In response to our epidemic of opioid addiction, Vermont has passed new rules regarding how certain medications are prescribed. These went into effect July 1, 2017 and are outlined below.

For acute pain, consideration will be given to non-opioid alternatives. If a prescription for opioid medicine is needed, there are limits to the number of pills that can be prescribed. There are also daily maximum limits based on the patient’s category of pain. Patients will receive counseling about the risks of opioid drug use and sign an informed consent. If a high dose pain medication is prescribed or if patients are also taking a certain class of medications, called benzodiazepines, a prescription of naloxone will be given. When benzodiazepines and opioids are taken together, there is more likelihood of overdose. Naloxone is an overdose reversal drug.

If patients receive opioids for pain lasting more than 90 days, Vermont requires documentation supporting their use. This includes a medical evaluation, physical examination, pertinent diagnoses, and risk assessment screening. Patients will be re-evaluated on a regular basis, no longer than once every 90 days. Part of this re-evaluation includes review on the risks of opioid use, consideration of alternative treatments, completion of certain monitoring forms and reviewing functional goals for treatment. At least once a year, patients will need to sign a Controlled Substance Treatment Agreement. Included in the agreement are the patient’s choice of a dispensing pharmacy, as well as agreement of safe storage and disposal of the medication. In addition, there will be periodic drug screens and pill counts.

There are exemptions to these requirements: patients who have chronic pain associated with cancer, who are receiving palliative care, or end-of-life and hospice care and patients in skilled and intermediated care nursing facilities.