TABLE 1.
Current Opioid Prescribing Laws and Cancer Exemptions by State
| State | Law | Date Enacted | Description | Cancer Exemption | Description of Exemption |
|---|---|---|---|---|---|
| Alabama | No | ||||
| Alaska | HB 159 | 07/2017 | 7-d limit for initial prescription for outpatient use | Yes | Does not apply to pain associated with cancer |
| Arizona | SB 1001a | 01/2018 | 5-d limit for initial prescription; 14-d limit following surgical procedure; 90 MME/d limit for any new prescription | Yes | Lias an active oncology diagnosis |
| Arkansas | No | ||||
| California | No | ||||
| Colorado | SB 18–22 | 05/2018 | 7-d limit for initial prescription if the patient has not received an opioid prescription by that prescriber in the last 12 mo | Yes | Does not apply to patients diagnosed with cancer and experiencing cancer-related pain |
| Connecticut | HB 7052 | 06/2017 | 7-d limit for initial prescription for outpatient use | Yes | Does not apply to pain associated with a cancer diagnosis |
| Delaware | Delaware Administrative Code CSA9.0 | 04/2016 | 7-d limit for initial prescription for an acute pain episode, outpatient use | Yes | Active cancer treatment patients or patients experiencing cancer-related pain |
| Florida | HB 21 | 03/2018 | 3-d limit for prescriptions for acute pain; on the basis of the provider’s judgment, prescription can be increased to a 7-d limit | Yes | Does not apply to pain related to cancer |
| Georgia | No | ||||
| Hawaii | SB 505 | 07/2017 | 7-d limit for initial concurrent prescriptions of opioids and benzodiazepines | Yes | Does not include treatment for cancer |
| Idaho | No | ||||
| Illinois | No | ||||
| Indiana | SB 226 | 03/2017 | 7-d limit for an initial prescription | Yes | Does not include treatment for cancer |
| Iowa | No | ||||
| Kansas | No | ||||
| Kentucky | HB 333 | 04/2017 | 3-d prescription limit for a Schedule III controlled substance for acute pain | Yes | Does not apply to pain associated with a valid cancer diagnosis |
| Louisiana | HB 192 | 08/2017 | 7-d limit for initial prescription for acute pain for outpatient use | Yes | Does not apply to pain associated with a cancer diagnosis |
| Maine | PL 488 | 03/2017 | 7-d limit and 100 MME/d for prescriptions for acute pain; 30-d limit and 100 MME/d for prescriptions for chronic pain | Yes | Does not apply to pain associated with active and aftercare cancer treatment |
| Maryland | HB 1432 | 05/2017 | 7-d limit for initial prescription for the treatment of pain | Yes | Does not apply to pain associated with a cancer diagnosis |
| Massachusetts | HB 4056 | 03/2016 | 7-d limit for initial prescription for outpatient use | Yes | Does not apply to pain associated with a cancer diagnosis |
| Michigan | PA 251 | 07/2018 | 7-d limit for acute pain within a 7-d period | No | |
| Minnesota | Minnesota Statute 152.11 | 07/2019 | 7-d prescription limit for acute pain; 4-d prescription limitation for dental pain or surgery and refractive surgery | Yes | Does not include pain being treated as part of cancer care |
| Mississippi | Mississippi Code 73–43–11 | 10/2018 | Requires prescription for lowest effective dosage and suggested minimum of 50 MME/d and maximum of 90 MME/d; 3-d limitation encouraged and maximum of 10-d supply for acute pain; long-acting opioids are prohibited for acute pain | Yes | Does not apply to acute noncancer/nonterminal pain |
| Missouri | SB 826 | 07/2018 | 7-d limit for initial prescriptions for acute pain; dentists must document and explain prescriptions of extended-release opioids or doses greater than 50 MMEs for the treatment of acute pain | Yes | Does not apply to pain being treated as a part of cancer care or to a patient who is currently undergoing treatment for cancer |
| Montana | HB 86 | 03/2019 | 7-d limit for an opioid-naive patient | Yes | Does not apply to pain associated with cancer |
| Nebraska | Legislative Bill 931 | 04/2018 | Recommended to treat acute pain with non-opiate or nonpharmacological options; short-term use of opiates may be appropriate for more severe pain or acute injury; if a patient needs medication beyond 3 d, the prescriber should reevaluate the patient before issuing another prescription for opiates | Yes | Does not apply to the treatment of pain associated with a cancer diagnosis |
| Nevada | AB 474 | 06/2017 | 14-d limit for initial prescription of Schedule II-IV controlled substances for acute pain; maximum of 90 MMEs for opioid that has never been issued to patient before or has been issued more than 19 d before the prescription | No | |
| New Hampshire | No | ||||
| New Jersey | SB 3 | 02/2017 | 5-d limit for initial prescription for acute pain and lowest effective dose of opioid for any prescription for acute pain | Yes | Does not apply to pain being treated as a part of cancer care or to a patient who is currently undergoing active treatment for cancer |
| New Mexico | No | ||||
| New York | SB 8139 | 07/2016 | 7-d limit for initial prescription for acute pain | Yes | Does not apply to pain being treated as a part of cancer care |
| North Carolina | HB 243 | 06/2017 | 5-d limit for initial prescription for acute pain; 7-d limit for prescription for postoperative relief | Yes | Does not apply to pain being treated as a part of cancer care |
| North Dakota | No | ||||
| Ohio | Administrative Code 4731–11–13 | 08/2017 | 7-d limit and MME cannot exceed an average of 30 MME/d for prescription for acute pain; may be exceeded if the pain is expected to persist for longer than 7 d on the basis of the pathology causing this pain | Yes | Does not apply to a patient with cancer or another condition associated with the patient’s cancer or history of cancer |
| Oklahoma | SB 1446 | 05/2018 | 7-d initial prescription limit for acute pain | Yes | Does not apply to a patient undergoing active treatment for cancer |
| Oregon | No | ||||
| Pennsylvania | Act 122 | 11/2016 | 7-d limit for prescriptions for an individual seeking treatment in an emergency department or urgent care center, or who is in observation status in a hospital | Yes | Does not apply to the treatment of pain associated with a cancer diagnosis |
| Rhode Island | SB 2823 | 03/2016 | 7-d limit for initial prescription; 30 MME/d for a maximum of 20 doses for initial prescriptions for acute pain | Yes | Does not apply to pain associated with a cancer diagnosis |
| South Carolina | HB 918 | 05/2018 | 7-d limit and 90 MME/d for initial prescriptions for acute pain or postoperative pain to the lowest effective dose | Yes | Does not apply to pain being treated as a part of cancer care |
| South Dakota | No | ||||
| Tennessee | PC 1039 | 05/2018 | 3-d/180-MME limit for initial prescription and initial fill of higher dosages and durations limited to half of the total prescribed amounts; 10- or 30-d limitation for medically necessary prescriptions (maximum 1200 cumulative MMEs) | Yes | Does not apply to the treatment of patients with malignant pain who are undergoing active or palliative cancer treatment or who are receiving hospice care |
| Texas | HB 2174 | 09/2019 | 10-d limit for opioid prescriptions for acute pain with no refills | Yes | Does not apply to pain being treated as a part of cancer care |
| Utah | HB 50 | 03/2017 | 7-d limit for Schedule II or III opioids for acute pain | No | |
| Vermont | Rule Governing the Prescribingof Opioids for Pain pursuant to Act 173 2a | 06/2016 | For patients who are opioid naïve and are receiving their first prescriptions not administered in a healthcare setting, the following limitations apply: up to 3-d limit and 72 MME/d or 5-d and 120 MME/d for moderate pain; 3-d limit and 96 MME/d or 5-d limit and 160 MME/d for severe pain; 7-d limit and 350 MME/d for extreme pain | No | |
| Virginia | Regulations Governing Opioid Prescribing for Pain and Prescribing of Buprenorphine for Addiction Treatment, 18 VAC 85–21–10 et seq. | 04/2017 | 7-d limit for prescription for acute nonoperative pain; documentation of the reasons to exceed 50 MME/d; before exceeding 120 MME/d, the prescriber shall document in the medical record the reasonable justification for such doses or refer to or consult with a pain management specialist; naloxone shall be prescribed for any patient when risk factors of prior overdose, substance abuse, doses in excess of 120 MME/d, or concomitant benzodiazepine are present | Does not apply to the treatment of acute or chronic pain related to cancer | |
| Washington | HB 1427 | 01/2019 | 3-d prescription limit recommended for acute, nonoperative pain; documentation required for more than a 7-d supply; 14-d prescription limit for subacute pain | Does not apply to the treatment of patients with cancer-related pain | |
| West Virginia | SB 273 | 06/2018 | Lowest effective dose for an initial prescription; 3-d limit for prescriptions written by a dentist or optometrist; 4-d prescription limit for outpatient use for care in the emergency room or urgent care; 7-d prescription limit for other practitioners | Yes | Does not apply to patients with cancer |
| Wisconsin | No | ||||
| Wyoming | SF 00046 | 07/2019 | 7-d limit for an opioid-naive patient | Yes | Does not apply to cancer treatment |
Abbreviations: HB, House Bill; MME, morphine milligram equivalent; CSA, Controlled Substances Act; PA, Public Act; PC, Public Chapter; PL, Public Law; SB, Senate Bill; SF, Senate File; VAC, Virginia Administrative Code.
Note: States that defer to Medical Boards and/or administrative bodies are not included if it is unclear whether prescribing regulations carry the force of law.