STATE-BY-STATE OPIOID PRESCRIBING POLICIES

http://www.medscape.com/resource/pain/opioid-policies
http://www.medscape.com/resource/pain/opioid-policies

STATE-BY-STATE OPIOID PRESCRIBING POLICIES

Introduction

Controlled substances are essential to the treatment of a myriad of disorders and represent a wide spectrum of pharmaceutical agents. Prescribing these substances involves considering a number of important medical, social, and cultural variables along with adherence to applicable federal and state regulations. Physicians often stand at the crossroads of these issues and serve as the ultimate gatekeepers of safe and effective treatment.

Physicians and others involved with prescribing controlled substances must be well-versed in the legal requirements including knowledge of both federal and state law. The Controlled Substances Act (CSA) is the federal law that regulates such substances. The CSA is a rather complete and functional law and provides an operational framework the prescriber should understand. The Drug Enforcement Administration (DEA) publishes a guide for prescribers entitled "Practitioner's Manual, an Informational Outline of the Controlled Substances Act." This resource provides a comprehensive overview of the Controlled Substances Act and the federal requirements for prescribing controlled substances.

Additionally, all states have further regulations involving controlled substances. The physician should be aware that state laws often impose additional, stricter requirements on prescribing controlled substances. Physicians must be aware of these regulations to practice lawfully within their local jurisdiction and in compliance with State Board of Medicine regulations.

In addition to physicians, the CSA generally authorizes dentists, podiatrists, and veterinarians to prescribe controlled substances. Furthermore, states can authorize other licensed healthcare professionals to prescribe controlled substances, including clinicians such as nurse practitioners and physician assistants with proper DEA registration. In rare cases, naturopathic physicians and optometrists can prescribe controlled substances in certain states with important limitations. Information on nurse practitioners and their authority to prescribe can be found at Medscape's US Nurse Practitioner Prescribing Law: A State-by-State Summary and DEA's Midlevel Practitioners Authorized by State Website.

The following is a summary of significant state laws involved with prescribing controlled substances for the physician. The information provided is not intended to be completely comprehensive and should not be exclusively relied upon for prescribing. The prescribing guide is intended as a living document and Medscape welcome readers to submit comments and updates to the Neurology site editor. Web links to detailed prescribing laws are provided for each state. For additional information on prescribing controlled substances, contact the DEA or your State Board of Medicine.

Alabama

• Physician must complete medical history and physical examination and must document nature and intensity of the pain, current and past medical treatments, history of substance abuse, etc. before prescribing a controlled substance
• Alabama Department of Public Health Prescription Monitoring Program
• Prescribing or dispensing controlled substances for self or family except in emergency situations is considered unprofessional conduct
• Physicians prescribing Schedule II amphetamines must maintain an inventory, separate dispensing record, and prescribing record for 5 years
• Carisoprodol is classified as a Schedule IV controlled substance
• Alabama State Board of Medical Examiners Medical Licensure Commission

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Alaska

• Prescription Monitoring Program to monitor prescription drugs authorized but not yet implemented.
• When prescribing any controlled substance, a prescriber must create and maintain a complete, clear, and legible written record of care that includes, at a minimum:
  • Patient history and evaluation sufficient to support a diagnosis;
  • Diagnosis and treatment plan;
  • Monitoring the patient for the primary condition that necessitates the drug, side effects of the drug, and results of the drug, as appropriate; and
  • Record of drugs prescribed, administered, or dispensed, including the type of drug, dose, and any authorized refills.
  • Alaska State Medical Board licensing information

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Arizona

• The physician must maintain adequate, accurate and timely records regarding pain assessment, treatment plan, informed consent, ongoing assessment and consultation of the patient. "Adequate Records" indicates legible records containing, at a minimum, sufficient information to identify the patient, support the diagnosis, and justify the treatment; adequate documentation of the results; advice and cautionary warnings provided to the patient; and sufficient information for another practitioner to assume continuity of the patient's care at any point in the treatment
• Physicians must secure all controlled substances in a locked cabinet or room and control access by a written procedure
• Prescribing or dispensing controlled substances for oneself or family members is considered unprofessional conduct
• Prescription Monitoring Program monitors controlled substances
• Arizona State Board of Pharmacy prescription monitoring information
• Carisoprodol is classified as a Schedule IV controlled substance
• Arizona Medical Board Website

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Arkansas

• License may be revoked or suspended for prescribing Schedule II controlled substances for oneself or an immediate family member
• Tramadol is classified as a Schedule IV controlled substance
• Carisoprodol is classified as a Schedule IV controlled substance
• Maintains the Intractable Pain Treatment Act (IPTA) which:
  • Prohibits the physician from prescribing or administering dangerous or controlled drugs intended to manage chronic intractable pain to treat a patient for chemical dependency on drugs or controlled substances
  • Prohibits the physician from prescribing or administering dangerous or controlled drugs to a person for other than legitimate medical purposes (i.e. cause or assist in causing the suicide, euthanasia, or mercy killing of any individual)
• A physician who prescribes Schedule 2, 3, 4, and 5 narcotic agents on a long term basis (more than 6 months) for a patient with pain not associated with malignant or terminal illness will be considered exhibiting gross negligence or ignorant malpractice unless he or she has complied with the following:
  • Keep accurate records
  • Periodically review the course of scheduled drug treatment
  • Obtain written informed consent from the patient
  • Arkansas State Medical Board Website

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California

• Prescribers must write for all controlled substances (Schedule II-V) on tamper-resistant security prescription forms that have at least 10 required security features
• The Medical Board of California Controlled Substance Prescription Form Requirements
• Prescription Monitoring Program monitors controlled substances
• California Prescription Drug Monitoring Program
• Prescribers cannot self-prescribe controlled substances
• Medical marijuana is permitted under state law
• Medical Board of California Laws and Regulations

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Colorado

• Issuing a prescription on the basis of a questionnaire, Internet-based consultation, or a telephonic consultation, without a valid preexisting patient-practitioner relationship is forbidden
• A physician must not be subject to disciplinary action by the Board solely for prescribing controlled substances for the relief of intractable pain.
• Prescribing, distributing, or giving any controlled substance to oneself or family members, except in an emergency, is considered unprofessional conduct and grounds for disciplinary action
• Prescribing stimulant drugs classified as Schedule II controlled substances is not acceptable for diet control, increasing work capacity, combating the normal fatigue associated with any endeavor, or chemically inducing euphoria
• Prescription Monitoring Program monitors controlled substances
• Colorado Department of Regulatory Agencies Prescription Monitoring
• Colorado Medical Board

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Connecticut

• Medical history and physical examination must be performed before prescribing any controlled substance
• A written prescription shall include:
  • The name and address of the patient
  • Whether the patient is an adult or a child, or his/her specific age
  • The compound or preparation prescribed and the amount
  • Directions for use of the medication
  • The name and address of the prescribing practitioner
  • The date of issuance
  • The Federal Registry number of the practitioner
• Prescriptions for schedule II controlled substances shall contain only one drug
• Prescription Monitoring Program monitors controlled substances
• Connecticut Prescription Monitoring Program
• Connecticut Medical Examining Board licensure information

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Delaware

• Each written prescription shall have the name of the practitioner stamped, typed, or hand-printed on it, as well as the signature of the practitioner
• Prescriptions for controlled substances in schedules II and III become void unless dispensed within 7 days of the original date of the prescription or if the original prescriber authorizes the prescription past the seven days period.
• Controlled substance prescriptions cannot be written nor dispensed for more than 100 dosage units or a 31-day supply
• Schedule II prescriptions for patients who are terminally ill or in long-term care facilities shall be valid for a period not to exceed 60 days from the issue date unless sooner terminated by the discontinuance of the medication
• Physicians are not permitted to dispense a Schedule III or IV controlled substance for weight reduction unless the drug has an FDA-approved indication for this purpose
• Delaware Board of Medical Practice Website

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District of Columbia

• Adopted Model Policy for the Use of Controlled Substances for the Treatment of Pain. The guidelines consist of evaluating the patient, development of a treatment plan, obtaining informed consent and agreement for treatment, periodically reviewing the treatment plan, consulting with the patient, maintaining good medical records, and complying with controlled substances laws and regulations.
• District of Columbia Health Professional Licensing Administration

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Florida

• Must not prescribe drugs from different schedules or noncontrolled substances on same prescription
• Can prescribe maximum 30-day supply of a controlled substance listed in Schedule III via oral prescription
• Each written prescription prescribed by a practitioner in this state for a controlled substance listed in Schedule II, Schedule III, or Schedule IV must include both a written and a numerical notation of the quantity of the controlled substance prescribed on the face of the prescription and a notation of the date, with the abbreviated month written out on the face of the prescription.
• Carisoprodol is a Schedule IV controlled substance
• Prescriptions or orders for any drug, synthetic compound, nutritional supplement or herbal treatment for weight loss must be in writing and signed by the prescribing physician. Initial prescriptions or orders of must not be called into a pharmacy by the physician or by an agent of the physician. Even if the physician is registered as a dispensing physician, a hard copy of the written prescription must be maintained in the patient's medical records for each time such weight loss drugs are prescribed, ordered, dispensed, or administered
• Prescription Monitoring Program to monitor controlled substances authorized but not yet implemented.
  • FL§ 893.055
• Self-prescribing controlled substances is prohibited
• Salvia is classified as a Schedule I controlled substance
• Florida Board of Medicine Laws and Rules

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Georgia

• Carisoprodol is classified as a Schedule IV controlled substance
• Self-prescribing controlled substances is considered unprofessional conduct
• Follows "Ten-Step Policy" on the use of controlled medications to treat pain:
  • Medical history and physical examination must be obtained
  • Create treatment plan
  • Determine that noncontrolled drugs are not appropriate or effective for the patient's condition
  • Review patient's medication record and discuss chemical history before prescribing a controlled drug
  • Discuss risks and benefits with the patient on the use of controlled substances
  • Maintain regular monitoring of the patient
  • Physician must keep detailed records of the type, dosage, and amount of the drug prescribed
  • With the patient's permission, family may be a valuable source of information on the patient's response to the therapy regimen and the patient's functional status (ie, tolerance and dependence)
  • Physician must maintain adequate records to assess and review treatment course and progress
  • Keep accurate and complete records including:
    • The medical history and physical examination
    • Diagnostic, therapeutic, and laboratory results
    • Evaluations and consultations
    • Treatment objectives
    • Medications (including date, type, dosage, and quantity prescribed)
    • Instructions and agreements and pain contracts (where applicable)
    • Georgia State Board of Medical Examiners Guidelines for Controlled Substances For the Treatment of Pain?
    • Georgia Composite Medical Board Rules and Laws

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Hawaii

• Self-prescribing controlled substances is only permitted in an emergency
• Prescription Monitoring Program monitors controlled substances
• Medical marijuana is permitted under state law
• Prescriber should use both words and figures (ie, indicate quantities both alphabetically and numerically: five [5]) to indicate the amount of controlled substances prescribed
• Carisoprodol is classified as a Schedule IV controlled substance
• Hawaii Department of Commerce and Consumer Affairs Professional And Vocational Licensing

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Idaho

• When prescribing a Schedule II controlled substance, the practitioner shall indicate the desired quantity of the drug on the prescription blank by both writing out the quantity and by indicating or writing the quantity in numerical form
• Prescription Monitoring Program monitors controlled substances
• Idaho Prescription Monitoring Program
• Schedule II orders for patients in properly licensed hospitals, nursing homes, or extended care facilities that use a unit dose distribution system shall be written into the patient's record and signed by the practitioner, with proper dating and drug information. A direct copy of this order must be given to the pharmacist within 72 hours. These records shall be kept for 3 years and must remain available for inspection.
• Disciplinary action may be taken for prescribing or providing controlled substances for oneself, spouse, child, or stepchild
• Prescribing narcotic or hallucinogenic drugs to addicted individuals to maintain their addictions and level of usage without attempting to treat the primary condition is considered grounds for medical discipline
• Idaho Board of Medicine

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Illinois

• Prescribers must have a state license to prescribe controlled substance
• Prescription Monitoring Program monitors controlled substances
• Illinois Prescription Monitoring Program
• Salvia is classified as Schedule I controlled substance
• Illinois Division Of Professional Regulation

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Indiana

• A physician shall not utilize, prescribe, order, dispense, administer, supply, sell, or give any controlled substance for weight loss unless he/she conducts a thorough review and documents that previous therapy was ineffective
• A physician shall not prescribe, dispense, or otherwise provide, or cause to be provided any controlled substance to a person who the physician has never personally physically examined and diagnosed (except in institutional settings, on-call situations, and cross-coverage situations)
• Prescription Monitoring Program monitors controlled substances
• Indiana Prescription Monitoring Program
• Carisoprodol is classified as a Schedule IV controlled substance
• When a controlled substance is prescribed for administration to an ultimate user who is institutionalized, it should not be prescribed or dispensed for more than 7-day supply at the same time for Schedule II controlled substances; and no more than a 34-day supply or 100 dosage units -- whichever is less -- at the same time for Schedule III or IV substances.
• Indiana Professional Licensing Agency Statutes and Rules

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Iowa

• Physicians are not permitted to self-prescribe or self-dispense controlled substances
• Prescription Monitoring Program monitors controlled substances
• Iowa Board of Pharmacy Prescription Monitoring Program
• To ensure that pain is properly and promptly assessed and treated, the physician must exercise sound clinical judgment by establishing an effective pain management plan in accordance with the following:
  • Patient evaluation
  • Treatment plan
  • Informed consent
  • Periodic review
  • Consultation/referral
  • Documentation
  • Physician-patient agreement
  • Termination of care
• Iowa Board of Medicine Website

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Kansas

• Adopted Model Policy for the Use of Controlled Substances for the Treatment of Pain. The guidelines consist of evaluating the patient, development of a treatment plan, obtaining informed consent and agreement for treatment, periodically reviewing the treatment plan, consulting with the patient, maintaining good medical records, and complying with controlled substances laws and regulations
• Controlled substance prescriptions in Schedules II through V shall not be issued on a prescription blank that is preprinted with the name of a proprietary preparation or with the strength, quantity, or directions.
• Prescription Monitoring Program to monitor controlled substances was implemented on April 1, 2011.
• Kansas State Board of Healing Arts Rules and Regulations

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Kentucky

• Kentucky Prescription Monitoring Program
• Physicians should avoid prescribing Scheduled controlled substances for themselves, immediate family, staff, or individuals knowingly that will abuse
• Kentucky Board of Medical Licensure has issued standards of acceptable and prevailing medical practice for prescribing controlled substances
• Prescriptions for controlled substance in Schedule II are valid for only 60 days from the date issued
• Tramadol is classified as a Schedule IV controlled substance
• Carisoprodol is classified as a Schedule IV controlled substance
• Schedule II amphetamine or amphetamine-like controlled substance should not be prescribed to treat obesity
• Kentucky Board of Medical Licensure physician information

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Louisiana

• Louisiana Prescription Monitoring Program
• The physician must see all patients treated, not to exceed every 12 weeks, and during these interval visits must assess the efficacy of treatment, assure that controlled substance therapy remains indicated, and must evaluate the patient's progress toward treatment objectives and any adverse drug effects.
• Carisoprodol is classified as a Schedule IV controlled substance
• Louisiana State Board of Medical Examiners Laws

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Maine

• Maine Prescription Monitoring Program
• Adopted Model Policy for the Use of Controlled Substances for the Treatment of Pain. The guidelines consist of evaluating the patient, development of a treatment plan, obtaining informed consent and agreement for treatment, periodically reviewing the treatment plan, consulting with the patient, maintaining good medical records, and complying with controlled substances laws and regulations
• Medical marijuana is permitted under state law
• Maine Board of Licensure in Medicine

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Maryland

• Prescriptions for a Schedule II, III, IV, or V controlled substance are valid for 120 days from the dated issued
• Prescribing of controlled substances to family members is strongly discouraged
• Maryland Board of Physicians licensure regulations

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Massachusetts

• Prescriptions must be manually signed when written. A rubber stamp signature may not be used
• Separate prescription blank must be used for each controlled substance prescribed
• Schedule II prescriptions valid only for 30 days after the date issued
• No controlled substance in Schedule II or III shall be filled for more than a 30-day supply upon any single filling; however, with regard to dextroamphetamine sulphate and methylphenidate hydrochloride, a prescription may be filled for up to a 60-day supply of such substance upon any single filling if the medication is being used for the treatment of minimal brain dysfunction or narcolepsy
• Patient contact must be maintained while prescribing controlled substances. Physicians prescribing controlled substances over a long period of time to a patient whose disease is stable must perform the following:
  • The physician sees the patient at least once every 6 months; or
  • The physician writes a note in his or her records explaining why it is impossible, impractical or inappropriate to see the patient at least once every 6 months
• Carisoprodol is classified as a Schedule IV controlled substance
• Massachusetts Board of Registration in Medicine

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Michigan

• Adopted Model Policy for the Use of Controlled Substances for the Treatment of Pain. The guidelines consist of evaluating the patient, development of a treatment plan, obtaining informed consent and agreement for treatment, periodically reviewing the treatment plan, consulting with the patient, maintaining good medical records, and complying with controlled substances laws and regulations
• Schedule II prescriptions are valid for 90 days from the date issued
• Michigan Prescription Monitoring Program
• A controlled substance prescription shall contain the quantity of the controlled substance prescribed in both written and numerical terms
• Medical marijuana is permitted under state law
• Michigan Department of Community Health

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Minnesota

• Adopted Model Policy for the Use of Controlled Substances for the Treatment of Pain. The guidelines consist of evaluating the patient, development of a treatment plan, obtaining informed consent and agreement for treatment, periodically reviewing the treatment plan, consulting with the patient, maintaining good medical records, and demonstrating compliance with controlled substances laws and regulations
• Minnesota Prescription Monitoring Program
• Carisoprodol is classified as a Schedule IV controlled Substance

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Mississippi

• No physician shall prescribe, administer, or dispense any controlled substance or other drugs having addiction-forming or addiction-sustaining liability without prior examination and medical indication
• Mississippi Prescription Monitoring Program
• Schedule II prescriptions expire after 6 months from the date of issuance
• No prescriptions for brand name or generic equivalents of nalbuphine HCl, carisoprodol, butalbital compounds, or tramadol HCl shall be faxed
• Mississippi State Board of Medical Licensure Laws

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Missouri

• If the prescription is for greater than a 30-day supply of a Schedule II drug, the prescriber must write the medical reason on the prescription. A diagnosis code number is not acceptable
• Physicians are prohibited from self-prescribing controlled substances except in a true medical emergency
• Schedule II prescriptions are valid for 6 months
• Quantity limitations for Schedule II controlled substances is 30 days for most; prescriptions for over 30 days require a medical reason, and the maximum is 90-day supply. Schedule III and IV controlled substances are limited to a 90-day supply
• Missouri Division of Professional Registration Rules and Statutes

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Montana

• Restricts the prescription quantity of Schedule II controlled substances to 30-day supply (may be increased up to 6 months if medical reason is described on prescription)
• Self-prescribing or prescribing controlled substances for family members may result in disciplinary action if it does not meet the generally accepted standards of practice
• Restricts the prescription quantity to initial maximum 3-month supply for CSIII-V with refills in writing
• Case law provides framework for physician assisted suicide
• Medical marijuana is permitted under state law
• Montana Board of Medical Examiners Website

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Nebraska

• Prescribing controlled substances for oneself or except in a medical emergency an immediate family member is considered grounds for disciplinary action
• Schedule II prescriptions expire in 6 months
• Adopted Model Policy for the Use of Controlled Substances for the Treatment of Pain. The guidelines consist of evaluating the patient, development of a treatment plan, obtaining informed consent and agreement for treatment, periodically reviewing the treatment plan, consulting with the patient, maintaining good medical records, and demonstrating compliance with controlled substances laws and regulations
• Salvia is a Schedule I substance
• Nebraska Department of Health and Human Services Physician and Surgeon Regulations and Statutes

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Nevada

• Prescribers are not permitted to self-prescribe controlled substances nor prescribe Schedule II controlled substances to immediate family
• Prescription Monitoring Program monitors controlled substances
• Prescriptions for Schedule II controlled substances may include other controlled substances not listed in Schedule II as well as other prescription drugs
• Nevada State Board Of Pharmacy
• All prescriptions for controlled substances expire after 6 months from the date written
• Carisoprodol is a Schedule IV controlled substance
• Medical marijuana is permitted under state law
• Nevada Board of Medical Examiners Statutes and Regulations

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New Hampshire

• Restricts the prescription quantity of Schedule II and III controlled substances to a 34-day supply or 100 dosage units, whichever is less (up to 60-day supply for amphetamine or methylphenidate if for attention-deficit disorder or narcolepsy)
• Schedule II prescriptions expire within 6 months
• Adopted Model Policy for the Use of Controlled Substances for the Treatment of Pain. The guidelines consist of evaluating patient, treatment plan, informed consent, agreement for treatment, periodic review, consultation, medical records (accurate and complete), and compliance with controlled substance laws and regulations
• Higher controlled substance doses can be administered if the physician determines that appropriate pain management warrants this and the benefit of the relief expected outweighs the risk of the high dosage. However, the controlled substance cannot be administered for the purpose of causing or assisting in the patient's death
• New Hampshire Board of Medicine Laws and Rules

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New Jersey

• All prescriptions must be written on state authorized prescription blanks printed with the prescriber's NPI serialized by vendor, and must include the collaborating physician's name, license number, address, and phone number
• Prescription Monitoring Program authorized, but not yet implemented
• Each prescription for a controlled substance shall be written on a separate Uniform Prescription Blank (NJPB). An NJPB that contains a prescription for only one controlled substance and contains other prescription other than controlled substance shall be valid. But an NJPB that contains prescriptions for 2 or more controlled substances shall be invalid
• A report must be filed within 72 hours of noticing any stolen, forged, or lost NJPBs
• Schedule II controlled substance prescriptions are limited to a 30-day supply
• As a general rule, the State of New Jersey limits prescribing to a 34-day supply or 100 dosage units -- whichever is less -- of controlled substance listed in schedule III or IV and dispensed at one time (this may be exceeded under certain circumstances to achieve pain management for patients with cancer, intractable pain or terminal illness)
• The practitioner should review the patient's progress toward the treatment objectives, the course of treatment, new information about the cause of pain at a minimum of every 3 months, if the patient is prescribed controlled substances for greater than 3 months
• All prescriptions for controlled substances expire within 30 days after the date when issued
• Within 72 hours after authorizing an emergency oral prescription, the prescriber must deliver the original prescription to the dispensing pharmacist
• Medical marijuana is permitted under state law
• New Jersey State Board of Medical Examiners

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New Mexico

• New Mexico Prescription Monitoring Program
• Medical marijuana is permitted under state law
• Carisoprodol is classified as a Schedule IV controlled substance
• Physicians being treated with opiates must have medical clearance to prescribe and be under medical care
• New Mexico Medical Board Governing Statutes

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New York

• Restricts the prescription quantity of Schedule II controlled substances to a 30-day supply, or up to 3 months in the case of gonadotropin and up to 6 months in the case of anabolic steroids, if used for the treatment of panic disorder (code A); ADD (code B); chronic debilitating neurological conditions characterized as movement disorder or exhibiting seizure, convulsive or spasm activity (code C); pain from chronic incurable conditions (code D); narcolepsy (code E); or hormone deficiency states in males, gynecologic conditions that are responsive to treatment with anabolic steroids or chorionic gonadotropin, metastatic breast cancer, anemia, and angioedema (code F). The same applies to Schedule III, IV, and V medications
• Oral prescriptions for Schedule IV medications limited to 30 days or 100 dosage units, whichever is less
• Prescribers must submit dispensing information for all controlled substances. Prescriptions for Schedule II medications (including anabolic steroids) and benzodiazepines must be written on official prescription forms with no refills
• The medical board recommends that physicians not self-prescribe or prescribe for family members
• Schedule II controlled substances and benzodiazepine prescriptions also require sex, age of the patient, telephone number of the prescribing practitioner, and maximum daily dosage
• New York State Prescription Monitoring Program

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North Carolina

• The patient's name and physical street address for all controlled substance prescriptions must be readily retrievable, but is not required to be handwritten on the face of the prescription hard copy
• The preprinting of or use of preprinted prescription blanks with the name of scheduled substances is prohibited. Prescription blanks that are individually generated (aka: computer-generated prescriptions) are permissible
• Each prescription for a DEA controlled substance (2, 2N, 3, 3N, 4 and 5) should be written on separate prescription blanks
• North Carolina Prescription Monitoring Program
• North Carolina Medical Board Professional Resources

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North Dakota

• Prescriptions for Schedule II controlled substances may not be filled more than 6 months after the date they were written
• Salvia is a schedule I controlled substance
• Prescribing or providing a controlled substance or addictive or dangerous drug for oneself, spouse, or child may be grounds for disciplinary action
• North Dakota Prescription Monitoring Program
• North Dakota State Board of Medical Examiners Medical Practice Act

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Ohio

• No prescription may be dispensed for the first time beyond 6 months from the date it was issued or refilled beyond 1 year from the date it was issued
• Physicians are not permitted to prescribe a Schedule II controlled substance for purposes of weight reduction or control
• A physician may utilize a schedule III or IV controlled substance that bears appropriate FDA approved labeling for weight loss or the maintenance of weight loss, in the treatment of obesity as an adjunct, and in a regimen of weight reduction based on caloric restriction, provided that the scheduled drug is at all times to be considered an adjunct to diet and lifestyle changes, which are appropriately the responsibility of the patient
• The physician shall personally meet face-to-face with the patient, at a minimum, every 30 days when controlled substances are being used for weight reduction
• The total course of treatment using controlled substance shall not exceed 12 weeks.
  • An exception is Meridia® (sibutramine), the only controlled substance drug approved for long-term use. Its safety and efficacy, however, have not been studied beyond 2 years. Its effectiveness in a particular patient is usually evident within the first 4 weeks of therapy. If the patient has not lost at least 4 pounds during this period, the physician is advised to reevaluate continued use of the drug
• Salvia is classified as a Schedule I controlled substance
• Physicians are prohibited from self-prescribing or self-administering controlled substances
• Physicians are permitted to prescribe controlled substances to a family member only in a medical emergency
• Ohio Prescription Monitoring Program
• Ohio State Medical Board Website

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Oklahoma

• Prescriptions for Schedule II controlled substances expire 30 days after the date of issuance
• Each scheduled drug must be written on a single prescription form, and no other prescriptions (controlled or noncontrolled) can be written on the same prescription form
• Refills must not be granted at the same time as the initial filling of the prescription for schedule III or IV controlled substances
• A new prescription for a specific controlled substance voids any existing refills or other prescriptions for the same drug
• Oklahoma Prescription Monitoring Program
• Salvia is a Schedule I controlled substance
• Carisoprodol is a Schedule IV controlled substance
• Physicians are not permitted to prescribe controlled substances to oneself or family except in an emergency when no other medical doctor is available
• Oklahoma Board of Medical Licensure and Supervision laws

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Oregon

• Before initiating treatment of "intractable pain" with controlled substances, the physician must discuss the material risks and provide written notice of said risks
• Pseudoephedrine is classified as a Schedule III controlled substance
• Oregon Prescription Monitoring Program
• Carisoprodol is schedule IV controlled substance.
• Medical marijuana is permitted under state law
• Physician-assisted suicide permitted under state law using a strict protocol
• Oregon Medical Board Rules and Statutes

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Pennsylvania

• Schedule II prescriptions expire 6 months after the date of issuance
• Patient's medical records must be kept for at least 7 years from the date of the last medical service for which a medical record entry is required. The medical record for a minor patient must be retained until 1 year after the minor patient reaches the majority, even if this means that the physician retains the record for a period of more than 7 years
• Prescription Monitoring Program monitors controlled substances
  • 28 PA. Code § 25.131
• Pennsylvania State Board of Medicine Website

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Rhode Island

• Physicians must perform a physical examination prior to prescribing any Schedule II, III, or IV controlled substance
• Rhode Island Prescription Monitoring Program
• The State of Rhode Island finds it inappropriate to issue "do not fill before [date]" prescriptions based on the DEA's Interim Policy Statement prohibiting this prescribing format
• A schedule II controlled substance prescription (with a few exceptions) becomes void unless dispensed within 30 days of the original date of the prescription
• Prescriptions for Schedule II controlled substances -- except for amphetamine mixtures, as specifically listed in the Rhode Island Controlled Substances Act -- may be written for up to a 30-day supply, with a maximum of 250 dosage units, as determined by the prescriber's directions for use of the medication. Amphetamines in certain forms may be written for up to a 60-day supply with a maximum of 250 dosage units, as determined by the prescriber's directions for use of the medication
• Schedule III, IV, and V prescriptions cannot be written for more than one 100 dosage units and not more than 100 dosage units may be dispensed at one time unless a duly licensed physician increases, by prescription, the dosage units to a maximum of 300 dosage units for Schedule IV and V medications to provide a patient with a 3 month supply. For purposes of this section, a "dosage unit" shall be defined as a single capsule, tablet, or suppository, or not more than 1 teaspoon of an oral liquid.
• Medical marijuana is permitted under state law
• Rhode Island Board of Medical Licensure and Discipline Website

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South Carolina

• With the exception of transdermal patches, supply limitation is 31 days and must be dispensed within 90 days of the date of issue. After 90 days, a Schedule II controlled substance prescription is void
• Self-prescribing or prescribing for family members is only permitted in an emergency
• The state limits the quantity of each prescription for Schedule III through V controlled medications to a 90-day supply. If authorized for refill, no prescription shall be refilled sooner than 48 hours prior to the time that the prescription should be consumed if the prescribed daily dosage is divided into the total prescribed amount
• Preprinted prescriptions for controlled substances in any schedule are prohibited
• South Carolina Prescription Monitoring Program
• Adopted Model Policy for the Use of Controlled Substances for the Treatment of Pain. The guidelines consist of evaluating the patient, development of a treatment plan, obtaining informed consent and agreement for treatment, periodically reviewing the treatment plan, consulting with the patient, maintaining good medical records, and complying with controlled substances laws and regulations.
• South Carolina Board of Medical Examiners Laws and Policies

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South Dakota

• Prescribers must have a South Dakota Controlled Substance Registration
• Cannot self-prescribe controlled substances. Prescribing for spouse and children is discouraged
• Adopted Model Guidelines for the Use of Controlled Substances for the Treatment of Pain. The guidelines consist of evaluating the patient, development of a treatment plan, obtaining informed consent and agreement for treatment, periodically reviewing the treatment plan, consulting with the patient, maintaining good medical records, and complying with controlled substances laws and regulations
• South Dakota Board of Medical Examiners Laws and Policies

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Tennessee

• Tennessee Prescription Monitoring Program
• Medical and prescription orders may be transmitted to a pharmacy practice site by a facsimile device
• Prescription or medical orders transmitted electronically can be filled if they meet certain requirements
• Physician may self-prescribe Schedule IV drugs only in an emergency. Prescribing, providing, or administering Schedule II and III drugs to oneself is prohibited
• Tennessee Department of Health Legislative Updates

Texas

• Adopted the Model Policy for the Use of Controlled Substances for the Treatment of Pain. The guidelines consist of evaluating the patient, development of a treatment plan, obtaining informed consent and agreement for treatment, periodically reviewing the treatment plan, consulting with the patient, maintaining good medical records, and complying with controlled substances laws and regulations
• Texas Prescription Monitoring Program
• A practitioner may issue a prescription for a Schedule II controlled substance only on an official Texas prescription form, which includes single or multiple copy forms. This also applies to a prescription issued in an emergency situation
• Carisoprodol is classified as a Schedule IV controlled substance
• Texas Medical Board Laws, Rules, and Guidelines

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Utah

• Adopted the Model Policy for the Use of Controlled Substances for the Treatment of Pain. The guidelines consist of evaluating the patient, development of a treatment plan, obtaining informed consent and agreement for treatment, periodically reviewing the treatment plan, consulting with the patient, maintaining good medical records, and complying with controlled substances laws and regulations
• It is considered unprofessional conduct to self-prescribe Schedule II or Schedule III controlled substances
• Age of the patient is required on controlled substance prescriptions
• When writing a prescription for a controlled substance, each prescription must contain only one controlled substance per prescription form and no other prescription drug can be listed
• Unless the prescriber determines there is a valid medical reason to allow an earlier dispensing date, the dispensing date of a second or third prescription shall be no less than 30 days from the dispensing date of the previous prescription, to allow for receipt of the subsequent prescription before the previous prescription runs out
• Utah Prescription Monitoring Program
• Utah Division of Occupational and Proffesional Licensing physician and surgeon information

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Vermont

• Adopted Model Policy for the Use of Controlled Substances for the Treatment of Pain. The guidelines consist of evaluating the patient, development of a treatment plan, obtaining informed consent and agreement for treatment, periodically reviewing the treatment plan, consulting with the patient, maintaining good medical records, and complying with controlled substances laws and regulations
• The prescribing practitioner's signature must be hand written on prescription drug orders. Stamped signatures are not permitted
• It is considered unacceptable medical practice and unprofessional conduct to prescribe a Schedule II through IV controlled substance for oneself, or, except in an emergency, for an immediate family member
• No prescription for a Schedule II controlled substance written to be filled at a future date may be filled more than 90 days after the date the prescription was issued
• Tamper Resistant Prescription Forms must be used for all prescriptions.
• Medical marijuana is permitted under state law
• Vermont Prescription Monitoring Program
• Vermont Department of Health Reports, Laws, Rules and Court Cases

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Virginia

• Adopted Model Policy for the Use of Controlled Substances for the Treatment of Pain. The guidelines consist of evaluating the patient, development of a treatment plan, obtaining informed consent and agreement for treatment, periodically reviewing the treatment plan, consulting with the patient, maintaining good medical records, and complying with controlled substances laws and regulations
• Only allowed 1 controlled substance written per prescription order form
• Virginia Prescription Monitoring Program
• Self-prescribing or prescribing for family members may occur in an emergency or isolated setting where no other physician is available
• Virginia Board of Medicine Laws and Regulations

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Washington

• Washington has a triplicate prescription form program
• Adopted Model Policy for the Use of Controlled Substances for the Treatment of Pain. The guidelines consist of evaluating the patient, development of a treatment plan, obtaining informed consent and agreement for treatment, periodically reviewing the treatment plan, consulting with the patient, maintaining good medical records, complying with controlled substances laws and regulations.
• Medical marijuana is permitted under state law Carisoprodol is classified as a Schedule IV controlled Substance
• Self-prescribing controlled substances is prohibited
• Physician assisted suicide is permitted under state law under a strict protocol
• Washington State Department of Health Laws

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West Virginia

• Adopted Model Policy for the Use of Controlled Substances for the Treatment of Pain. The guidelines consist of evaluating the patient, development of a treatment plan, obtaining informed consent and agreement for treatment, periodically reviewing the treatment plan, consulting with the patient, maintaining good medical records, and complying with controlled substances laws and regulations
• Each controlled substance prescription must be written on a separate prescription blank. Controlled substances cannot be ordered on a blank with a controlled substance. Only one prescription for a controlled substance may be written per prescription blank
• A prescription for a Schedule II controlled substance can be filled up to 90 days from date of issuance
• Carisoprodol is classified as a Schedule IV controlled substance
• Self-prescribing or prescribing controlled substances for family members may be grounds for disciplinary action
• West Virginia Board of Medicine Website

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Wisconsin

• Physicians are prohibited from self-prescribing controlled substances
• Prescribing, ordering, dispensing, administering, supplying, selling, or giving any Schedule II amphetamine is considered unprofessional conduct and is prohibited except for specified conditions
• Weight control is not considered an accepted indication for Schedule II stimulants in Wisconsin
• No more than a 30-day supply of drugs may be prescribed or dispensed at any one time for Schedule III-V controlled substances for weight or obesity
• Medical marijuana is permitted under state law
• Wisconsin Department of Regulation and Licensing physicians laws and rules

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Wyoming

• Wyoming Prescription Monitoring Program
• It is considered a violation of the Wyoming Medical Practice Act to repeatedly prescribe or provide a controlled substance to one-self or a parent, spouse, or child
• All controlled substance prescriptions must be issued on security paper and include the following features:
  • If scanned or copied, "void" is displayed prominently throughout the front side of the document
  • Erasure protection on green or blue background is utilized on the front side
  • Clear instructions printed on the paper indicating the front and back sides
  • Security warning list on the blank
  • All suppliers of security paper must be approved by the Board
  • Use of preprinted prescriptions is allowed
  • Under no circumstance may stickers be utilized for information relating to drug, strength, quantity, or directions.
• Wyoming State Board of Medicine Web site

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