Pain Warriors Unite - (202) 792-5600

Pain Warriors Unite

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

Prescribing Laws & Regulations by State

STATE OPIOID LAWS, GUIDELINES, & REGULATIONS:

OPIOID PRESCRIBING information regulations GUIDELINES by state


State Prescribing Guidelines 


ALABAMA

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

Officials Announce Plan Opioid Crisis

Opioids in Alabama


ALASKA

Alaska State Opioid Prescribing Policy Guide

Alaska Opioid Task Force

ASHNHA Opioid Crisis: State & Nationwide


ARIZONA

Arizona Clinical Opioid Guidelines & References

Arizona Medical Association Opioid Prescribing Safety

Arizona News Regarding Opioid Bill


ARKANSAS

Arkansas Senate Bill 717

ASMB Proposes New Rules

Arkansas Medical Society: Professional Resources, Prescription Drug Abuse

Arkansas Emergency Department Opioid Prescribing Guidelines


CALIFORNIA

California Medical Board Prescribing Guidelines in Pain

California DPH Guidance Letter

California DPH Introduction to Prescribing Guidelines Comparison

California DPH Resource for Opioid Prescribers


COLORADO

Colorado Policy for Prescribing and Dispensing Opioids

Opioid Prescribing Call To Action

Pain Management Resources and Opioid Use


CONNECTICUT

Connecticut Opioid Abuse Laws

Connecticut State Medical Society Opioid Resources

Backgrounder: Medicaid & Opioids


DELAWARE

Delaware Prescribing Rules

MSD: Opioid Abuse and Prescribing

Opioid Addiction Resources


FLORIDA

Florida State Opioid Prescribing Guidelines

Florida Counterfeit Proof Prescription Pad Vendors FAQ

Florida's Opioid Crisis


GEORGIA

Georgia Pain Management Rules

Medical Association of Georgia Six Point Platform

Georgia's Opioid Epidemic and Ways to Get Help


HAWAII

Hawaii Board of Medical Examiners Pain Management Guidelines

Hawaii Emergency Department Opioid Prescribing Guidelines

The-Hawaii-Opioid-Initiative, A Statewide Response


IDAHO

Idaho Board of Medicine Use of Opioid Analgesics in Treatment of Chronic Pain

Idaho Board of Medicine Opioid & Controlled Substance Prescribing Resources

Idaho's Response to the Opioid Crisis: Impact on Physicians and Other Prescribers


ILLINOIS

Illinois Controlled Substance Act

Illinois State Medical Society Opioid Resources

Illinois Opioid Action Plan


INDIANA

Indiana State Medical Association Opioid Prescribing Controlled Substances

Indiana Overdose Prevention Resources

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


IOWA

Iowa Medical Board Regulations Pain Management

Iowa Medical Society Opioid Resources

Iowa Pharmacy Board E-prescribing Controlled Substances


KANSAS

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


KENTUCKY

Kentucky Professional Standards for Prescribing and Dispensing Controlled Substances

Kentucky Prescribing Substance Abuse Screening & Treatment Resources

2018 Kentucky Legislative Initiatives


LOUISIANA

Louisiana Opioid Prescription Policy Update

Louisiana Short Acting Opioid Prescription Policy Update

Louisiana Department of Health: Opioid Fact Sheet


MAINE

Maine Opioid Prescription Requirements

Maine Medical Association Opioid Law Q&A

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


MARYLAND

Maryland Opioid Prescribing Guidance & Policy

Maryland Board of Physicians Opioid Prescribing Guidance

Overdose Prevention in Maryland

Maryland Medicaid Opioid Prescribing Guidance & Policy


MASSACHUSETTS

Massachusetts Law About Prescription Medication

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


MICHIGAN

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


MINNESOTA

Minnesota Medical Association Prescription Opioid Task Force

Minnesota Opioid Prescribing Rules

Minnesota Opioid Prescribing Improvement Program

Minnesota State Targeted Response to the Opioid Crisis


MISSISSIPPI

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


MISSOURI

Missouri Guidelines for the Use of Controlled Substances for the Treatment of Pain

Controlled Substance Guidelines for EMS

Missouri Controlled Substance Guidelines for Practitioners


MONTANA

Montana Guidelines for the Use of Controlled Substances for the Treatment of Pain

Reducing Prescription Misuse, Abuse and Diversion in Montana

Montana Prescribing and Dispensing Profile


NEBRASKA

Nebraska Pain Management Guidance Document

Nebraska Opioid Prescribing Resource

Nebraska Drug Overdose Prevention Homepage


NEVADA

Nevada Assembly Bill 474

Nevada Resources for Prescribing Controlled Substances

Nevada Prescription Drug Abuse Prevention 


NEW HAMPSHIRE

New Hampshire Opioid Prescribing

New Hampshire Medical Society Opioid Prescribing Resources

New Hampshire Prescribing Opioids for Pain Management


NEW JERSEY

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 MEXICO

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 YORK

New York Prescribing and Dispensing Controlled Substances

New York State Laws Governing Opioids and Controlled Substances

NY: Limited Initial Opioid Prescribing


NORTH CAROLINA

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 DAKOTA

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


OHIO

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


OKLAHOMA

Oklahoma Opioid Prescribing Guidelines

Oklahoma Medical Board Use of Controlled Substances for Pain

Oklahoma Prescribing and Dispensing Guidelines


OREGON

Oregon Opioid Prescribing Guidelines

Oregon Medical Association Practice Help Center Opioid Epidemic

OHSU Guideline for Safe Chronic Opioid Therapy for Patients with Chronic Non-Cancer Pain

Oregon Pain Guidance Provider and Community Resource: Opioid Prescribing Guidelines


PENNSYLVANIA

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


RHODE ISLAND

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


SOUTH CAROLINA

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


SOUTH DAKOTA

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


TENNESSEE

Tennessee Laws & Policies

Tennessee Chronic Pain Guidelines

Tennessee Pain Clinic Rules

Tennessee Pain Clinic Guidelines

Tennessee Medical Association Member Resource Center


TEXAS

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


UTAH

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


VERMONT

Vermont Department of Health: Regulations 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


VIRGINIA

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


WASHINGTON

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


WEST VIRGINIA

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

Wisconsin Medical Examining Board Opioid Prescribing Guidelines

Wisconsin Department of Health Services Provider Resources: Opioids

Wisconsin State Legislature 961.385 Prescription Drug Monitoring Program

Wisconsin Medical Society: Opioid Prescribing Principles


WYOMING

Wyoming Controlled Substances Act/Rule 2017 & WORx

Wyoming State Board of Pharmacy: Controlled Substance Registration

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

Wyoming Department of Health: Opioid Abuse Data and Resources


THE DISTRICT OF COLUMBIA (D.C.)

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




More Resources: 


State Prescribing Laws  - NCSL

Opioid Regulations by State -- Athena  Health 



Tapering :






Resources

image83

Additional Rx Resources


  • State Specific Resources: https://sharingsolutions.us/resources/state-specific-resources/




  • 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.

What is Health IT EHR Technology?

What is Appriss and Narxcare?

image87


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


  BACK TO BLOG


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

image88


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.


NOTES:


(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

image89


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).