New Hampshire, like many states, is facing an opioid addiction crisis. In 2015, there were over 400 deaths in New Hampshire caused by powerful opioids like Heroin and Fentanyl. Federal, state, and local governments have struggled to find workable solutions to this extremely complicated problem. After considering comments and feedback from a myriad of stakeholders on both sides of the issue, the NH Board of Medicine passed new opioid prescription rules on April 5, 2016 that became effective on May 4, 2016. The final rules are now in effect and physicians must adhere to them in order to avoid discipline from the NH Board of Medicine and other collateral effects of discipline such as reporting to the National Practitioner Data Bank, receiving reciprocal discipline from other states of licensure, and revocation of DEA controlled substances registration.
The rules, codified in the Med 502 series of the NH Administrative Regulations, are divided into rules governing treatment of acute pain and rules governing treatment of chronic pain. Notably, the rules do not apply to physicians treating cancer or palliative care patients. These rules cover a myriad of important topics such as: (a) use of written treatment agreements; (b) provision of information to patients on topics such as risk of addiction and overdose, and safe storage and disposal; (c) use and documentation of opioid risk assessments; (d) prescription of the lowest effective dose; (e) use of informed consent forms; (f) periodic review of treatment plans; (g) required clinical coverage; and (h) use of random and periodic urine drug testing for patients using opioids long term.
All physicians who prescribe opioids to patients experiencing acute or chronic pain should promptly read the final rules and adopt policies, procedures, and appropriate forms to ensure immediate compliance with these rules. The NH Medical Society has made various opioid prescribing tools and sample forms such as a pain evaluation, risk assessment, written consent form, and opioid treatment agreement available on its website at http://nhms.org/resources/opioid. Physicians should also consult with legal counsel or the NH Board of Medicine if they do not understand any aspect of these rules.
I have drafted a comprehensive white paper explaining the requirements of these rules, which can be found here: White Paper – New Hampshire Board of Medicine Adopts Final Opioid Prescription Rules