (SCRIPTS) database

may result in loss of Medicaid payments for the office visit during which the prescription

was given. For Medicaid members treated chronically with controlled substances, SCDHHS

provider.

Link to SCDHHS’s bulletin on the new policy:

https://www.scdhhs.gov/sites/default/files/SCRIPTS%20Bulletin-

%20%28v15%29%20w%20CLS%20signature.pdf

South Dakota

Quasi-regulatory guidelines: Model Policy for the Use of Controlled Substances for the

Treatment of Pain

In 2004, the South Dakota State Board of Medical and Osteopathic Examiners issued

guidelines on the prescribing of controlled substances for treating pain. The guidelines

or to have a history of substance abuse, conduct periodic review of the opioid treatment,

and maintain a complete medical record of the patient’s treatment.

Link to the guidelines:

http://www.painpolicy.wisc.edu/sites/www.painpolicy.wisc.edu/files/SD_model.pdf

Tennessee

Advisory Guidelines: Clinical Practice Guidelines for Outpatient Management of Chronic

Non-Malignant Pain

In 2014, the Tennessee Department of Health issued guidelines for the prescribing of

opioids to treat chronic non-malignant pain. The guidelines include recommendations

regarding patient evaluation prior to initiating the opioid treatment and recommendations

as to the proper dosing of opioid that should be prescribed. Some of the guidelines include:

includes, among other, opioids and benzodiazepines.

Texas

Requirements with the force of law: 22 Tex. Admin. Code § 170.3 (2007)

In 2007, the Texas Medical Board adopted regulations with regards to treating pain with

controlled substances. The guidelines set the appropriate standard of care in those

situations and have been amended twice, in 2014 and 2016. The guidelines include

performing a patient evaluation before prescribing opioids (including reviewing

prescription data and history related to the patient contained in the state’s prescription

_tloc=&p_ploc=&pg=1&p_tac=&ti=22&pt=9&ch=170&rl=3

Utah

Advisory Guidelines: Utah Clinical Guidelines on Prescribing Opioids for Treatment of Pain

In 2009, the Utah Department of Health adopted recommended guidelines for physicians

prescribing opioids for treating pain.

Summary of guidelines for Opioid Treatment for Acute Pain

severity of the pain warrants that choice and after determining that other non-

should be counseled to store the medications securely, to not share with others, and

to dispose of medications properly when the pain has resolved.

for abuse, if persistence of pain suggests the need to continue opioids.

continuation of opioid treatment.

using short-acting opioid medications.

the period when the dose of opioids is being adjusted (titration period).

should be conducted at face-to-face visits.

patients with serious co-morbidities including mental illness, patients who have a

history or evidence of current drug addiction or abuse.

and appropriate use, and who are prepared to conduct the necessary careful

monitoring.

Link to the guidelines:

http://www.health.utah.gov/prescription/pdf/guidelines/final.04.09opioidGuidlines.pdf

Requirements with the force of law: Utah Code Ann. §§ 58-37-6(7)(f)(iii) and 58-37f-

surgery, the prescriber must not prescribe a dose exceeding a 30-day supply. The law

exempts pharmacists from verifying that a prescription is in compliance with these

requirements. The enacted law also requires prescribers to check the PDMP database for

information about the patient when prescribing more than a 3-day supply of opioids for the

first time, unless the prescription is for post-surgical treatment and is a 30-day or less

supply.

term pain therapy of 90 days or more;

treat chronic pain; and

In 2016, the Vermont Legislature amended the statute to direct the state’s Commissioner of

Health to adopt rules on prescribing opioids after consulting with the Controlled

Substances and Pain Management Advisory Council, which may include number and time

limits on pills prescribed.

In 2014, the Vermont Board of Medical Practice updated its policy on the use of opioids for

treating chronic pain to incorporate the latest best practices and new developments in the

healthcare profession regarding the safe and effective use of controlled substances to treat

pain.

Summary of guidelines:

physical examination, as well as laboratory investigations

relative risk for medication misuse or abuse should be completed prior to a decision

as to whether to prescribe opioid analgesics

for chronic, nonmalignant pain.

defined period of time (usually no more than 90 days) and with evaluation points.

opioid naïve patient. It is generally suggested to begin opioid therapy with a short

acting opioid and consider rotating to a long-acting/extended release opioid only if

Advisory Guidelines: Opiate Prescribing Guidelines for Vermont Emergency Departments

In 2014, Vermont ED Directors issued a consensus statements outlining their

recommended guidelines for prescribing opioids in EDs. The guidelines include:

(VPMS) prior to treating or prescribing opiates for patients with high risk features.

inclusion of either pulse oxymetry or capnography.

treatment for chronic pain or requesting parenteral administration of opiates

as part of an established outpatient plan for chronic pain management.

(meperidine) for treatment of acute or chronic pain is discouraged.

been lost, stolen, or destroyed or continuation of treatment for patients who have

run out of narcotics early or while their usual provider is off duty.

methadone.

which could potentiate the respiratory depression effects.

Link to the guidelines:

http://legislature.vermont.gov/assets/Documents/2016/WorkGroups/Senate%20Health

%20and%20Welfare/Bills/S.201/W~Dr.%20Mark%20Depman~Opioid%20Presribing%2

0Guidelines~1-27-2016.pdf

consider and document in the patient’s medical record:

shall receive a signed Informed Consent from the patient.

appropriate specialist when the patient is not meeting the goals of treatment despite

escalating doses of controlled substances or when the patient is at high risk for

substance misuse, abuse, diversion, addiction, or overdose as determined by the

patient’s history or a screening.

MED/day the prescriber of opioids to treat chronic pain shall document in the

management plan, including an assessment of the patient’s adherence to the

treatment regimen;

necessary revisions, including pill counts and directly observed urine testing

professional.

prescribing-for-pain.pdf

Requirements with the force of law: Vermont Prescription Monitoring System Rule

In August 215, the Vermont Department of Health issued a rule to implement the state’s

nonpalliative long-term pain therapy of 90 days or more;

substance;

without meaningful interruption) with an opioid Schedule II, III, or IV controlled

substance;

prescription for pain from an Emergency Department or Urgent Care prescriber if

the prescriber intends to write a prescription for an opioid;

exceeds the dosage threshold approved by the Vermont Medicaid Drug Utilization

prior approval from the Chief Medical Officer or Medical Director of the Department

of Vermont Health Access or designee

Link to the rule:

http://www.healthvermont.gov/sites/default/files/documents/2016/12/REG_vpms-

20170701.pdf

Virginia

Advisory Guidelines: Medical Society of Virginia’s Guidelines for the Use of Opioids in the

Management of Chronic Non-Cancer Pain

In 2013, the Virginia Board of Medicine updated its guidelines on the use of opioid

analgesics to treat pain by adopting the Federation of State Medical Board’s new guidelines.

The guidelines include:

medical indications for prescribing an opioid analgesic and reflect an appropriately

detailed patient evaluation.

possible, involve consultation with an addiction specialist before opioid therapy is

initiated (and follow-up as needed).

information about the patient’s response to opioid therapy should be obtained from

family members or other close contacts, and the state PDMP.

as well as in detecting the use of non-prescribed drugs.

Link to the guidelines: http://www.dhp.virginia.gov/medicine/guidelines/85-24.pdf

Requirements with the force of law: Va. Code Ann. § 54.1-2522.1 (2015)

Since 2015, Virginia law requires prescribing physicians to request information from the

substances are currently prescribed to the patient. The following situations are exempted

from this requirement:

procedure and such prescription is not refillable;

discharge;

Link to the statute: http://law.lis.virginia.gov/vacode/title54.1/chapter25.2/section54.1-

2522.1/

Advisory Guidelines: Virginia Hospital Emergency Department Opioid Prescribing

Guidelines

In January 2016, the Virginia Hospital & Healthcare Association’s Board of Directors

appropriate. This generally should be for no more than three days.

substance misuse.

of the ED care is communicated to the primary opioid prescriber or primary care

provider.

lost, destroyed, stolen, or finished prematurely.