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Prescribing Rules and Guidelines

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 pain.
  • Mandated registration and targeted checks of the prescription drug monitoring program.
  • 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.

WSMA resources

Complying with State Opioid Regulations through Improved Prescribing Practices – 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.

Other resources

Patient handouts (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 resources

CDC Guideline for Prescribing Opioids for Chronic Pain

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