Prescribing Rules and Guidelines
New rules governing opioid prescribing are now in effect for most
prescribing professions in Washington state, including physicians and
physician assistants, prompted by House Bill 1427 from 2017. Information
on these state requirements, plus links to state and federal opioid
prescribing guidelines, below.
Washington State Opioid Prescribing Rules
New rules governing opioid prescribing, prompted by
House Bill 1427
from 2017, are now in effect in Washington state. The comprehensive rules
represent a significant change in how opioids are prescribed. Key
provisions applicable to all prescribing physicians and PAs include:
A seven-day pill limit for acute prescriptions and 14 days for acute
operative pain, with an exemption to these limits when clinical judgment
is documented in the medical record.
A specific care plan and documentation requirements for each phase of
Mandated registration and targeted checks of the prescription drug
- Required continuing medical education on opioid prescribing.
The prescribing boards and commissions for MDs, DOs, and PAs offer more
information and resources on the new rules in effect:
Prescribing clinicians are advised to review this
table of differences
from the Department of Health to understand the differing requirements
between Medical Commission and osteopathic board rulemaking.
Opioid prescribing rule amendments effective February 2020
Washington's prescribing boards and commissions have adopted amendments to
their opioid prescribing rules to comply with
Senate Bill 5380
from the 2019 state legislative session. New requirements include patient
notification of the risks of prescription opioids, including the risk of
dependence and overdose, pain management alternatives to opioids, when
clinically appropriate, evidence-based alternatives exist, and
notification to the patient that they have the right to refuse an opioid
prescription for any reason.
Review the adopted amendments, which also identify situations where the
notification requirements would not apply:
Medical Commission rule amendments are effective starting Feb. 29, 2020;
osteopathic board rule amendments Feb. 21, 2020. These new requirements
must be documented in the medical record when applicable. To help you
successfully incorporate these new requirements into your workflow, the
WSMA has updated its Epic-compatible pain management rule requirements
checklist, available below.
Complying with State Opioid Regulations through Improved Prescribing
– WSMA members only—sign-in required
WSMA's free one-hour on-demand webinar can help clinicians understand how
to comply with the new requirements. Completion of the webinar will
fulfill the new state requirement for continuing medical education on
opioid prescribing. This activity has been approved for
AMA PRA Category 1 Credit™.
Preparing Care Teams for New Opioid Rx Rule
The WSMA has put together this customizable PowerPoint template to help
practice leaders educate their practice care teams, regardless of size, on
the new rules.
WSMA Pain Management Rule Requirements Checklist
- updated February 2020
Use this updated document to build prompts into your electronic health
record (e.g. Epic dot phrase) or simply use as a checklist to help you
successfully incorporate opioid prescribing rule requirements into your
practice workflow. The checklist was updated in in February 2020 to
reflect new patient notification requirements now in effect.
(look under Public/Patient)
The Department of Health offers patient handouts for all categories of
pain patients (chronic, surgical, acute, and subacute) to satisfy a new
state requirement for prescribers to inform patients of the risks, safe
storage, and safe disposal of prescription opioids.
More information on the new rules
The Washington State Department of Health
opioid prescribing webpage.
State and Federal Prescribing Guidelines
Washington Agency Medical Directors' Group prescribing guidelines and
CDC Guideline for Prescribing Opioids for Chronic Pain