New Hampshire is starting 2017 with stepped-up efforts to manage its oft-described opioid epidemic.  Though the most recent regulations are directed at individual prescribers, and do not apply to the administration of opioids to patients in a health care setting, now is the time for New Hampshire hospitals, ambulatory surgical centers, urgent care facilities, and other health care facilities to revisit their protocols, record-keeping practices, and informed consent agreements relating to opioid prescribing.

In recent weeks the New Hampshire Board of Medicine and the Board of Nursing have each finalized and adopted, with minor amendments, emergency opioid prescribing rules that had been issued during 2016.  Both sets of rules were effective January 1, 2017.

The final regulations follow on the heels of clinical guidelines and standards for managing chronic, non-cancer pain with opioids that have been published by the Centers for Disease Control and Prevention and various national professional societies, by establishing a legal framework of safe opioid prescribing practices for  New Hampshire physicians and advanced practice registered nurses (APRNs).  The regulations also provide 3 exemptions from the general requirement to query the Controlled Drug Prescription Health and Safety Program (the State’s prescription drug monitoring program or “PDMP”).

The final regulations set forth a laundry list of requirements that New Hampshire APRNs and physicians must meet before they may prescribe (or continue to prescribe) opioids to treat non-cancer and non-terminal pain (acute and chronic).  Specifically, licensees must, among other things and with certain limited exceptions, query the PDMP, conduct and document a history and physical exam, conduct and document a risk assessment (the evidence-based screening tool Screener and Opioid Assessment for Patients with Pain (SOAPP) is suggested but not required), prescribe the lowest effective dose for a limited duration, document a pain treatment plan, create and document a written treatment agreement with the patient, and utilize a written informed consent that explains risks associated with opioids, including addiction, overdose and death, physical dependence, physical side effects, hyperalgesia, tolerance, and crime victimization.  The rules also specify the information that must be provided to patients prior to prescribing opioids for either acute or chronic pain.  In an emergency department, urgent care setting, or walk-in clinic, opioid prescriptions cannot exceed 7 days (or such fewer days as may be medically necessary to treat the patient’s medical condition).  Clinical coverage must be made available 24 hours per day, 7 days  per week for the management of patients treated with opioids for chronic pain.

The goal of these final regulations is to encourage licensees to assure that opioids are prescribed to New Hampshire patients only in limited and clinically appropriate circumstances, and that sufficient information, tools, and support are made available to patients to prevent overuse, addiction, and overdose.  Practitioners who historically have been adverse or resistant to treating pain with opioids due to the potential for patient overuse or addiction, or concerns for personal liability, can now rely upon the rules as a legal framework and best practice for safe prescribing practices.  The adoption of these final rules should serve as a reminder to New Hampshire health care facilities that all of its prescribing practitioners play a vital role in combatting opioid abuse in New Hampshire, which has been characterized by federal Drug Enforcement Agency officials as “ground zero” in the opioid epidemic.