Opioid Laws
State and Bill Number (Year Enacted) | Number of Days or MME | Limitations/
Requirements |
Exceptions to Number of Days/MME | ||||||
Chronic Pain | Cancer | Palliative Care | Hospice Care | Provider Judgment | SUD/MAT | Other Info/Exceptions | |||
Alaska
HB 159 (2017) |
7 days | -Initial prescription for adult
-Any prescription for minor |
X | X
(Medicine & Nursing only) |
X | X | X
(Medicine only) |
-Patient travel or logistical barrier | |
4 days | -Initial prescription for adult when prescribed by an optometrist
-Any prescription for minor when prescribed by an optometrist |
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Arizona
SB 1001a (2018) |
5 days
90 MME/day
|
-Initial prescription
-New prescription |
X | X | X | X
(MME exception only) |
X | -Traumatic injury
-Skilled nursing facility care -Burn treatment -Infant being weaned off opioids at time of discharge (day exception only) -Hospitalization (MME exception only) |
|
14 days | -Following surgical procedure | ||||||||
Connecticut
HB 5053 (2016) HB 7052 (2017) |
7 days | -Initial prescription for adults | X | X | X | X | X | -1 hour of CME per license renewal – covers opioid/pain management
-Any Rx longer than 72 hours must include review of PDMP -Pharmacists can prescribe opioid antagonists, need to provide record and training to patient |
|
5 days | -Any prescription for minor | ||||||||
Florida
HB 21 (2018) |
3 days | -Prescription for acute pain | -7 day supply permitted if medically necessary based on practitioner professional judgement
-Definition of acute pain excludes: cancer, terminal conditions, traumatic injury and palliative care -Exceptions in dispensing provisions allow for MAT |
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Hawaii
SB 505 (2017) |
7 days | -Initial concurrent prescriptions of opioids and benzodiazepines | X | X | X | X | X | -Post-operative care | |
Indiana
SB 226 (2017) |
7 days | -Initial prescription for adult
-Any prescription for minor |
X | X | X | X | -Adopted by medical licensing board rule
-Patients can request to dispense a lesser amount (pharmacist must document) -Inspect PDMP |
||
Kentucky
HB 333 (2017) |
3 days | -Initial prescription of Schedule II controlled substance for acute pain | X | X | X | X | X | -Inpatient setting
-Major surgery or trauma -Determined by licensing board in consultation with state Office of Drug Control Policy |
|
Louisiana
HB 192 (2017) |
7 days | -Initial prescription for adult for acute pain
-Any prescription for minor |
X | X | X | X | X | ||
Maine
SB 671 (2016) SB 338 (2017) |
100 MME/day
7 within 7 days OR 30 within 30 days |
-Acute pain
-Chronic pain |
X | X | X | X | -Determined by Dept. of Health
-ER, inpatient hospital setting, long-term care facility or residential care facility -Surgical procedures -3 hours of CME every 2 years -Must be electronic prescriptions as of 7/1/2017 -Partial prescription fills allowed |
||
Maryland
HB 1432 (2017) |
-Required practitioners to prescribe lowest effective dose of an opioid and a quantity that is not greater than needed for the expected duration of pain | X | X | X | X | X | |||
Massachusetts
HB 4056 (2016) |
7 days | -Initial prescription for adult
-Any prescription for minor |
X | X | X | X | X | -Information on opioid use and misuse must be disseminated at annual head safety programs for high school athletes
-Required CME credits ranging from training on effective pain management to risks of abuse and opiate addiction -Patients can partially fill prescription -Patients will receive access to non-opiate directive forms |
|
Minnesota
SF 2a (2017) |
4 days | -Schedule II through IV controlled substances when used for acute dental or ophthalmic pain | X | X | X | X | X | -Post-op can be 7-day supply or up to 200 MME
|
|
Nebraska
LB 931 (2018) |
7 days | -Prescription for minor for acute pain | X | X | X | ||||
Nevada
AB 474 (2017) |
14 days
90 MME/day |
-Initial prescription of Schedule II-IV controlled substances for acute pain
-MME limit for opioid that has never been issued to patient before or has been issued more than 19 days prior |
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New Jersey
SB 3 (2017) |
5 days | -Initial prescription for acute pain
-Requires “lowest effective dose” of opioid for any prescription for acute pain |
X | X | X | X | -Long-term care facility
-Need written pain management plan for patients that require chronic use -Must document risks of opiate use discussed with patient -State-regulated health insurers must cover first 4 weeks of inpatient or outpatient substance abuse treatment without need for authorization; must provide additional coverage for up to 6 months of treated if deemed medically necessary |
||
New York
SB 8139 (2016) |
7 days | -Initial prescription for adult | X | X | X | X | -Ends prior authorization to allow immediate treatment as inpatient as long as needed
-Ends prior authorization to allow greater access to Rx treatment meds -Requires all insurance companies to follow state-approved criteria to determine the level of care for individuals suffering from substance abuse -Mandates naloxone coverage -3 CME credits in addiction and pain management every 3 years |
||
North Carolina
HB 243 (2017) |
5 days | -Initial prescription for certain Schedule II and III controlled substances for acute pain | X | X | X | X | X | -Administered in hospital, nursing home or residential care facility | |
7 days | -Prescription for certain Schedule II and III controlled substances for post-operative relief | ||||||||
Pennsylvania
SB 1367 (2016) HB 1699 (2016) |
7 days | -Prescription in ER, urgent care, hospital observation
-Any prescription for minor |
X (minors only) | X | X | X (minors only) | X | -100 MME/day recommended; higher doses require practitioner/pharmacist discussion
-120 MME/day max allowed -Safe and Effective Prescribing Practices Task Force formed for education to prescribers -General guidelines about methadone use -Separate guidelines for chronic pain, ED pain treatment guidelines, dental practice, Ob/Gyn pain treatment, geriatric pain, addiction treatment in pregnant patients with opioid use disorder, benzodiazepines for acute treatment of anxiety and insomnia, orthopedics/sports medicine and pediatric/adolescent populations |
|
Rhode Island
SB 2823 (2016) HB 8224 (2016) |
30 MME/day | -Up to 20 doses for initial prescriptions for adults for acute pain | X | X | X | X | -Department of health regulations
-Informed consent for opioid prescription -Electronic prescriptions |
||
Utah
HB 50 (2017) |
7 days | -Prescription for Schedule II and III opioids for acute pain | X | -Surgery (permits up to 30 days)
-Complex or chronic conditions |
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West Virginia
SB 273 (2018) |
7 days | -Initial prescription for “lowest effective dose” | X | X | X | X | -Long-term care facility
-7-day supply permitted in urgent care if medical rationale is documented |
||
3 days | -Prescription for minor
Also: -3 day supply written by a dentist or optometrist -4-days supply of an opioid for outpatient use for an adult seeking care in an emergency room or urgent use |
MME = morphine milligram equivalent
SUD/MAT = Substance-use disorder, medication-assisted treatment
http://www.ncsl.org/research/health/prescribing-policies-states-confront-opioid-overdose-epidemic.aspx (Accessed July 2018)
Alabama:
-Alabama Opioid Overdose Addiction Council Report – https://www.scribd.com/document/369920282/Alabama-Opioid-Overdose-Addiction-Council-Report#from_embed
-Alabama Department of Public Health has PDMP
Arkansas:
-Arkansas Medical Society resources regarding prescription drug abuse – https://www.arkmed.org/resources/prescription-monitoring/
-Arkansas Emergency Department Opioid Prescribing Guidelines – http://www.arkhospitals.org/Misc.%20Files/Arkansas%20Emergency%20Department%20Opioid%20Prescribing%20Guidelines.pdf
-Arkansas State Medical Board changes rules in 2017 – focusing on controlled substances and support the PDMP – https://www.arkmed.org/news/2017/08/asmb-proposes-new-amended-rules/
California: No opioid laws
-Statewide Prescription Opioid Misuse and Overdose Prevention Workgroup:
-Strategies for assisting high-risk patients
-Medication-assisted treatment certification programs
-Local addiction recovery services locator
-CURES (California’s prescription drug monitoring program)
-Opioids prescribing guidelines
-Opioids prescriber resource sheet
Colorado: No opioid laws
-Colorado Medical Society passed July 2017 board meeting – Opioid Prescribing and Treatment Guidelines for Emergency Departments
-Regulatory Boards for dental, medical, nursing and pharmacy in Colorado along with the Nurse-Physician Advisory Taskforce for Colorado Healthcare supported development of Policy for Prescribing and Dispensing Opioids:
-Bright line thresholds for additional safeguards at certain levels: 90 days in duration, 120 MME dosages or certain formulations such as transdermal or long-acting preparations
-Assessing patient risk in all prescribing situations
-Classifying pain – acute vs chronic pain
Georgia:
-Georgia House Bill 965 – Good Samaritan Law signed in April 2014
-Georgia’s blog on opioid epidemic and ways to get help – https://georgia.gov/blog/2017-12-12/georgia%E2%80%99s-opioid-epidemic-and-ways-get-help
-Georgia pain management rules as per medical board – https://medicalboard.georgia.gov/sites/medicalboard.georgia.gov/files/imported/GCMB/Files/360-3-.06%20Pain%20Management%20Rules.pdf
Idaho: No opioid laws:
-Idaho Board of Medicine Policy for the Use of Opioid Analgesics in the Treatment of Chronic Pain
-Idaho Division of Public Health using funding from CDC:
-Integrate Idaho PDMP data into HER
-Educate prescribers
-Enhance data quality and availability of data for public health purposes
-Develop a data dashboard
-Educate patients
-Idaho Division of Behavioral Health using funding for:
-Introduce publicly-funded Medication-Assisted Treatment (MAT) to Idaho
-Distribute prescriber report cards to prescribers in the PDMP
-Establish drop-box programs in pharmacies
-Improve recovery support
-Increase the use of naloxone to reverse opiate overdoses
Illinois:
-Released a state opioid action plan (9/1/17) to combat state opiate abuse
-ILPMP use not mandatory but preferred; being integrated into EHRs
-IL Controlled Substance Act allows for 3 30-day Schedule II prescriptions, requires legitimate medical purpose documented in medical record
Iowa:
-Must check PMP. Rules to be set by state licensing board.
-All opioid prescriptions be sent electronically (to cut down on forged prescriptions) (as of 2020)
-Good Samaritan protection to those that report an overdose
-Providers will receive an annual report showing how many prescribed and peer comparison
-Automatic notification if there is evidence of doctor shopping
-No limits on days prescribed
Kansas: No opioid laws:
-Joint Policy Statement of the Boards of Healing Arts, Nursing and Pharmacy on the Use of Controlled Substances for the Treatment of Pain:
-Assessment of the patient
-Treatment plan with stated objectives
-Informed consent
-Written agreement for treating of high-risk patients
-Periodic review
-Consultation to experts in pain management as needed
-Medical records documentation
-Compliance with Controlled Substance Laws and Regulations
-HB 2217 – Opioid Antagonists:
-Create standards governing the use and administration of emergency opioid antagonists for approved by the U.S. FDA in inhibit the effects of opioids and for the treatment of an opioid overdose
Michigan: Public Acts 246-55 of 2017: Effective 6/1/2018:
-Prescriber must discuss: Dangers of opioid addiction; how to dispose of unwanted controlled substances; that delivery of a controlled substance is a felony; must disclose to pregnant patients dangers to fetus.
-Patients must sign consent for opioid use
-Prescribers have to prove “bona fide prescriber-patient relationship with the patient” (effective date is 3/31/19), defined as “prescriber has reviewed medical record and made a full assessment of the patient’s medical history and current condition” and the prescriber has “created and maintained records of the patient’s condition in accordance with medically accepted standards”.
-Prescribers have to provide follow-up care after prescription is given or refer to PCP or “another licensed provider who is geographically accessible” for follow-up
-Greater than 3-day supply requires consulting MAPS (PMP) and as of 6/1/18 prescribers must register with MAPS
-Acute pain limited to 7-day prescriptions
-Pharmacists can partial fill prescriptions
Missouri: No opioid laws:
-Controlled substance guidelines for EMS
-Controlled substance guidelines for Practitioners:
-List of controlled substances
-Controlled substance registrations
-How to purchase/receive controlled substances
-Continuous records for accountability
-Controlled substance receipt records
-Inventory of controlled substances and storage
-Administering and dispensing controlled substances
-Required documentation in patients’ charts
-Disposing of unwanted controlled substances
-Documentation required on written prescriptions
-Prescribing recommendations
Prescription Characteristic | Limitation Schedule II | Limitation Schedule III and IV | Limitation Schedule V |
Mode of issuing prescription |
· Written mostly; · Verbal in an emergency by physician only · Faxed if injectable, To LTCF or hospice— doctor must manually sign; · Electronic |
· May be written or; · Orally phoned in; or · Faxed with manual signature; or · Electronic |
· May be written or; · Orally phoned in; or · Faxed with manual signature; or · Electronic |
Refills |
· No Refills Allowed; · Partial filling allowed for patients in LTCF or hospice |
Maximum of five within six months of issuing prescription |
As authorized by the physician. Can be refilled PRN as prescriber allows for one year |
Length of prescription validity |
Six months |
Six months |
One year |
Quantity limitations |
· 30 days for most; · Rx for over 30 days requires medical reason; · Maximum is 90 day supply · Can write multiple & separate Rx with “Do Not fill until date” written on bottom. Can’t exceed 90 day supply · Mid-level practitioners are limited to only hydrocodone, and then a 5 day supply. |
90 days |
90 days |
Mississippi:
-Mississippi State Medical Board proposed new opioid prescribing rules: https://www.msmaonline.com/M/Public/Press_Room/Physicians_Position2/PP__October_5__2017.aspx
-Requirement for all licensees to run a PDMP at each encounter when prescribing opioids for acute or chronic pain
-PDMP reports must be kept in the patient file and available for inspection
-Point of service drug testing must be conducted each time a Schedule II prescription is written for treatment of chronic non-cancer pain and every 90 days for patients prescribed Benzodiazepines for chronic medical and/or psychiatric conditions
-Prohibition from prescribing more than a 7-day supply of opioids for acute pain
-Benzodiazepines and opioids may not be prescribed concurrently, with limited exception for an acute injury and for no more than 7 days
-Pain management practices now include those issuing controlled substances to 30% of patients for chronic pain (previously 50%)
-Expanded requirements for Bariatric Medicine, Medical Weight Loss or Weight Management practices but carved out clinics offering non-pharmacological products as part of overall practice
Montana: No opioid laws:
-Montana Medical Association – White paper on reducing prescription drug abuse, misuse and diversion in Montana
-Montana Utilization and Treatment Guidelines – Chronic Pain Disorder – effective January 1, 2018 – http://erd.dli.mt.gov/Portals/54/Documents/Work-Comp-Claims/Medical-Regs/U%26T%20Guidelines/MT%20ChronicPain%20FINAL%2001%2001%202018.pdf
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.
New Mexico: No opioid laws:
-New Mexico Clinical Guidelines on Prescribing Opioids for Treatment of Pain – 2011: Summary of Recommendations
–Opioid Treatment of Acute Pain:
-Opioid medications should only be used for treatment of acute pain when the severity of the pain warrants that choice and after determining that other non-opioid pain medications or therapies will not provide adequate pain relief.
-When opioid medications are prescribed for treatment of acute pain, the number 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.
-When opioid medications are prescribed for treatment of acute pain, the patient should be counseled to store the medications securely, to not share with others, and to dispose of medications properly when the pain has resolved in order to prevent non-medical use of the medications.
-Long duration-of-action opioids should not be used for treatment of acute pain, including post-operative pain, except in situations where monitoring and assessment for adverse effects can be conducted. Methadone is rarely, if ever, indicated for treatment of acute pain.
-The use of opioids should be re-evaluated carefully, including assessing the potential for abuse, if persistence of pain suggests the need to continue opioids beyond the anticipated time period of acute pain treatment for that condition.
–Opioid Treatment for Chronic Pain:
-A comprehensive evaluation (including the pathophysiologic causation, risk for abuse, and other co-morbid conditions) should be performed before initiating opioid treatment for chronic pain.
-Alternatives to opioid treatment should be tried (or an adequate trial of such treatment by a previous provider documented) before initiating opioid treatment.
-The provider should screen for risk of abuse or addiction before initiating opioid treatment.
-When opioids are to be used for treatment of chronic pain, a written treatment plan should be established that includes measurable goals for reduction of pain and improvement of function.
-The patient should be informed of the risks and benefits and any conditions for continuation of opioid treatment, ideally using a written and signed treatment agreement.
-Opioid treatment for chronic pain should be initiated as a treatment trial, usually using short-acting opioid medications.
-Regular visits with evaluation of progress against goals should be scheduled during the period when the dose of opioids is being adjusted (titration period).
-Once a stable dose has been established (stable chronic dose period), regular monitoring should be conducted at face-to-face visits during which treatment goals, analgesia, activity, adverse effects are monitored. Patients should be monitored for aberrant behavior (tools include drug screening and prescription drug monitoring program report surveillance).
-Continuing opioid treatment after the treatment trial should be a deliberate decision that considers the risks and benefits of chronic opioid treatment for that patient. A second opinion or consult may be useful in making that decision.
-An opioid treatment trial should be discontinued if the goals are not met and opioid treatment should be discontinued at any point if adverse effects outweigh benefits or if dangerous or illegal behaviors are demonstrated.
-Clinicians treating patients with opioids for chronic pain should maintain records documenting the evaluation of the patient, treatment plan, discussion of risks and benefits, informed consent, treatments prescribed, results of treatment and any aberrant behavior observed.
-Clinicians should consider consultation for patients with complex pain conditions, patients with serious co-morbidities including mental illness, patients who have a history or evidence of current drug addiction or abuse, or when the provider is not confident of his or her abilities to manage the treatment.
-Methadone should only be prescribed by clinicians who are familiar with its risks and appropriate use, and who are prepared to conduct the necessary careful monitoring.
-Clinicians should be aware of the potential toxicity of acetaminophen in opioid-acetaminophen combination products, warn patients not to exceed the maximum daily dose of acetaminophen and monitor acetaminophen doses in the patient‘s known medication regimen.
North Dakota: No opioid laws: Pre-Approved Evidence-Based Strategies Menu to align with the goals and objectives of North Dakota’s State Targeted Response to the Opioid Crisis Grant:
PREVENTION | |
Strategy | Description and Guidance for Implementation |
Objective 2.1: Decrease access to unneeded prescription opioid medication | |
Support adoption of best practice policies relating to pain management and prescribing practices |
· Collaborate with primary care providers, the medical association, and other prescribing professionals about best practices for prescribing opioids, managing patient pain, and identifying signs of OUD.
· Advocate for the adoption or enhancement of policies relating to pain management and prescribing practices. · Utilize evidence-based strategies, outlined in North Dakota’s Stop Overdose resources for professionals, SAMHSA’s Opioid Overdose Prevention Toolkit, and CDC’s Opioid Prescribing Guidelines. |
Increase utilization of North Dakota’s PDMP | · Assess local utilization rates for various professions and identify gaps to target activities.
· Pursue policy development and promote benefits of PDMP utilization to prescribers, pharmacies, and authorized behavioral health providers. |
Increase ND Take Back locations |
· Provide information and resources to pharmacies about the Yellow Jug Old Drug program available in North Dakota and how to apply to participate in the program.
· Promote existing/new local Prescription Drug Take Back programs within service area. |
Promote safe use of medication through comprehensive messaging | · Disseminate Lock. Monitor. Take Back. resources and materials to the general public, Yellow Jug Old Drug pharmacies, and Take Back locations at local law enforcement centers.
· Make enhancements to Lock. Monitor. Take Back. messaging to support local conditions and needs when necessary. |
Objective 2.2: Increase availability and utilization of naloxone as an evidence-based opioid overdose prevention practice | |
Purchase naloxone for professional organizations | · Work with stakeholders to purchase naloxone for community agencies/organizations, including law enforcement, first responders, and schools.
· Provide naloxone training to community agencies/organizations, as approved by the State. |
Promote evidence-based overdose prevention through comprehensive messaging | · Disseminate Stop Overdose resources and materials to those most impacted by (risk of) overdose, including the general public and professionals.
· Implement messaging specific to North Dakota’s Good Samaritan Law. · Make enhancements to Stop Overdose messaging to support local conditions and needs when necessary. |
Increase number of pharmacists prescribing naloxone | · Advocate for the prescribing of naloxone within pharmacies, utilizing supporting data and resources.
· Provide information on how to become a naloxone prescriber to all local pharmacists not currently prescribing naloxone. · Promote local pharmacies prescribing naloxone to the general public. |
TREATMENT/RECOVERY | |
Strategy | Description and Guidance for Implementation |
Objective 1.1: Increase utilization of Medication Assisted Treatment (MAT) as a clinically appropriate evidence-based practice for Opioid Use Disorder (OUD) treatment | |
Enhance utilization of MAT as an evidence-based practice for treatment of OUD | · Collaborate with State-level Champion Prescriber to support efforts to increase utilization of MAT.
· Collaborate with physicians, nurses, nurse practitioners, physician’s assistants, and other behavioral health providers. · Utilize evidence-based strategies outlined in North Dakota’s Stop Overdose resources for professionals, SAMHSA’s Opioid Overdose Prevention Toolkit, and CDC’s Opioid Prescribing Guidelines to support efforts. |
Support adoption or enhancement of policies supportive of MAT within local behavioral health residential programs | · Collaborate with relevant stakeholders to advocate for the adoption or enhancement of policies supportive of MAT within local behavioral health residential programs.
· Provide training to local behavioral health residential programs about effective policies and procedures supportive of MAT, as approved by the State.
|
Address barriers to receiving treatment | · Utilize local data to support the development of systems of care to expand access to treatment.
· Support treatment providers with the implementation of activities to engage and retain patients in treatment. |
Support innovative telehealth in rural and underserved areas to increase the capacity of communities to support OUD treatment | · Collaborate with relevant stakeholders to support the adoption or expansion of telehealth programs in rural and underserved areas within identified service area. |
Objective 1.2: Increase access to peer and other evidence-based recovery support services | |
Offer localized train-the-trainer program for evidence-based peer recovery support services | · Enhance community-based recovery support systems through the utilization and implementation of evidence-based training programs, as approved by the State.
· Collaborate with State to develop process for ensuring peer and other evidence-based recovery support services are locally implemented. · Collaborate with relevant stakeholders to identify and recruit appropriate professionals to participate in train-the-trainer program. |
Support innovative telehealth in rural and underserved areas to increase the capacity of communities to support recovery | · Collaborate with relevant stakeholders to support the adoption or expansion of telehealth programs in rural and underserved areas within identified service area. |
Objective 1.3: Increase communication efforts to reduce stigma surrounding Opioid Use Disorder (OUD), Medication Assisted Treatment (MAT) and needle exchange/syringe service programs | |
Reduce stigma surrounding OUD through comprehensive messaging | · Develop an ongoing community awareness messaging plan addressing stigma surrounding Opioid Use Disorder (OUD), utilizing Stop Overdose resources when applicable.
· Implement messaging plan to the general public. |
Increase awareness of and reduce stigma surrounding Opioid Treatment Program (OTP) services through comprehensive messaging | · Develop an ongoing community awareness messaging plan addressing stigma surrounding Opioid Treatment Program (OTP) services.
· Implement messaging plan to the general public. |
Reduce stigma relating to syringe service programs through comprehensive messaging | · Disseminate evidence-based information and literature about syringe service programs, including North Dakota-specific information, to relevant stakeholders, individuals at risk, and the general public within service area.
· Collaborate with community stakeholders and North Dakota Department of Health to pursue the implementation of a community syringe services program. |
Ohio: Prescription law (8/31/2017):
-OARRS – Ohio’s prescription monitoring system – all opioid scripts must be entered, and this must be checked; diagnosis and procedure code must also be entered for acute pain scripts
-7-day limit for adult for acute pain
-5-day limit for minors for acute pain
-No more than 30 MME/day
-Can prescribe in excess if documented in medical record
-Cancer, palliative care, end-of-life/hospice and addiction treatment exempt
-Rules apply to first script only
-Naloxone OTC and can be given without Rx by first responders.
Oklahoma: No opioid laws:
-Oklahoma State Board of Medical Licensure and Supervision Policy on Use of Controlled Substances for the Treatment of Pain
-Oklahoma Opioid Prescribing Guidelines – Oklahoma State Department of Health
-Opioid Treatment of Acute Pain:
- Health care providers are encouraged to consider non-pharmacological therapies and/or non-opioid pain medications. Opioids should only be used for treatment of acute pain when the severity of the pain warrants that choice.
- By Oklahoma law, it is mandatory that providers check the Oklahoma Prescription Monitoring Program (PMP) prior to prescribing and every 180 days prior to authorizing refills for opiates, synthetic opiates, semi-synthetic opiates, benzodiazepines, or carisoprodol. More frequent checks of the PMP are recommended.
- When opioids are started, providers should prescribe the lowest possible effective dose. Prescribe no more than a short course; most patients require opioids for no more than three days.
- Avoid prescribing opioids to patients currently taking benzodiazepines and/or other opioids.
- Patients should be counseled to store medications securely, never to share them with others, and to dispose of medications when the pain has resolved.
- Long-acting or extended-release opioids should not be prescribed for acute pain.
- Providers should provide screening, brief intervention, and referral to treatment, if indicated.
- Continued opioid use should be evaluated carefully, including assessing the potential for abuse, if pain persists beyond the anticipated period of acute pain.
- In general, health care providers should not provide replacement prescriptions for opioids that have been lost, stolen, or destroyed.
-Opioid Treatment of Chronic Pain:
- Alternatives to opioid treatment should be tried, or previous attempts documented, before initiating opioid treatment for chronic pain.
- By Oklahoma law, it is mandatory that providers check the Oklahoma Prescription Monitoring Program (PMP) prior to prescribing and every 180 days prior to authorizing refills for opiates, synthetic opiates, semi-synthetic opiates, benzodiazepines, or carisoprodol. More frequent checks of the PMP are recommended.
- A comprehensive evaluation should be performed before initiating opioid treatment for chronic pain.
- The health care provider should screen for risk of abuse or addiction before initiating opioid treatment.
- Patients should be counseled to store medications securely, never to share them with others, and to dispose of medications when pain has resolved.
- Long-acting or extended-release opioids are associated with an increased risk of overdose death, and should only be prescribed by health care providers familiar with their indications, risks, and need for careful monitoring.
- A written treatment plan should be established that includes measurable goals for reduction of pain and improvement of function.
- The patient should be informed of the risks, benefits, and terms for continuation of opioid treatment, ideally using a written and signed treatment agreement. Consider co-prescribing naloxone for patients with increased risk of opioid overdose.
- Opioids should be initiated as a short-term trial to assess the effects of opioid treatment on pain intensity, function, and quality of life. The trial should begin with a short-acting opioid medication.
- During the titration period, regular visits for evaluation of progress toward goals should be scheduled and the PMP should be checked more frequently.
- Continuing opioid treatment should be a deliberate decision that takes into consideration the risks and benefits of chronic opioid treatment for that patient. Patients and health care providers should periodically reassess the need for continued opioid treatment, weaning whenever possible. A second opinion or consultation may be useful in making that decision.
- Opioid treatment should be tapered or gradually discontinued if adverse effects outweigh benefits or if aberrant, dangerous, or illegal behaviors are demonstrated. Care should be taken when tapering opioid treatment, particularly in patients on higher dosages, the elderly, and patients who are pregnant. Abrupt discontinuation of opioids should be avoided.
- Health care providers should consider consultation for patients with complex pain conditions, serious co-morbidities, mental illness, or a history or evidence of current drug addiction or abuse.
- In general, health care providers should not provide replacement prescriptions for opioids that have been lost, stolen, or destroyed.
- Health care providers should offer or arrange evidence-based treatment (usually medication-assisted treatment with buprenorphine or methadone in combination with behavioral therapies) for patients with opioid use disorder.
Oregon: No opioid laws:
-Oregon Opioid Prescribing Guidelines – Oregon Health Authority: Public Health Division – https://www.oregon.gov/obnm/rules/opioidprescribingguidelines.pdf
-Oregon Medical Association – Opioid Epidemic Page – http://www.theoma.org/practice-help-center/opioid-epidemic
-Oregon Pain Guidance Provider and Community Resource: Opioid Prescribing Guidelines – http://www.oregonpainguidance.org/wp-content/uploads/2014/04/OPG_Guidelines.pdf
South Carolina:
-Joint Pain Management Guidelines – State Boards of Dentistry, Medical Examiners, Nursing and Pharmacy – 2017 – https://www.llr.sc.gov/pol/Medical/pdf/FINAL%20Joint%20Revised%20Pain%20Management%20Guidelines%20August%202017.pdf
-South Carolina Department of Health and Environmental Control – website for Opioid Epidemic – https://www.scdhec.gov/Health/Opioids/
–
South Dakota: No opioid laws:
-South Dakota’s Statewide Targeted Response to the Opioid Crisis – https://doh.sd.gov/documents/news/SDOpioidAbuseStrategicPlan.pdf
-South Dakota’s Prescription Opioid Abuse Prevention Initiative – https://doh.sd.gov/news/Opioid.aspx
Tennessee: New law passed, effective July 1, 2018 –
-Law specifics:
-Pharmacists can only partially fill a prescription for no more than half of the number of days its written for
-General prescriptions limited to 10-day supply (no more than 500 MME)
-After surgery limited to 20-day supply (maximum 850 MME)
-“Medical necessity” prescriptions limited to 30-day supply (maximum 1200 MME)
-Effective July 1, but mandatory Jan 1, 2019
-Must check state PDMP – checked with initial prescription, and at least every 6 months as long as getting refills
-Must document reason for prescription in medical record
-3-day supply (maximum 180 MME) without restrictions
-Some exceptions: palliative cancer treatments or hospice care, sickle cell disease, inpatients at licensed facilities, seen by deemed “pain management specialists” as per state rules, those treated with opioids for more than 90 days or more; severe burns of “major physical trauma”, and those on methadone, buprenorphine or naltrexone
-Tennessee government policy center for opioids and prescribing guidelines – https://www.tn.gov/opioids/health-care-professionals/laws-and-policies.html
-Tennessee Chronic Pain Guidelines – https://www.tn.gov/content/dam/tn/health/healthprofboards/ChronicPainGuidelines.pdf
Texas: No opioid laws:
-Texas Medical Board Minimum Requirements for the Treatment of Chronic Pain – https://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=22&pt=9&ch=170&rl=3
-Texas Medical Association House of Delegates Policy on Opioid Prescribing for Pain Management – http://www.texaspain.org/assets/resolution313.pdf
-Texas State Board of Pharmacy: Information Regarding Controlled Substances – https://www.pharmacy.texas.gov/controlledsubstances.asp
Vermont: No opioid laws:
-Prescription rules (4/20/2017):
-Providers must discuss and document alternatives to opiates
-Providers must access VPMS (state monitoring system)
-Must provide patient education (standardized and developed by state) and informed consent
-Acute pain is broken down into minor, moderate, severe, and extreme pain; morphine mg equivalent limits set for each category
-Rules set by Dept of Health and not by statute
Virginia:
-Regulations Governing Prescribing of Opioids and Buprenorphine – http://townhall.virginia.gov/l/ViewXML.cfm?textid=11462
-VA Board of Medicine – Regulations on Opioid Prescribing and Buprenorphine – https://www.dhp.virginia.gov/medicine/newsletters/OpioidPrescribingBuprenorphine03142017.pdf
-Medical Society of Virginia Opioid and Buprenorphine Prescriber Regulations Guide – https://www.msv.org/sites/default/files/opioid_and_buprenorphone_guide.pdf
Washington: No opioid laws:
-ESHB 1427 – Concerning opioid treatment programs – http://lawfilesext.leg.wa.gov/biennium/2017-18/Pdf/Bill%20Reports/House/1427-S.E%20HBR%20FBR%2017.pdf
-Interagency Guideline on Prescribing Opioids for Pain – Developed by Washington State Agency Medical Directors’ Group – http://agencymeddirectors.wa.gov/Files/2015AMDGOpioidGuideline.pdf
-Washington State Department of Health Pain Management Resources – https://www.doh.wa.gov/LicensesPermitsandCertificates/MedicalCommission/MedicalResources/PainManagement
Wisconsin:
-30 laws signed by current governor to combat opioid use
-New guidelines (4/19/18) – consider two smaller prescriptions rather than one large one: “lowest dose and fewest number of opioid pills”
-Consider non-opioid alternatives
-Encourages use of PMP; law requires consulting PMP to prescribe for > 3 days
-Avoid oxycodone whenever possible
-Avoid methadone unless prescriber has specialized training
-Consider prescribing home naloxone for chronic opioid users
-Note: above has caused 29.7% decrease in opiate prescriptions since 2015
Wyoming: No opioid laws:
-Wyoming Controlled Substances Act and Rules – Changes 2017 – https://www.deadiversion.usdoj.gov/mtgs/pharm_awareness/conf_2017/aug13_2017/walker-wills.pdf
-Wyoming Workers’ Compensation Division Treatment Guidelines – Chronic Non-Malignant Pain – http://www.wyomingworkforce.org/_docs/providers/Chronic-Pain-Treatment-Guidelines.pdf
-Wyoming Department of Health – Opioid Abuse Data and Resources – https://health.wyo.gov/publichealth/prevention/substanceabuseandsuicide/opioid-information-wyoming/opioid-abuse-data-resources/
https://www.affirmhealth.com/blog/opioid-prescribing-guidelines-a-state-by-state-overview (accessed July 2018)
PDMP Laws/Mandates
Alaska | Arizona | California | Colorado | Hawaii | Idaho | |
Type of mandate | ||||||
-Does the mandate apply to all prescribers and at least all initial opioid prescriptions? | Yes | Yes | Yes | No – prescribers must check the PDMP prior to writing a second opioid prescription; additionally, prescribers must review the PDMP as clinically appropriate upon intake at an opioid treatment program and for workers’ compensation when drug screen tests are ordered | No mandate | No mandate |
Drugs included | ||||||
What drugs are included in the mandate? | DEA Schedules II and III | Schedule II-IV opioids and benzodiazepines | Schedules II-IV | Opioids | No mandate | No mandate |
Timing triggers | ||||||
Is the prescriber required to review the PDMP for the initial prescription for drugs that are subject to the mandate? | Yes | Yes – for all patients, prescribers must review a patient’s PDMP report before prescribing an opioid or benzodiazepine in Schedules II-IV | Yes | No | No mandate | No mandate |
Is the prescriber required to review the PDMP at regular intervals after the initial prescription? | No | Yes – at least quarterly | Yes – every four months | Yes | No mandate | No mandate |
Are there other timing triggers? | Yes – for every DEA schedule II or III prescription | No | No | Yes – prescribers must review the PDMP prior to writing a second opioid prescription | No mandate | No mandate |
Exceptions to PDMP review | ||||||
Are short duration prescriptions exempt from the mandate? | Yes – 3-day supply or less is exempt; controlled substance dispensed to a patient for an outpatient supply of 24 hours or less at a hospital inpatient pharmacy or ED is also exempt | Yes – 5-day supply or less for an invasive medical or dental procedure that results in acute pain is exempt, also 5-day supply or less to treat an acute injury or a medical or dental disease process that is diagnosed in an ED setting and results in acute pain is also exempt | Yes- 7-day supply or less provided by ED is exempt; 5-day supply or less as part of treatment for a surgical procedure is exempt | No | No mandate | No mandate |
Are prescriptions for terminally ill patients exempt from PDMP review? | Yes | Yes | Yes – only controlled substance prescriptions for patients receiving hospice care are exempt | Yes | No mandate | No mandate |
Are prescriptions issued or administered at hospitals and long-term care facilities exempt from the mandate? | Yes | Yes | Yes | Yes | No mandate | No mandate |
Is there an exception to the mandate if the PDMP is inaccessible? | No | Yes | Yes – if the PDMP Is inaccessible, controlled substance prescriptions must not exceed a nonrefillable 5-day supply | No | No mandate | No mandate |
Are there other exceptions? | Yes – mandate does not apply for dispensing, prescribing or administering a controlled substance to a person who is receiving treatment at the scene of an emergency or in an ambulance, in an ED, immediately before, during, or within the first 48 hours after surgery or medical procedure, or in a hospice or nursing home that has an in-house pharmacy | Yes – mandate does not apply for patients receiving care for cancer, cancer-related illness or condition, or dialysis treatment | Yes – mandate does not apply to controlled substances in Schedule II-V that are administered to a patient; mandate does not apply to veterinarians, does not apply if it is not reasonably possible for a health care practitioner to access the PDMP in a timely manner | Yes – mandate does not apply to second opioid prescriptions for patients receiving the prescription in a correctional facility, patients who have been diagnosed with cancer and are experiencing cancer-related pain, patients experiencing post-surgical pain that is expected to last more than 14 days, patients receiving treatment during a natural disaster or during an incident where mass casualties have taken place, and patients who have received only a single dose to relieve pain for a single test or procedure. | No mandate | No mandate |
Kansas | Missouri | Montana | Nebraska | Nevada | New Mexico | |
Type of mandate | ||||||
-Does the mandate apply to all prescribers and at least all initial opioid prescriptions? | No mandate | No mandate – On April 25, 2017, the Saint Louis County Department of Public Health implemented a county-based prescription drug monitoring program (PDMP) with patient-level data that grants access to prescribers and dispensers. As of May 10, 2018, 60 counties and cities passed legislation allowing their jurisdiction to participate in St. Louis County’s PDMP. On July 17, 2017, Missouri’s governor signed an executive order directing the Missouri Department of Health and Senior Services (DHSS) to create a statewide PDMP. De-identified pharmacy benefit management data will be analyzed by DHSS to identify and investigate activity indicating that controlled substances are being inappropriately prescribed, dispensed, or obtained. The agency will report such activity to appropriate government officials (e.g., law enforcement, professional licensing boards). Prescribers and dispensers will not have access to the state system. The county and state systems are complementary and will operate simultaneously. | No mandate | No mandate | Yes | Yes |
Drugs included | ||||||
What drugs are included in the mandate? | No mandate | No mandate | No mandate | No mandate | Schedule II-IV controlled substances and Schedule V opioids | Schedules II-V |
Timing triggers | ||||||
Is the prescriber required to review the PDMP for the initial prescription for drugs that are subject to the mandate? | No mandate | No mandate | No mandate | No mandate | Yes | Yes |
Is the prescriber required to review the PDMP at regular intervals after the initial prescription? | No mandate | No mandate | No mandate | No mandate | Yes – evry 90 days | Yes – every three months |
Are there other timing triggers? | No mandate | No mandate | No mandate | No mandate | No | No |
Exceptions to PDMP review | ||||||
Are short duration prescriptions exempt from the mandate? | No mandate | No mandate | No mandate | No mandate | No | Yes – four-day supply or less is exempt |
Are prescriptions for terminally ill patients exempt from PDMP review? | No mandate | No mandate | No mandate | No mandate | No | Yes – only terminally ill patients under hospice care are exempt |
Are prescriptions issued or administered at hospitals and long-term care facilities exempt from the mandate? | No mandate | No mandate | No mandate | No mandate | Yes | Yes |
Is there an exception to the mandate if the PDMP is inaccessible? | No mandate | No mandate | No mandate | No mandate | Yes – practitioner must document the attempt and failure to access the PDMP in the medical record of the patient | No |
Are there other exceptions? | No mandate | No mandate | No mandate
|
No mandate | No | No |
|
||||||
North Dakota | Oklahoma | Oregon | South Dakota | Texas | Utah | |
Type of mandate | ||||||
-Does the mandate apply to all prescribers and at least all initial opioid prescriptions? | No – legislation requires professional licensing boards for each discipline to define rules for required PDMP checks; mandates have been applied to advanced practiced RNs, opioid treatment programs, dentists and physicians | Yes | No Mandate | No mandate | Yes | No |
Drugs included | ||||||
What drugs are included in the mandate? | Schedules II-V | Opioids, benzodiazepines, carisoprodol | No mandate | No mandate | Opioids, benzo, barbiturates, carisoprodol | Schedule II or III opioids |
Timing triggers | ||||||
Is the prescriber required to review the PDMP for the initial prescription for drugs that are subject to the mandate? | Yes – mandate currently applies to APRN for controlled substance prescriptions for new or unestablished patients | Yes – PDMP must be checked for initial prescritpions for methadone; must be checked prior to prescribing opioids, benzo, carisoprodol if patinet’s PDMP profile has not been checked for 180 days | No mandate | No mandate | Yes | Yes |
Is the prescriber required to review the PDMP at regular intervals after the initial prescription? | Yes – for APRNs, every 6 months during treatment with a controlled substance, monthly for opioid treatment program ptaients only | Yes – every 180 days | No mandate | No mandate | No | No |
Are there other timing triggers? | Yes – For advanced practice registered nurses and dentists, when the client requests early refills or engages in patterns of taking more than the prescribed dosage, and upon suspicion or known drug overuse, diversion, or abuse by the client. Physicians shall access the PDMP when he or she has knowledge that the patient exhibits signs of potential abuse or diversion or when a physician expects to prescribe reported drugs for a chronic condition or on a protracted basis | Yes – mandate requires a check each time methadone is prescribed, administered or dispened | No mandate | No mandate | Yes – PDMP must be checked each time a patient is prescribed or dispensed drugs subject to the mandate | Yes – if prescriber is repeatedly prescribing drugs subject to the mandate to a patient, he or she should review the PDMP periodically |
Exceptions to PDMP review | ||||||
Are short duration prescriptions exempt from the mandate? | No | No | No mandate | No mandate | No | No |
Are prescriptions for terminally ill patients exempt from PDMP review? | Yes – for dentists only, prescription for patients in hospice care are except | Yes | No mandate | No mandate | Yes – only terminally ill patients under hospice care are exempt, prescriber must clearly note in the prescription record that the patient is receiving hospice care | No |
Are prescriptions issued or administered at hospitals and long-term care facilities exempt from the mandate? | No | Yes | No mandate | No mandate | No | Yes |
Is there an exception to the mandate if the PDMP is inaccessible? | No | No | No mandate | No mandate | Yes – prescriber is not subject to the mandate if the prescriber makes a good faith attempt to comply but is unable to access the information because of circumstances outside the prescriber’s control | No |
Are there other exceptions? | Yes – For dentists only, nonrefillable prescriptions as part of treatment for a surgical procedure for patients of record, prescriptions made after oral surgery with a prescription duration of no more than a 72-hour supply, and prescriptions for pre-appointment medications for the treatment of procedure anxiety are exempt. | No | No mandate | No mandate | Yes – prescriber not subject to the mandate if the patient has been diagnosed with cancer; the prescriber must clearly note in the prescription record that the patient has this diagnosis | Yes – prescribers are exempt from the mandate when necessary due to an emergency situation |
Alabama | Arkansas | Connecticut* | Delaware | District of Columbia | Florida | |
Type of mandate | ||||||
-Does the mandate apply to all prescribers and at least all initial opioid prescriptions? | No – mandate applies to physicians only | Yes | Yes | No – when prescriber has a reasonable belief that the patient may be seeking the controlled substance, in whole or in part, for any reason other than the treatment of an existing medical condition | -No mandate | -Yes |
Drugs included | ||||||
What drugs are included in the mandate? | Opioids | Schedule II or III opioids, benzodiazepines, tramadol | Schedules II-V (only non-narcotics for Schedule V) | Schedules II-V | No mandate | Schedules II-V – does not apply to non-opioid Schedule V |
Timing triggers | ||||||
Is the prescriber required to review the PDMP for the initial prescription for drugs that are subject to the mandate? | Yes – every time a prescription is written for more than 90 MME/day, physicians shall query the PDMP on the same day the prescription is written to review patient history | Yes | Yes | No | No mandate | Yes |
Is the prescriber required to review the PDMP at regular intervals after the initial prescription? | No | Yes – at least every 6 months for the treatment of chronic, nonmalignant pain. A licensed oncologist shall check the PDMP when prescribing to a patient on an initial malignant episodic diagnosis and every 3 months following the diagnosis while continuing treatment | Yes – every 90 days for Schedule II-V, excluding Schedule V non-narcotic controlled substances. Once annually for Schedule V non-narcotics. | No | No mandate | No |
Are there other timing triggers? | Yes – physicians shall review the PDMP at least two times/year when prescribing for more than 30 MME/day. Shall query every time a prescription for more than 90 MME/day written on the same day as the prescription is written. | Yes – must check every time a schedule II or III opioid is prescribed. | No | Yes – chronic pain patients – query whenever patient is also being prescribed a benzodiazepine, or when patient is assessed to be potentially at risk for substance use disorder, or demonstrates behavior indicative of substance use disorder | No mandate | Yes – for every Schedule II-V prescription |
Exceptions to PDMP review | ||||||
Are short duration prescriptions exempt from the mandate? | No | No | Yes – 3-day supply or less is exempt | Yes – 7-day supply or less is exempt | No mandate | No |
Are prescriptions for terminally ill patients exempt from PDMP review? | Yes – only when prescription indicates “hospice” on the physical prescription | Yes | No | Yes – under hospice care | No mandate | No |
Are prescriptions issued or administered at hospitals and long-term care facilities exempt from the mandate? | Yes – nursing home patients | Yes | Yes | Yes – written at discharge for 7-day supply or less are exempt | No mandate | No |
Is there an exception to the mandate if the PDMP is inaccessible? | No | Yes | Yes – prescriptions for greater than a 3-day supply allowed, must review within 24 hour after regaining access | No | No mandate | Yes – document reason did not consult the system in the patient’s medical record or prescription record, cannot prescribe greater than 3-day supply |
Are there other exceptions? | Yes – does not apply to physicians writing for active, malignant pain or intraoperative patient care | Yes – for malignant condition, for those administered directly to a patient, or a controlled substance sample | No | Yes – active cancer treatment patients, cancer-related pain | No mandate | Yes – patients under age 16 |
Washington | Wyoming | Georgia | Illinois | Indiana | Wisconsin | |
Type of mandate | ||||||
-Does the mandate apply to all prescribers and at least all initial opioid prescriptions? | No – mandate applies only to workers’ compensation ptaients and patient admission to an opiod treatment program | No mandate | No – Schedule II opioids and benzodiazepines | Yes – also document an attempt to access PDMP when providing an initial prescription for Schedule II opioids | Yes | Yes |
Drugs included | ||||||
What drugs are included in the mandate? | Opioids | No mandate | Schedule II opioids and benzodiazepines | Schedule II opioids – prescriptions for buprenorphine, or a drug containing buprenorphine or methadone, to patient in a substance use disorder program | Opioids and benzodiazepines, must be checked before patients in an opioid treatment program can be prescribed a controlled substance | Schedules II-V – includes tramadol |
Timing triggers | ||||||
Is the prescriber required to review the PDMP for the initial prescription for drugs that are subject to the mandate? | Yes | No mandate | Yes | Yes | Yes | Yes |
Is the prescriber required to review the PDMP at regular intervals after the initial prescription? | Yes – annually after admission to an opioid treatment program and subsequent to any incidents of concern | No mandate | Yes – every 90 days | No | Yes – every 90 days for those patients on a pain management contract | No |
Are there other timing triggers? | Yes – the PDMP must be checked at intervals determined by the individual’s risk during chronic opiate therapy | No mandate | No | No | Yes – working at an opioid treatment program must review periodically during course of the treatment | Yes – must be checked each time a prescription order is issued |
Exceptions to PDMP review | ||||||
Are short duration prescriptions exempt from the mandate? | No | No mandate | Yes – 3-day supply or less, no more than 26 pills; 10-day supply and 40 pills exempt for outpatient surgery | No | No | Yes – 3-day supply or less if nonrefillable |
Are prescriptions for terminally ill patients exempt from PDMP review? | No | No mandate | Yes | Yes | No | Yes – under hospice care |
Are prescriptions issued or administered at hospitals and long-term care facilities exempt from the mandate? | No | No mandate | Yes | No | No | Yes |
Is there an exception to the mandate if the PDMP is inaccessible? | No | No mandate | No | No | No | Yes |
Are there other exceptions? | No | No mandate | Yes – does not apply to patients receiving treatment for cancer | Yes – patients undergoing oncology treatments and prescriptions for a 7-day supply or less by a hospital ED when treating an acute, traumatic medical condition | No | Yes – does not apply in case of emergency where it is not possible for practitioner to review patient’s records before prescribing for the patient |
Iowa | Kentucky* | Louisiana | Maine | Maryland | Massachusetts | |
Type of mandate | ||||||
-Does the mandate apply to all prescribers and at least all initial opioid prescriptions? | No – as stipulated by rules by prescribing practitioner’s licensing board | No | Yes | Yes | Yes | No |
Drugs included | ||||||
What drugs are included in the mandate? | Opioids | Controlled substances in Schedule II and Schedule III-V designated by individual prescriber licensure boards | Opioids | Opioids and benzodiazepines | Opioids and benzodiazepines | Schedule II and III narcotics, benzodiazepines, Schedule IV and V as designated in guidance to be issued by the Department of Public Health |
Timing triggers | ||||||
Is the prescriber required to review the PDMP for the initial prescription for drugs that are subject to the mandate? | No – before issuing an opioid prescription as stipulated by rules by prescribing practitioner’s licensing board | Yes | Yes | Yes | Yes | Yes |
Is the prescriber required to review the PDMP at regular intervals after the initial prescription? | No | Yes – every 3 months | Yes – every 90 days | Yes – every 90 days | Yes – every 90 days | No |
Are there other timing triggers? | No | Yes – before issuing a new prescription or refill for Schedule II controlled substance, also when suspecting diversion or illegal use | No | No | No | Yes – each time a patient is prescribed a Schedule II or III narcotic |
Exceptions to PDMP review | ||||||
Are short duration prescriptions exempt from the mandate? | No | No | Yes – 7-day supply or less | No | Yes – 3-day supply or less | No |
Are prescriptions for terminally ill patients exempt from PDMP review? | Yes – patients receiving inpatient hospice care | Yes – terminally ill patients under hospice or end-of-life care | Yes | Yes – when directly ordered, prescribed or administered to a person suffering from pain associated with end-of-life hospice care | Yes | Yes |
Are prescriptions issued or administered at hospitals and long-term care facilities exempt from the mandate? | Yes | Yes | Yes | Yes | Yes | Yes |
Is there an exception to the mandate if the PDMP is inaccessible? | No | Yes – documented in patient’s medical record | Yes – once accessibility restored, check the PDMP and note the cause for the delay in the patient’s chart | Yes | Yes | Yes |
Are there other exceptions? | No | Yes – does not apply to patients with prescription issued within 14 days of surgery or 3 days of oral surgery, during an emergency (disaster or mass casualties impacting prescriber’s practice), single-dose treatments to relive symptoms when submitting to a diagnostic test or procedure and for treatment of cancer pain | Yes – treatment of cancer-related chronic or intractable pain | Yes – when directly ordering or administering a benzodiazepine or opioid in an emergency room setting; does not apply to veterinarians | Yes – does not apply to treatment of cancer or cancer-related pain; does not apply to treat or prevent acute pain for no more than 14 days following: surgical procedure, fracture, significant trauma or childbirth | Yes – samples of controlled substances only in Schedule VI, veterinarians, practitioners treating a patient in an emergency department who do not anticipate writing a prescription for a controlled substance in Schedule II-V during that encounter, an instance in which emergency care is required and it is the prescriber’s professional opinion that utilizing the PDMP is likely to result in patient harm, prescriptions for patients younger than 96 months old, dispensed medications for the immediate and proper treatment of the patient until it is possible for the patient to have a prescription filled by a pharmacy, or Other exceptions as defined in guidance issued by the Department of Public Health. |
Michigan | Minnesota | Mississippi | New Hampshire | New Jersey | New York* | |
Type of mandate | ||||||
-Does the mandate apply to all prescribers and at least all initial opioid prescriptions? | Yes | No – applies to prescriptions for the treatment of opioid use disorder, separate mandate applies to prescribers participating in the Minnesota Health Care Programs | No – applies to pain management clinics and opioid treatment programs only | Yes | Yes | Yes |
Drugs included | ||||||
What drugs are included in the mandate? | Schedules II-V – includes buprenorphine, drug containing buprenorphine or methadone | Controlled substance prescriptions for treatment of opioid use disorder | Schedules II-V – includes other specified noncontrolled substances identified by the State Board of Pharmacy | Opioids in Schedules II-IV when used for the treatment of pain | Opioids, Schedule II controlled substances, Schedule III or IV benzodiazepines | Schedules II-IV |
Timing triggers | ||||||
Is the prescriber required to review the PDMP for the initial prescription for drugs that are subject to the mandate? | Yes | No | No | Yes | Yes | Yes |
Is the prescriber required to review the PDMP at regular intervals after the initial prescription? | No | Yes – every 90 days when treating for opioid use disorder | No | Yes – at least twice per year | Yes – every three months | No |
Are there other timing triggers? | Yes – for every Schedule II-V prescription | Yes – monthly if the data contains a recent history of multiple prescribers or multiple prescriptions for controlled substances | Yes – in pain management clinics must review at initial visit and at intervals deemed appropriate for good patient care; opioid treatment programs must review at initial visit | No | Yes – reasonable belief that person may be seeking a controlled substance | Yes – for every Schedule II-IV prescription |
Exceptions to PDMP review | ||||||
Are short duration prescriptions exempt from the mandate? | Yes – 3-day supply or less | Yes – 2-day supply or less | No | No | Yes – 5-day supply or less if prescribed in the ED, immediately following surgery, or if not reasonably possible to access the PDMP in a timely manner | Yes – 5-day supply or less if cannot access PDMP in a timely manner, ED prescription as well |
Are prescriptions for terminally ill patients exempt from PDMP review? | No | No | No | Yes | Yes – terminally ill patients under hospice care | Yes – receiving hospice care |
Are prescriptions issued or administered at hospitals and long-term care facilities exempt from the mandate? | Yes | No | No | Yes | Yes | Yes |
Is there an exception to the mandate if the PDMP is inaccessible? | No | No | No | Yes – if due to internal or external electronic issue, should be documented in patient’s medical record | Yes | Yes |
Are there other exceptions? | Yes – if patient is an animal (veterinary use) | No | No | Yes – in a health care setting or ED when experiencing higher than normal patient volume – need to be documented in patient’s medical record | Yes – does not apply to methadone or another controlled substance as interim treatment for patients on waiting lists for substance use treatment programs or to the administration of methadone or another controlled substance for the treatment of a patient with substance use disorder. The mandate does not apply to practitioner administration of a controlled substance directly to a patient; if the PDMP consultation would result in the patient’s inability to obtain a prescription in a timely manner, thereby adversely affecting a patient’s medical condition; if the prescription is dispensed by an in-hospital pharmacy; or prescriptions written by veterinarians. The mandate does not apply to physicians who have been granted a waiver due to technological limitations. | Yes – veterinarians, administration of a controlled substance or if PDMP consultation would adversely affect patient’s medical condition |
North Carolina | Ohio* | Pennsylvania | Rhode Island | South Carolina | Tennessee | |
Type of mandate | ||||||
-Does the mandate apply to all prescribers and at least all initial opioid prescriptions? | No – applies to initial prescribing a Schedule II or III opioid and to medical directors of opioid treatment programs
|
Yes | Yes | Yes | No – applies to Schedule II controlled substances, but Medicaid practitioners are required to review before issuing a prescription for any Schedule II-IV controlled substance | Yes |
Drugs included | ||||||
What drugs are included in the mandate? | Schedule II and Schedule III opioids | Opioids, benzodiazepines, drugs identified with potential for misuse and diversion | Opioids, benzodiazepines and all initial prescriptions for controlled substances | Opioids | Schedule II – Medicaid practitioners required o review before issuing a prescription for any Schedule II-IV controlled substance | Opioids, benzodiazepines, other drugs identified by the committee or commissioner to have the potential for abuse |
Timing triggers | ||||||
Is the prescriber required to review the PDMP for the initial prescription for drugs that are subject to the mandate? | Yes | Yes | Yes – must be checked for all initial controlled substance prescriptions | Yes | Yes | Yes |
Is the prescriber required to review the PDMP at regular intervals after the initial prescription? | Yes – must check every 3 months, medical director of an opioid treatment program must review at least annually | Yes – every 90 days if treatment includes monitored drugs for more than 90 days | No | Yes – every 3 months for patients on continuous opioid therapy for 3 months or longer for the treatment of pain | Yes – every 3 months for treatment of a chronic condition with a Schedule II controlled substance | Yes – every 6 months |
Are there other timing triggers? | Yes – medical director of an opioid treatment program must review upon admission of a new patient | No | Yes – each time a patient is prescribed an opioid or benzodiazepine, also must be checked if believed the patient is abusing or diverting drugs | Yes – must be checked prior to a new take-home phase for opioid use disorder treatment and for each new admission to an opioid treatment program | No | Yes – if prescriber is aware of reasonably certain that a person is attempting to obtain a Schedule II-V for fraudulent, illegal or medically inappropriate purposes |
Exceptions to PDMP review | ||||||
Are short duration prescriptions exempt from the mandate? | No | Yes – 7-day supply or less | No | No | Yes – less than 5-day supply | Yes – 3-day supply or less if nonrefillable |
Are prescriptions for terminally ill patients exempt from PDMP review? | Yes – under hospice or palliative care | Yes | No | No | Yes | Yes – under hospice care |
Are prescriptions issued or administered at hospitals and long-term care facilities exempt from the mandate? | Yes | Yes | No | No | Yes | Yes |
Is there an exception to the mandate if the PDMP is inaccessible? | Yes – documented in medical record, must review once have access again and document in medical record | Yes | No | No | Yes – must be documented in the patient’s medical record | Yes |
Are there other exceptions? | Yes – administered in a nursing home, outpatient dialysis facility, treatment of cancer pain | Yes – does not apply for cancer treatment or another condition associated with cancer of for the treatment of acute pain from surgical or other related invasive procedures | No – does not apply to initial prescription when in the exercise of sound clinical judgement does not believe that the patient is abusing or diverting, so long as the prescriber or dispense is otherwise in compliance | No | No | Yes – veterinarians, prescribers in specialties exempted by the state committee and nonrefillable prescriptions issued following surgery, complimentary packages of medicinal drugs that are labeled as a drug sample or complimentary drug dispensed to the practitioner’s own patients adequate to treat the patient for a maximum of 48 hours, samples of Schedule IV or V controlled substances in a quantity limited to 72 hours, samples of a nonnarcotic Schedule V drug in an amount limited to 14 days, and drugs prescribed in a narcotic treatment program. |
Vermont | Virginia | West Virginia | ||||
Type of mandate | ||||||
-Does the mandate apply to all prescribers and at least all initial opioid prescriptions? | No – Schedule II-IV controlled substances written to treat pain when such a prescription exceeds 10 pills or the equivalent; Schedule II-IV controlled substances for nonpalliative long-term pain therapy of 90 days or more; replacement prescriptions (an unscheduled prescription request in the event that the document on which a patient’s prescription was written or the patient’s prescribed medication is reported to the prescriber as having been lost or stolen) for a Schedule II-IV controlled substance; the first time a provider prescribes a benzodiazepine, extended-release hydrocodone, or oxycodone manufactured without abuse-deterrent formulations; and buprenorphine or a drug containing buprenorphine. | No – opioid and benzodiazepine prescriptions for treatment anticipated to last more than 90 consecutive days | Yes | |||
Drugs included | ||||||
What drugs are included in the mandate? | Schedules II-IV | Opioids | Schedule II controlled substances and all opioids and benzodiazepines | |||
Timing triggers | ||||||
Is the prescriber required to review the PDMP for the initial prescription for drugs that are subject to the mandate? | Yes | Yes | Yes | |||
Is the prescriber required to review the PDMP at regular intervals after the initial prescription? | Yes – At least annually for patients who are receiving ongoing treatment with an opioid Schedule II-IV controlled substance, no less than twice annually for buprenorphine or a drug containing buprenorphine (except prescriptions written from an opioid treatment program [OTP]), annually and when clinically warranted when prescribing buprenorphine, methadone, or a drug containing buprenorphine at an OTP, and at least every 120 days for any patient prescribed 40 mg or greater of extended-release hydrocodone or 30 mg or greater of extended-release oxycodone per day that is not an abuse-deterrent opioid | No | Yes – At least annually for all patients. For patients in opioid treatment programs, the PDMP must be reviewed no less than quarterly. The PDMP must be reviewed at least every 90 days for pain management clinics | |||
Are there other timing triggers? | Yes – checked prior to writing a replacement prescription for a Schedule II-IV controlled substance and prior to prescribing buprenorphine or a drug containing buprenorphine that exceeds the dosage thresholds approved by the Vermont Medicaid Drug Utilization Review Board and published in its preferred drug list. In emergency departments or urgent care settings, the PDMP must be checked when a patient requests, and the prescriber intends to write, an opioid prescription for chronic pain | No | Yes – opioid treatment programs, the PDMP must be reviewed at the patient’s intake, before the administration of methadone or other treatment, after the initial 30 days of treatment, prior to any take-home medication privileges being granted, after any positive drug test, and at each 90-day treatment review | |||
Exceptions to PDMP review | ||||||
Are short duration prescriptions exempt from the mandate? | Yes – 10 or fewer pills, or the equivalent | Yes – 7-day supply or less | No | |||
Are prescriptions for terminally ill patients exempt from PDMP review? | No | Yes | Yes | |||
Are prescriptions issued or administered at hospitals and long-term care facilities exempt from the mandate? | Yes | Yes – in a nursing home or assisted living facility that uses a sole-source pharmacy | Yes – opioid treatment programs, must be reviewed prior to dispensing or prescribing medication-assisted treatment drugs, at each patient’s physical examination, no less than quarterly | |||
Is there an exception to the mandate if the PDMP is inaccessible? | Yes – mandate does not apply if not available due to technological failure | Yes | Yes – circumstance of the PDMP being unavailable must be documented in the patient’s medical record, and upon having access restored, the PDMP must be accessed and the practitioner shall adjust patient care as needed. If the PDMP is inaccessible due to unavailability of commercially affordable broadband coverage in a practitioner’s area and it is determined by the practitioner that providing a controlled substance is medically necessary, this determination shall be documented in the medical record and the controlled substance may be provided in a limited amount. The practitioner shall access the PDMP through alternate means and document the treatment rendered and the practitioner shall adjust patient care as needed | |||
Are there other exceptions? | Yes – chronic pain due to cancer or cancer treatment and patients in skilled and intermediate care nursing facilities are exempt | Yes – does not apply to emergency or disaster situations in which the prescriber must document such circumstances in the patient’s medical record | No |
http://www.pewtrusts.org/en/research-and-analysis/data-visualizations/2018/when-are-prescribers-required-to-use-prescription-drug-monitoring-programs (Accessed July 2018)