Pain Warriors Unite - (202) 792-5600
ACCESS OUR COMPREHENSIVE STATE BY STATE INDEX OF OPIOID PRESCRIBING LAWS, GUIDELINES, STATUTES & REGULATIONS: HERE
(NOTE, SOME LINKS MAY BE UNAVAILABLE OR OUTDATED)
Arkansas Senate Bill 717
THE DISTRICT OF COLUMBIA
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.
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State Prescribing Guidelines
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
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)
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
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
Energy Assistance (LIHEAP)
Health Insurance (HealthCare.gov)
Public Health Departments (States and Territories)
Agency for Healthcare Research and Quality (AHRQ)
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.
Assistant Secretary for Health (ASH)
ASH advises on the nation's public health and oversees HHS' U.S. Public Service (PHS) for the Secretary.
Centers for Disease Control and Prevention (CDC)
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
Use this form
Centers for Medicare & Medicaid Services (CMS)
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.
Departmental Appeals Board (DAB)
DAB provides impartial review of disputed legal decisions involving HHS.
Food and Drug Administration (FDA)
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.
Health Resources and Services Administration (HRSA)
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.
Immediate Office of the Secretary (IOS)
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Indian Health Service (IHS)
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.
National Institutes of Health (NIH)
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.
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.
Link to Contact Your: State PDMP
District of Columbia
Alabama ▪ Alaska ▪ Arizona ▪ Arkansas ▪ California ▪ Colorado ▪ Connecticut▪ Delaware ▪ Florida ▪Georgia ▪ Hawaii ▪ Idaho ▪Illinois▪ Indiana ▪ Iowa ▪ Kansas ▪ Kentucky ▪ Louisiana ▪Maine ▪ Maryland ▪Massachusetts ▪ Michigan ▪ Minnesota ▪ Mississippi ▪ Missouri ▪ Montana ▪Nebraska ▪ Nevada▪ New Hampshire▪ New Jersey ▪ New Mexico ▪New York ▪North Carolina▪ North Dakota ▪Ohio▪ Oklahoma ▪ Oregon ▪ Pennsylvania ▪ Rhode Island ▪South Carolina ▪South Dakota ▪ Tennessee ▪ Texas ▪ Utah. ▪ Vermont.▪ Virginia. ▪ Washington. ▪ West Virginia ▪ Wisconsin • Wyoming ▪ *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
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.
Federation of State Medical Boards Opioid Policy Survey, 2019
Board-by-Board Overview of Laws, Regulations, and Guidelines
The Latest Legislative Tracking on Telemedicine
The Latest Legislative Tracking on Pain Management
Continuing Medical Education requirements for medical marijuana
The Latest Legislative Tracking on Pain Management
The Latest Legislative Tracking on Telemedicine
The Latest Legislative Tracking on Prescription Drug Monitoring Programs
The Latest Legislative Tracking on Telemedicine
Telemedicine Policies by State
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:
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.
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:
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:
Questions that need to be asked
"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.
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).