Prescribers in West Virginia are bound by new restrictions set forth in the Opioid Reduction Act, aimed at combating the opioid crisis in West Virginia.  The Act was enacted by the state legislature to limit patient access in an effort to minimize the number of opioids on the street and to reduce the likelihood that a patient will become addicted while seeking medical treatment.  The Act’s limitations and documentation requirements should prompt facilities to examine their policies and procedures and ensure that all practitioners with prescriptive authority are trained on the requirements and are appropriately documenting care.

Patients seeking treatment for cancer, patients in hospice care, and residents of long term care facilities are excluded. Below is a brief list of the new restrictions in place:

• Four day prescription limit for emergency room and urgent care facility (seven day prescription permitted in urgent care facility if medical purpose stated in the records);

• Three day prescription limit for minors;

• Seven day limit for an initial prescription; 

• Following the initial prescription, no more than a 30 day supply of any Schedule II medication, unless the prescriber accesses the West Virginia Controlled Substances Monitoring Program Database, and then two subsequent prescriptions can be issued, for a total 90 day supply.

In addition to the above limitations, the Act imposes other requirements including:

• A prescriber must: a) document the patient’s medical history; b) conduct a physical exam, as appropriate; c) develop a treatment plan with a focus on determining the cause of pain; and d) access the patient’s history in the Controlled Substances Monitoring Program Database prior to the initial prescription;

• Schedule II prescriptions for longer than seven days require a patient to execute a narcotics contract with specific provisions;

• A prescriber must describe the benefits of seeking treatment through a pain clinic or specialist to patient who has received a third subsequent prescription; and

• A prescriber must document the refusal of a patient to seek treatment from a pain clinic or specialist, revisit the plan every three months, and make a continued effort to discontinue the use of opioids.

In addition to potential liability issues, the Opioid Reduction Act also permits disciplinary action for abnormal prescribing or dispensing patterns creating professional licensing issues.