N.H. Admin. Code § Opt 504.05 - Chronic Pain

If opioids are indicated and clinically appropriate for prescription for chronic pain, prescribing licensees shall:

(a) Conduct and document a history and physical examination;

(b) Conduct and document a risk assessment including, but not limited to, the use of an evidence based screening tool such as the Screener and Opioid Assessment for Patients with Pain (SOAPP);

(c) Document the prescription and rationale for all opioids;

(d) Prescribe the lowest effective dose for a limited duration;

(e) Comply with all federal and state controlled substances laws, rules, and regulations;

(f) Utilize a written informed consent that explains the following risks associated with opioids:

(1) Addiction;

(2) Overdose and death;

(3) Physical dependence;

(4) Physical side effects;

(5) Hyperalgesia;

(6) Tolerance; and

(7) Crime victimization;

(g) 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;

(h) Utilize a written treatment agreement that is included in the medical record, and specifies conduct that triggers the discontinuation or tapering of opioids;

(i) The treatment agreement shall also address, at a minimum, the following:

(1) The requirement for safe medication use and storage;

(2) The requirement of obtaining opioids from only one prescriber or practice;

(3) The consent to periodic and random drug testing; and

(4) The prescriber's responsibility to be available or to have clinical coverage available;

(j)Document the consideration of a consultation with an appropriate specialist in the following circumstances:

(1) When the patient receives a 100 mg morphine equivalent dose for longer than 90 days;

(2) When a patient is at high risk for abuse or addiction; or

(3) When a patient has a co-morbid psychiatric disorder;

(k) Reevaluate treatment plan and use of opioids at least twice a year;

(l) Require random and periodicurine 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; and

(m) Have clinical coverage available for 24 hours per day, 7 days per week, to assist in the management of patients; and

(n) The prescriber may forego the requirements for a written treatment agreement and for periodic drug testing for patients:

(1) Who are residents in a long-term, nonrehabilitative nursing home facility where medications are administered by licensed staff; or

(2) Who are being treated for episodic intermittent pain and receiving no more than 50 dose units of opioids in a 3 month period.

Notes

N.H. Admin. Code § Opt 504.05

Derived from Volume XXXVII Number 2, Filed January 12, 2017, Proposed by #12060, Effective 1/1/2017, Expires 1/1/2027.