New Hampshire

No opioid laws

Acute pain:

• Conduct and document a physical examination and history;
• Consider the patient’s risk for opioid misuse, abuse, or diversion and prescribe for the lowest effective dose for a limited duration;
• Document the prescription and rationale for all opioids
• Ensure that the patient has been provided information that contains the following:
  • Risk of side effects, including addiction and overdose resulting in death;
  • Risks of keeping unused medication;
  • Options for safely securing and disposing of unused medication; and
  • Danger in operating motor vehicle or heavy machinery;
• Comply with all federal and state controlled substances laws, rules, and regulations;
• Complete a board-approved risk assessment tool, such as the evidence based screening tool Screener and Opioid Assessment for Patients with Pain (SOAPP);
• Document an appropriate pain treatment plan and consideration of non-pharmacological modalities and non-opioid therapy;
• Utilize a written informed consent that explains the following risks associated with opioids:
  • Addiction;
  • Overdose and death;
  • Physical dependence;
  • Physical side effects;
  • Hyperalgesia;
  • Tolerance; and
  • Crime victimization;
• In an emergency department, urgent care setting, or walk-in clinic:
  • Not prescribe more than the minimum amount of opioids medically necessary to treat the patient’s medical condition. In most cases, an opioid prescription of 3 or fewer days is sufficient, but a licensee shall not prescribe for more than 7 days; and
  • If prescribing an opioid for acute pain that exceeds a board-approved limit, document the medical condition and appropriate clinical rationale in the patient’s medical record.
• Prescribers shall not be obligated to prescribe opioids for more than 30 days, but if opioids are indicated and appropriate for persistent, unresolved acute pain that extends beyond a period of 30 days, the licensee shall conduct an in-office follow-up with the patient prior to issuing a new opioid prescription.

Chronic pain:

• Conduct and document a history and physical examination;
• Conduct and document a risk assessment, including, but not be limited to, the use of an evidence-based screening tool such as the Screener and Opioid Assessment for Patients with Pain (SOAPP);
• Document the prescription and rationale for all opioids according to Med 501.02(d) and (e);
• Prescribe for the lowest effective dose for a limited duration;
• Comply with all federal and state controlled substances laws, rules, and regulations;
• Utilize a written informed consent that explains the following risks associated with opioids:
  • Addiction;
  • Overdose and death;
  • Physical dependence;
  • Physical side effects;
  • Hyperalgesia;
  • Tolerance; and
  • Crime victimization;
• Create and discuss a treatment plan with the patient. This shall include, but not be limited to the goals of treatment, in terms of pain management, restoration of function, safety, time course for treatment, and consideration of non-pharmacological modalities and non-opioid therapy. Informed consent documents and treatment agreements may be part of one document for the sake of convenience;
• Utilize a written treatment agreement that is included in the medical record, and specifies conduct that triggers the discontinuation or tapering of opioids;
• The treatment agreement shall also address, at a minimum, the following:
  • The requirement of safe medication use and storage;
  • The requirement of obtaining opioids from only one prescriber or practice;
  • The consent to periodic and random drug testing; and
  • The prescriber’s responsibility to be available or to have clinical coverage available;
• Document the consideration of a consultation with an appropriate specialist in the following circumstances:
  • When the patient receives a 100 mg morphine equivalent dose daily for longer than 90 days;
  • When a patient is at high risk for abuse or addiction; or
  • When a patient has a co-morbid psychiatric disorder;
• Reevaluate treatment plan and use of opioids at least twice a year;
• Require random and periodic urine drug testing at least annually for all patients using opioids for longer than 90 days. Unanticipated findings shall be addressed in a manner that supports the health of the patient;
• Have clinical coverage available for 24 hours per day, 7 days per week, to assist in the management of patients; and
• The prescriber may forego the requirements for a written treatment agreement and for periodic drug testing for patients:
  • Who are residents in a long-term, non-rehabilitative nursing home facility where medications are administered by licensed staff; or
  • Who are being treated for episodic intermittent pain and receiving no more than 50 dose units of opioids in a 3 month period.