Pain Warriors Unite - (202) 792-5600

Pain Warriors Unite

Calling ALL Pain Warriors, It's NOW or NEVER!

Calling ALL Pain Warriors, It's NOW or NEVER!

Calling ALL Pain Warriors, It's NOW or NEVER!Calling ALL Pain Warriors, It's NOW or NEVER!



AffirmHealth State-by-State Opioid Prescribing Guidelines



Alabama Board of Medical Examiners & Medical Licensure Commission

A Health Care Professional's Toolbox to Reverse the Opioid Epidemic

State of Alabama Opioid Action Plan

Opioids in Alabama

Alabama Prescription Drug Monitoring Program (PDMP)


Alaska State Opioid Prescribing Policy Guide

Alaska Opioid Task Force

ASHNHA Opioid Crisis: State & Nationwide

Alaska's Prescription Drug Monitoring Program (PDMP)

Alaska HB 159: Opioids; Prescriptions; Database; Licenses


Arizona Clinical Opioid Guidelines & References

Arizona Medical Association Opioid Prescribing Safety

Arizona State Board of Pharmacy: FAQ for 2018 Arizona Opioid Epidemic Act

2018 Opioid Prescribing Guidelines


Arkansas Senate Bill 717

ASMB Proposes New Rules

Arkansas Medical Society: Professional Resources, Prescription Drug Abuse

Arkansas Emergency Department Opioid Prescribing Guidelines


California Medical Board Prescribing Guidelines in Pain

Are Your Prescription Forms Compliant?

California Partial Fill Legislation

State of California Plan to Address Prescription Misuse, Abuse and Overdose Epidemic


Colorado SB 19-022: Clinical Practice for Opioid Prescribing

Opioid Prescribing Call To Action

Pain Management Resources and Opioid Use

Colorado Chapter of the American College of Emergency Room Physicians: 2017 Opioid Prescribing & Treatment Guidelines


Connecticut Opioid Abuse Laws

Connecticut State Medical Society Opioid Resources

Backgrounder: Medicaid & Opioids

New CT Law Allows Prescribing of Controlled Substances via Telemedicine

CT Current Laws Related to Opioids Overdose Prevention


Delaware Opioid Fact Sheet for Healthcare Providers

Delaware Prescription Fact Sheet for Patients

MSD: Opioid Abuse and Prescribing

Opioid Addiction Resources

Uniformed Controlled Substance Act Regulations


AffirmHealth Blog: Florida Legislative Update

Florida Counterfeit Proof Prescription Pad Vendors FAQ

Florida's Opioid Crisis

Florida Take Control: Resource Kit

Florida CS/CS/HB 21


Georgia PDMP Enrollment Requirements

Medical Association of Georgia Six Point Platform

Georgia's Drugs and narcotics Agency Tips for Physicians

Checklist for Prescribing Controlled Substances in Georgia for the Treatment of Chronic Pain


Hawaii Board of Medical Examiners Pain Management Guidelines

Hawaii's PDMP FAQ's

The-Hawaii-Opioid-Initiative, A Statewide Response


Idaho's PDMP FAQ's

Idaho Board of Medicine Opioid & Controlled Substance Prescribing Resources

Idaho Controlled Substance Registration for Prescribers

IROC: Idaho's response to the Opioid Crisis


Illinois Controlled Substance Act

Illinois State Medical Society Opioid Resources

Illinois Opioid Action Plan


Indiana State Medical Association Opioid Prescribing Controlled Substances

Indiana Overdose Prevention Resources

Indiana General Assembly Senate Bill 226: Prescribing and Dispensing of Opioids

Indiana's PDMP FAQ's   


Iowa's PDMP FAQ's

Iowa Medical Society Opioid Resources

Iowa Pharmacy Board E-prescribing Controlled Substances

Iowa Board of Pharmacy: Summary of Drug Schedules


Kansas Joint Policy Statement: Use of Controlled Substances for the Treatment of Pain

Kansas HB 2217: Standards Governing The Use and Administration of Emergency Opioid Antagonists

Kansas's PDMP FAQ's


AffirmHealth Blog: Kentucky Legislative Update

Kentucky Prescribing Substance Abuse Screening & Treatment Resources

2018 Kentucky Legislative Initiatives

Kentucky Office of Drug Control Policy: The Heroin Epidemic


Louisiana Opioid Prescription Policy Update

Louisiana Short Acting Opioid Prescription Policy Update

Louisiana Department of Health: Opioid Fact Sheet

Louisiana Board of Pharmacy PMP Information

LA State Board of Medical Examiners: Synopsis of Recent Changes in Opioid Prescribing Laws 


Maryland PDMP Resources

Maine Medical Association Opioid Law Q&A

Maine Medical Society: The Newest Opioid Crisis Documents

What You Need to Know About Maine's New Opioid Prescribing Law

Maryland Prescribing Guidelines


Maryland Board of Physicians Opioid Prescribing Guidance

Overdose Prevention in Maryland

Maryland Medicaid Opioid Prescribing Guidance & Policy


Fact Sheet Regarding Changes to the MA Controlled Substance Act

Commonwealth of Massachusetts Department of Industrial Accidents Workers Compensation Opioid & Controlled Substance Protocol

The Massachusetts Opioid Epidemic

Massachusetts Medical Society Opioid Therapy & Physician Communication Guidelines

Massachusetts PDMP Resource Guide


AffirmHealth Michigan Legislative Update

Michigan Opioid Laws & FAQs

Michigan Department of Health & Human Services - Opioid Treatment Resources

State of Michigan SB 274

Michigan State Medical Society - Reversing the Opioid Epidemic

Michigan Automated Prescription System (MAPS) Resource Guide


Minnesota Medical Association Prescription Opioid Task Force

Minnesota Opioid Prescribing Rules

Minnesota Opioid Prescribing Improvement Program

Minnesota State Targeted Response to the Opioid Crisis

Minnesota Prescription Monitoring Program FAQ's


Mississippi Medical Board Regulations

Mississippi Opioid Prescribing Rules

Summary of Proposed Regulation Changes to 2640

How Does Mississippi's Response To Excessive Opioid Prescribing Compare To Other States


A Guide to Prescribing, Administering and Dispensing Controlled Substances in Missouri

Controlled Substance Guidelines for EMS

Missouri Controlled Substance Guidelines for Practioners


Montana Prescription Drug Registry Resource Page

MT Opioid Overdose Prevention Resources

Montana Providers Toolkit


Nebraska Pain Management Guidance Document

Nebraska Opioid Prescribing Resource

Nebraska Drug Overdose Prevention Homepage


Nevada Assembly Bill 474

Nevada Resources for Prescribing Controlled Substances

Nevada Prescription Drug Abuse Prevention 

Nevada PMP Resource Section


New Hampshire Opioid Prescribing

New Hampshire Medical Society Opioid Prescribing Resources

New Hampshire Prescribing Opioids for Pain Management

New Hampshire Nurse Practitioner Opioid Update


New Jersey Prescribing for Pain Opioid Law

Controlled Dangerous Substances and Special Consideration for Managing Acute and Chronic Pain

New Jersey Opioid Abuse Prevention

New Jersey Academy of Family Physicians: What You Need to Know About the New Opioid Prescribing Laws

New Jersey Prescription Monitoring Program Frequently Asked Questions


New Mexico Guidelines on Prescribing Opioids for Treatment of Pain

Review of CDC Guidelines

Prescription Drug Misuse and Overdose Prevention and Pain Management Advisory Council

New Mexico PMP FAQ's

New Mexico Department of Health: Opioid Safety


New York Prescribing and Dispensing Controlled Substances

New York State Laws Governing Opioids and Controlled

NY: Limited Initial Opioid Prescribing

FAQ for the New York State Prescription Monitoring Program Registry

What is I-STOP


North Carolina Strengthen Opioid Misuse Prevention Act

North Carolina Medical Board Professional Resources Responsible Opioid Prescribing

North Carolina Policy for the use of Opioids For the Treatment of Pain

The STOP Act Summary

North Carolina's Controlled Substances Reporting System (CSRS) FAQ's


North Dakota Medical Board Opioid Abuse Prevention a Review of Best Practice Approaches

North Dakota Prescribing and Dispensing Profile

Preventing Prescription Drug Opioid Abuse

Addressing Opioid Drug Abuse in North Dakota

North Dakota PDMP FAQ's


Ohio Mental Health and Addiction Services Opioid Prescribing Guidelines

State Board of Ohio Opioid Prescribing Resources

Ohio State Board of Pharmacy New Requirements for Opioid Prescriptions

Ohio Automated RX Reporting System MED (Morphine Equivalent Dose) Calculator


Oklahoma Opioid Prescribing Guidelines

Oklahoma Medical Board Use of Controlled Substances for Pain

Oklahoma Prescribing and Dispensing Guidelines

Opioid Prescribing Guidelines for Oklahoma Healthcare Practioners in an Office Based Setting

Oklahoma Emergency Department (ED) and Urgent Care Clinics (UCC) Opioid Prescribing Guidelines


Oregon Opioid Prescribing Guidelines

Oregon Medical Association Practice Help Center Opioid Epidemic

Oregon PDMP Healthcare Provider FAQ's

Oregon Pain Guidance Provider and Community Resource: Opioid Prescribing Guidelines

Oregon Opioid Epidemic Task Force


Pennsylvania Department of Health Opioid Prescribing Guidelines

Pennsylvania Medical Society Tools You Can Use Opioids

Pennsylvania's New Opioid Laws And How They Impact Physicians

PDMP Latest Updates


Rules and Regulations for Pain Management, Opioid Use and the Registration of Distributors of Controlled Substances in Rhode Island

State of Rhode Island Department of Health Safe Opioid Prescribing

State of Rhode Island Department of Health Existing Opioid Regulations

Prevent Overdose RI


Revised Pain Management Guidelines South Carolina State Boards of Dentistry, Medical Examiners, Nursing and Pharmacy 2017

South Carolina Department of Health Opioid Resources

South Carolina State Board of Medical Examiners: Pain Management Guidelines

South Carolina Department of Health and Environmental Control New Schedules for Controlled Substances

The South Carolina Reporting & Identification Prescription Tracking System (SCRIPTS) Resource Page


South Dakota Controlled Substance Registration for Practitioners

SD Statewide Response to the Opioid Crisis

South Dakota Department of Health Prescription Opioid Abuse Prevention Initiative

The Journal of the South Dakota Medical Association: Addressing the Challenges of Prescribing Controlled Drugs

South Dakota Board of Pharmacy PDMP FAQ's


AffirmHealth Tennessee Legislative Update

Tennessee Laws & Policies

Tennessee Chronic Pain Guidelines

Tennessee Pain Clinic Rules

TN Controlled Substance Monitoring Database and Prescription Safety Act FAQ's

Tennessee Medical Association Member Resource Center


Texas Medical Board Minimum Requirements for the Treatment of Chronic Pain

Texas Medical Association House of Delegates: Responsible Opioid Prescribing for Pain Management

Texas Medical Board Pain Management Clinic Registration

Texas State Board of Pharmacy: Information Regarding Controlled Substances

Texas Prescription Monitoring FAQ's

Texas Medical Association Opioid Resources


Utah Clinical Guidelines on Prescribing Opioids for Treatment of Pain

Utah Medical Association: Controlled Substances: Education for the Prescriber

Utah Department of Health, Violence & Injury Prevention Program: Prescription Opioid Deaths

Utah Controlled Substances Database Program Overview and Resources


Vermont Department of Health: Regultions For Opioid Prescribing for Pain

Vermont Department of Health, Vermont Medical Society Opioid and VPMS Rules Summary

Vermont Medical Society: Opiate Prescribing & Substance Use Disorder Information

Vermont Opioid and Prescribing Resources for Patients and Providers


Virginia Regulations Governing Prescribing of Opioids and Buprenorphine

Dear Prescriber Letter from the VA Department of Health Professionals

Medical Society of Virginia: Mandatory Prescribing Regulations for Treating Pain and Addiction

Virginia PMP Toolkit


Washington State ESHB 1427

Interagency Guidelines on Prescribing Opioids for Pain: Developed by the Washington State Agency Medical Directors’ Group (AMDG)

Washington State Department of Health: Pain Management Resources

Washington PMP Provider Frequently Asked Questions


West Virginia Board of Medicine Management of Pain Act

Substance Abuse in West Virginia: The Road Forward

Best Practices for Prescribing Opioids in West Virginia

A Guide to State Opioid Prescribing Policy: West Virginia


Wisconsin Department of Health Services Provider Resources: Opioids

Wisconsin State Legislature 961.385 Prescription Drug Monitoring Program

Wisconsin Medical Society: Opioid Prescribing Principles


Wyoming Controlled Substances Act/Rule 2017 & WORx

Wyoming State Board of Pharmacy: Controlled Susbstance Registration

Workers' Compensation Division Treatment Guidelines for Chronic Non-Malignant Pain

Wyoming Department of Health: Opioid Abuse Data and Resources


DC Emergency Department Opioid Prescribing Guidelines

The DC Center for Rational Prescribing

The District of Columbia Prescribing and Dispensing Profile

The District of Columbia Department of Health: Getting Patients Off of Opioids

To learn more about compliant prescribing check out Affirm Health's  blog posts on the topic:

The information presented on or through this website is made available solely for general information purposes and is not intended to substitute for professional, medical or legal advice. We do not warrant the accuracy, completeness, or usefulness of this information. Any reliance you place on such information is strictly at your own risk. We disclaim all liability and responsibility arising from any reliance placed on such materials.

by Mitch Evans posted on June 15, 2017

by Mitch Evans posted on January 16, 2018

by John Cole posted on July 10, 2018

Controlled Substance legislation continues to evolve. 

Stay up to date on related issues by subscribing to the AFFIRMHEALTH blog.  Subscribe

More Resources: 

State Prescribing Laws

(Source:  NCSL)

State Prescribing Guidelines 

(Source:  Ballotpedia)


CDC Guidelines for Prescribing Opioids for Chronic Pain: At a Glance

CDC Guidelines for Prescribing Opioids for Chronic Pain — United States, 2016

The Comprehensive Addiciton and Recovery Act (CARA)

National Council of State Boards of Nursing: : Opioid Tool Kit

VA/DoD Clinical Practice Guideline For Opioid Therapy for Chronic Pain

American Bar Association Prudent Prescribing: An Overview of Recent Federal and State Guidelines for Opioid Prescriptions


State & Federal Prescribing Strategies

In partnership with CDC’s National Center for Injury Prevention and Control, PHLP created menus summarizing some of the legal strategies states have used to address prescription drug misuse, abuse, and overdose.

View Website Here Prescription Drugs

  • Menu of Doctor Shopping Lawspdf icon[PDF 335KB]
    An inventory of state legal strategies to help assess doctor shopping laws. Doctor shopping is when a patient visits multiple healthcare practitioners to obtain controlled substances without the prescribers’ knowledge of the other prescriptions.

Learn more about prescription drug overdose on

CDC’s Injury Prevention & Controlpage.

View CQ StateTrack reports on recent legal developments concerning opioids:

(Large files; might take several minutes to load)


Federal resources

Federal Resources

Centers for Disease Control information on the opioid epidemic.Centers for Disease Control

DEA’s 360 Strategy responds to the heroin and prescription opioid pill crisis with a three-pronged strategy: Law Enforcement, Diversion, and Community Outreach.Drug Enforcement Administration

National Institute of Health's National Institute on Drug Abuse information on opioid use and addiction.National Institute on Drug Abuse – National Institutes of Health

U.S. Department of Health and Human Services offers information on prevention, treatment, and recovery.U.S. Department of Health and Human Services

State-Specific Resources

Autofill Limits and Decreasing Opioid Counts

Trump Administration's Opioid Progress

The U.S. Department of Health & Human Services
Hubert H. Humphrey Building

200 Independence Avenue, S.W.
Washington, D.C. 20201
Toll Free Call Center: 1-877-696-6775

Department Contacts: 

Department-wide Contact Lists

HHS Leadership

HHS Public Affairs Contacts

HHS Freedom of Information Act Contacts

HHS Grant Officials

HHS Small Business Staff and Specialists

HHS Chief Financial Officers and Services Contacts

HHS Heads of Contracting Activity and Key Managers

State & Local Agency Contacts

Child Care and Development Fund State and Territory Contacts

Child Support and Tribal Child Support Agencies - PDF

Eldercare Locator

Energy Assistance (LIHEAP)

Head Start Locator

Health Insurance (

HHS Office for Civil Rights Headquarters and Regional Addresses

Intellectual and Developmental Disabilities Program Contacts

Public Health Departments (States and Territories)

Agency for Healthcare Research and Quality (AHRQ)

AHRQ logo

The Agency for Healthcare Research and Quality's mission is to produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable, and to work within HHS and with other partners to make sure that the evidence is understood and used.

Visit AHRQ for more info

Assistant Secretary for Health (ASH)

ASH advises on the nation's public health and oversees HHS' U.S. Public Service (PHS) for the Secretary.

Visit ASH for more info

Centers for Disease Control and Prevention (CDC)

CDC logo

The Centers for Disease Control and Prevention, part of the Public Health Service, protects the public health of the nation by providing leadership and direction in the prevention and control of diseases and other preventable conditions, and responding to public health emergencies.

Please direct all inquiries to CDC-INFO at 

1-800-CDC-INFO (1-800-232-4636)

Use this form

Visit CDC for more info

Centers for Medicare & Medicaid Services (CMS)

CMS Logo

The Centers for Medicare & Medicaid Services combines the oversight of the Medicare program, the federal portion of the Medicaid program and State Children's Health Insurance Program, the Health Insurance Marketplace, and related quality assurance activities.

Visit CMS for more info

Departmental Appeals Board (DAB)

DAB provides impartial review of disputed legal decisions involving HHS. 

Visit DAB for more info

Food and Drug Administration (FDA)

FDA logo

The Food and Drug Administration, part of the Public Health Service, ensures that food is safe, pure, and wholesome; human and animal drugs, biological products, and medical devices are safe and effective; and electronic products that emit radiation are safe.

Visit FDA for more info

Health Resources and Services Administration (HRSA)

HRSA logo

The Health Resources and Services Administration, part of the Public Health Service, provides health care to people who are geographically isolated, economically or medically vulnerable.

Visit HRSA for more info

Immediate Office of the Secretary (IOS)

IOS oversees the Secretary’s operations and coordinates the Secretary’s work.

Visit IOS for more info

Indian Health Service (IHS)

IHS Logo

The Indian Health Service, part of the Public Health Service, provides American Indians and Alaska Natives with comprehensive health services by developing and managing programs to meet their health needs.

Visit IHS for more info

National Institutes of Health (NIH)

NIH logo

The National Institutes of Health, part of the Public Health Service, supports biomedical and behavioral research with the United States and abroad, conducts research in its own laboratories and clinics, trains promising young researchers, and promotes collecting and sharing medical knowledge.

Visit NIH for more info

Office for Civil Rights (OCR)

OCR ensures that individuals receiving services from HHS-conducted or -funded programs are not subject to unlawful discrimination, that individuals and entities can exercise their conscience rights and religious freedom, and that individuals can access and trust the privacy and security of their health information. 

Visit OCR for more info




Link to Contact Your:  State PDMP 









District of Columbia























New Hampshire

New Jersey

New Mexico

New York 


North Carolina

North Dakota





Puerto Rico

Rhode Island

South Carolina

South Dakota







West Virginia




Disability Rights Resources by State

Find Disability Rights Organizations in your State:

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinois▪  IndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtah.  ▪ Vermont.▪  Virginia. ▪ Washington. ▪ West VirginiaWisconsinWyoming*District of Columbia

Americans with Disabilities Act (ADA)

ADA law is enforced by agencies like the Department of Justice and the Equal Employment Opportunity Commission. Many disability advocacy groups like the American Association of People with Disabilities or the National Organization on Disability advocate for implementation of the law.

The ADA is a civil rights law that prohibits discrimination against individuals with disabilities in all areas of public life, including jobs, schools, transportation, and all public and private places that are open to the general public.

The ADA law does prohibit discrimination against individuals with disabilities who have chronic pain, as well as people in recovery from opioid and substance use disorders. People with disabilities who use medically prescribed opioids for pain cannot be discriminated against in access to employment and government programs, for example. However, the ADA law does not address the prescribing decisions of doctors.

The National Council on Independent Living (NCIL) Chronic Pain/ Opioids Task Force has written a letter about chronic pain to U.S. senators and representatives that has been signed by many organizations: 

In this letter, the organizations push back against one size fits all policy making approach to prescribing, unintended consequences that risk patient safety, and the need for comprehensive care. This letter does an excellent job describing the policy issues related to pain and opioid use and is recommended reading.

If you have a disability and are experiencing abuse, neglect or discrimination, are experiencing a legal problem or are having difficulty obtaining disability services, call your state’s P&A.

A description of Self-Advocacy and the materials and links on this page.

A description of the Americans with Disabilities Act, its history, and each part of the Act.

Information and materials you and other self-advocates can use to explain and understand Olmstead, Medicaid Waivers, and other concepts.

Five Minutes of Olmstead Podcasts.

Find Olmstead, Advocacy, Medicaid and other resources in your state.

The best websites on Olmstead and related information



Additional Rx Resources

  • State Specific Resources: HERE 

  • The Health Innovations Database" covers what state legislatures are enacting that changes Medicaid, private and commercial health insurance, access, health exchanges and other state action on health reforms.

On July 24, 2019, the OIG released a report  titled: “Oversight of Opioid Prescribing and Monitoring of Opioid Use: States Have Taken Action To Address the Opioid Epidemic.” The report reviewed the actions taken by eight states to monitor opioid prescribing and use. The OIG detailed how states are using data analytics and implementing outreach programs for both patients and providers. The report also compares the states’ opioid prescribing limits with CDC guidelines.

FSMB | Opioids and Pain Management - Federation of State Medical Boards
Highlighted State Initiatives. 

FSMB Releases Updated Guidelines for Chronic Use of Opioid Analgesics - Federation of State Medical Boards
May 17, 2017 · “As our nation's opioid epidemic worsens, it is critical that state medical and osteopathic boards - and the physicians and physician assistants they license and regulate - have updated guidance on the responsible management of chronic pain,” said FSMB President and CEO, Humayun Chaudhry, DO, MACP.

Continuing Medical Education by State - Federation of State Medical Boards



Federation of State Medical Boards Opioid Policy Survey, 2019

Learn More


State-by-State Overview

Learn More

Board-by-Board Overview of Laws, Regulations, and Guidelines

Learn More

Board-by-Board Overview

Board-by-Board Overview

The Latest Legislative Tracking on Telemedicine

The Latest Legislative Tracking on Pain Management

Continuing Medical Education requirements for medical marijuana

State-by-State Overview


The Latest Legislative Tracking on Pain Management

Board-by-Board Overview

State-by-State Overview

Board-by-Board Overview

The Latest Legislative Tracking on Telemedicine

State-by-State Overview

The Latest Legislative Tracking on Prescription Drug Monitoring Programs

Board-by-Board Overview

Board-by-Board Overview

The Latest Legislative Tracking on Telemedicine

Telemedicine Policies by State

What is Health IT EHR Technology?

What is Appriss and Narxcare?


New Appriss Health Resource Page to Help Inform Patients and Their Families


Millions of Americans suffer from chronic pain and part of their treatment plan often includes prescription opioids to treat and manage their conditions. However, when considering opioid therapy for chronic pain, it is important to consider the risks along with the benefits. With an emphasis on patient safety and better outcomes, Appriss Health provides healthcare providers with solutions to inform and support clinical decision-making.

While we are committed to helping providers, and others involved in patient care, work together to achieve better patient outcomes through earlier interventions, we also feel the responsibility and obligation to always communicate with patients and put them at the forefront of our solutions. That’s why we have dedicated a new section of our website specifically designed to help patients and their families better understand how Appriss Health’s solutions support them and enable better patient care. 

This resource page includes:

  • An FAQ about our prescription drug monitoring and risk assessment solutions.

  • And a Contact Us form so that if someone would like to reach out and talk with us they can.

Every day we approach our work with the goal to provide a usable and balanced clinical tool that protects access to care while also ensuring that clinicians and patients are well informed of potential risks. We will continually update this page, and we hope this will serve as a valuable resource to patients and their families.

Narxcare = Big Brother on Steroids


In the name of battling our misnamed "opioid epidemic," (1) which has only resulted in making things worse (2) there is a casualty that is far worse than anything that could be caused by a drug - the loss of our right to make healthcare decisions with our own providers and the right to privacy. A whistleblower document from Walmart which I obtained discusses "scoring" patients based on their medical and prescription history. It should terrify you. And it will. Following are some passages from the seven-page document, which, despite its benign-sounding title, is anything but. 

What you will read is not guidance. It is all but certain it will become a mandate, just like the CDC 2016 Opioid Prescribing Guidelines are now law or becoming law in most states. And it goes far beyond its alleged goal of helping to control opioid overprescription. Very far beyond. Here are some "highlights" that Walmart does not want you to know about.

Page 1: Pharmacist "guidance" for prescription drug users with different scores as determined by NarxCare  (2), an algorithm designed to sniff out potential problems with the legal use of certain prescribed medicines. 

Two things jump off the page here. First, the group that encompasses people with scores of 10-200 represents most of the people with a prescription. In the red circle on the right, it becomes obvious how badly Walmart is overstepping. Let's get this straight. If I have a legitimate prescription for Vicodin from my doctor I do not want to "consider the risks/benefits of new prescriptions." 

Here's how healthcare works:

  1. The doctor writes the prescription
  2. The pharmacist fills the prescription. 
  3. There is no #3

You may wonder what it takes to get into the 10-200 scoring group. Not much. From page 2:

Out of the blue, we are no longer talking about painkillers. Walmart is now interested in other potential drugs of abuse. If you happen to be taking Vicodin for chronic pain, Valium as a muscle relaxant, and an ADHD drug - a legitimate combination for some patients, you are going to get a worse score, which will likely mark you as a higher risk.

This is really awful. First, if you use an MME calculator it becomes quickly obvious that Walmart is not talking about addicts who are taking huge doses of opioids. But that doesn't stop the company from treating people that way. And it doesn't have to be much. 

Walmart calls 40 MME an "unsafe condition," and is recommending tapering or discontinuing other drugs, such as Valium, which could potentiate the action of the opioid. How much is 40 MME? It's equivalent to 26.6 mg of oxycodone -  2.7 10 mg Percocet pills - not even half the maximum recommended daily dose of 60 mg.

The maximal daily dose of Percocet. Source: RxList

It is perfectly clear that patients are going to get some kind of a grade from The Walmart Enforcement Agency and you'd better believe that there will be consequences if that grade isn't good. Good luck getting a legal prescription filled there if you don't make the grade. 

Pharmacies around the country are already arbitrarily deciding who does or does not get their scripts filled. Although is not explicitly stated it a pretty safe bet that patients could be refused prescriptions because of their score doesn't meet Walmart's "standards." 

What can make scores bad? All sorts of things. For example, if you:

  • See your doctor too often within a certain time period.
  • See more than five different doctors in one year. It doesn't matter if they are dermatologists or cardiologists.
  • Use more than four pharmacies in a three-month period.
  • Take an average of more 40 morphine equivalents (less than three 10 mg Percocet) in one day
  • Take a total of 100 morphine equivalents (total) in a day. There are plenty of pain patients who need more than this just to get by. 

Questions that need to be asked

  • Walmart sells lawnmowers to people who could run over their own own foot, yet it doesn't claim the authority or ability to monitor and control how they are used. So, how can the company claim it is better equipped than doctors to determine what painkillers, stimulants, and antianxiety drugs you are permitted to buy?

  • Walmart sells ovens, but can't teach you how to cook. How does this give it the right or ability to determine who should have their medicines tapered and at what rate? 

  • What is Appris Health, the company that created the algorithm Narx Care, which does the scoring? 
  • How did it get so much information on and influence over our private, personal matters? Why and how did the State of Ohio decide to implement this program in 2017 despite the fact that it already has a Prescription Monitoring Program?

  • Why should Appris (and of course, Walmart) have access to our individual health histories? In what other ways will this information be used? What safeguards are in place to safeguard our privacy?

  • Why is Walmart lying? The CDC's number, which itself is ridiculous, it 90. 

"Within the next 60 days, Walmart and Sam’s Club will restrict initial acute opioid prescriptions to no more than a seven-day supply, with up to a 50 morphine milligram equivalent maximum per day. This policy is in alignment with the Centers for Disease Control and Prevention’s (CDC) guidelines for opioid use."
Walmart press release. 

Take a good look in your rearview mirror. Most likely you'll see your right to determine your own medical care growing steadily smaller.


(1) We are having a fentanyl epidemic, NOT an opioid epidemic. It should be called by its correct name.

(2) Numbers of prescription for opioid painkillers have declined by almost 30 percent since 2011. Total opioid deaths shot up during that same time. Big surprise. 

What Every Patient Should Know About NarxCare


NarxCare,  is a prescription tracking tool that analyzes real-time data about opioids and other controlled substances from Prescription Drug Monitoring Programs (PDMP’s).

Recent studies question the value of PDMP’s, but 49 states have implemented them so that physicians, pharmacists and insurers can see a patient's medication history. Granted, there is a need for monitoring the select few who doctor shop and/or abuse their medications, albeit that number is only in the 2 percent range.

What is NarxCare? Appriss Health developed NarxCare as a “robust analytics tool” to help “care teams” (doctors, pharmacists, etc.) identify patients with substance use disorders. Each patient is evaluated and given a “risk score” based on their prescription drug history. According to Appriss, a patient is much more willing to discuss their substance abuse issues once they are red flagged as a possible abuser.

“NarxCare automatically analyzes PDMP data and a patient’s health history and provides patient risk scores and an interactive visualization of usage patterns to help identify potential risk factors,” the company says on its website.

“NarxCare aids care teams in clinical decision making, provides support to help prevent or manage substance use disorder, and empowers states with the comprehensive platform they need to take to the next step in the battle against prescription drug addiction."

Sounds great doesn't it? Except prescription drugs are not the problem and never really have been. Illicit drug use has, is, and will continue to be the main cause of the addiction and overdose crisis. 

Even the name NarxCare has a negative connotation. “Narx” stands for narcotics. And in today's environment, narcotics is a very negative word. NarxCare makes me feel like a narcotics police officer is just around the corner.

Each patient evaluated by NarxCare gets a “Narx Report” that includes their NarxScores, Overdose Risk Score, Rx Graph, PDMP Data and my favorite, the Red Flags. The scores are based on the past two years of a patient’s prescription history, as well as their medical claims, electronic health records and even their criminal history.

Ohio, Michigan, Indiana, Iowa, and several other states are using NarxCare to supplement their own PDMPs. And Walmart isn’t the only big retail company to adopt it. Kroger, Ralphs, Kmart, CVS, Rite Aid and Walgreens are already using NarxCare. There’s a good chance your prescriptions are already being tracked by NarxCare and you don’t even know it.

Rochelle Odell lives in California. She’s lived for nearly 25 years with Complex Regional Pain Syndrome (CRPS/RSD).