Section Med 502.05 - Chronic Pain(a) This section shall only apply to the treatment of "chronic pain" as defined in Med 502.03(d) and shall not apply to the treatment of pain from cancer or pain from terminal disease.(b) If opioids are indicated and prescribed for chronic pain, prescribing licensees shall: (1) Conduct and document a history and physical examination;(2) Conduct and document a risk assessment, including, but not be limited to, the use of an evidence-based screening tool such as the Screener and Opioid Assessment for Patients with Pain (SOAPP);(3) Document the prescription and rationale for all opioids according to Med 501.02(d) and (e);(4) Prescribe opioid analgesics in a measured and monitored manner and administered in the lowest amount necessary to control pain.(5) Comply with all federal and state controlled substances laws, rules, and regulations;(6) Utilize a written informed consent that explains the following risks associated with opioids: d. Physical side effects;(7) 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;(8) Utilize a written treatment agreement that is included in the medical record, and specifies conduct that triggers the titration, discontinuation, or tapering of opioids based on ongoing, objective evaluation of the patient's injury or illness as required for ongoing successful treatment of chronic pain;(9) The treatment agreement shall also address, at a minimum, the following: a. The requirement of safe medication use and storage;b. The requirement of obtaining opioids from only one prescriber or practice;c. The consent to periodic and random drug testing; andd. The prescriber's responsibility to be available or to have clinical coverage available;(10) Document the consideration of a consultation with an appropriate specialist in the following circumstances: a. When a patient is at high risk for abuse or addiction; orb. When a patient has a co-morbid psychiatric disorder;(11) Reevaluate treatment plan and use of opioids at least twice a year;(12) Require random and periodic urine 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; (13) Have clinical coverage available for 24 hours per day, 7 days per week, to assist in the management of patients;(14) The prescriber may forego the requirements for a written treatment agreement and for periodic drug testing for patients:a. Who are residents in a long-term, non-rehabilitative nursing home facility where medications are administered by licensed staff; orb. Who are being treated for episodic intermittent pain and receiving no more than 50 dose units of opioids in a 3 month period; and(15) Be allowed to continue prescribing opioid treatment, when there is no indication of misuse or diversion, for patients: a. Who experience chronic illness or injury which results in chronic pain; andb. Who are on a managed and monitored regimen of opioid analgesic treatment which has resulted in an increase in functionality and quality of life.N.H. Admin. Code § Med 502.05
Derived From Volume XXXVI Number 49, Filed December 8, 2016, Proposed by #12038, Effective 1/1/2017, Expires 1/1/2027.Amended by Volume XLI Number 36, Filed September 9, 2021, Proposed by #13248, Effective 8/6/2021, Expires 8/6/2031.