Opioid Prescribing Legislation (HB 2876)

Resources for Working with the Washington State Law 2876

Summary compiled by Gordon Irving, M.D.

Disclaimer: Although I have attempted to give an accurate interpretation and reasonable resources that a busy practitioner can use, these are my personal summaries and most of the forms are those I use in my practice. There are many others that may be equally as adequate or even better suited for an individuals practice. Adherence to these rules will not assure an accurate diagnosis or a successful outcome. The sole purpose of these rules is to assist practitioners in following a reasonable course of action based on current knowledge, available resources, and the needs of the patient to deliver effective and safe medical care. Where the term SHALL applies it means it is mandated. Where the term SHOULD applies it means strongly recommended by the law.

~Gordon Irving, M.D., Medical Director, Swedish Pain and Headache Center


The law HB 2876 final ruling

Charting HB 2876

This should have been the standard you have always maintained for prescribing opioids long term; now it has become mandated.

(The chart) SHALL be maintained in an accessible manner, to include:

  • Nature/intensity of pain, impact of pain, medications for pain (detailed)
  • Risk screening: history of addiction, psychiatric disorder, use of CNS altering medications, history of multiple ED visits, multiple providers, sleep apnea, pregnancy
  • Current and past pain treatments
  • Comorbidities
  • History of substance abuse
  • The diagnosis, treatment plan, and objectives
  • Documentation of the presence of one or more recognized indications for the use of pain medication
  • Discussion of risks and benefits of treatment
  • Documentation of any medication prescribed
  • Results of periodic reviews


CME Requirements for Physicians to Prescribe Opioids

Short Acting Opioids for acute pain, trauma or post operatively

Educational Requirements: None

CME Resources: N/A

Opioids for palliative care and end of life issues

Educational Requirements: None

CME Resources: N/A

Long Acting Opioids less than 120 MED (morphine equivalents/day)

Educational Requirements:

SHOULD have a one time (lifetime) 4 hrs CME relating to chronic pain management, including education on long acting opioids and methadone

CME Resources:

Online CME Activity: Using Methadone for Chronic Pain

Other resources:

Long Acting Opioids more than 120 MED (morphine equivalents a day)

Educational Requirements:

SHALL have a "Specialist Consultation"
• Office visit with a specialist
• Telephone or electronic consultation with a specialist
• Audio visual evaluation with a pain specialist (e.g. ECHO project U Washington

          Exceptions when no consultation is required:

• Patient on a tapering schedule, acute pain and expected return to below baseline dose, documented reasonable attempts to refer to a specialist, physician document pain and function are stable and dose is stable.

Physician Exemption from required consultation:
• 12 hours CME pain management, within the last two years 2 hours of which should be on long acting opioids and methadone, or has to be a:

o Pain management specialist, or board eligible or certified by the ABMS. Or AOA or has to be:
o Working in a multidisciplinary pain clinic or academic research facility or has to have
o 3 years experience in CP management and at least 30% is in the current practice of pain management

CME Resources:

Online CME Activity: Using Methadone for Chronic Pain

Pain Management Symposium - Annual CME event on the last Friday in September.

The medical commission worked with the agency medical directors’ group to provide four hours of free CME. Information regarding this CME is available at: http://www.agencymeddirectors.wa.gov/opioiddosing.asp#CME

Other resources:



Treatment Agreements HB2876

“If the patient is at high risk for medication abuse, or has a history of substance abuse, or psychiatric comorbidities. Practitioner SHALL use a written agreement for treatment with the patient outlining patient responsibilities.” The physician SHALL discuss the risk, and benefits of treatment options.

Suggested language includes:

  • To take medications at the dose and frequency prescribed with a specific protocol for lost prescriptions and early refills
  • Reasons for which drug therapy may be discontinued e.g. violation of agreement
  • All chronic pain management prescriptions are provided by a single prescriber or multidisciplinary pain clinic and dispensed by a single pharmacy or pharmacy system
  • Patient will not abuse alcohol or use other medically unauthorized substances


Periodic Review HB2876

“At least annually: stable patients with chronic non-cancer pain < 40mg morphine equivalent dose (MED) or less. At least every six months or if not on stable dosing”

Charting HB2876

  • Compliance with treatment plan
  • If pain, function, or quality of life have changed using objective evidence, consider information from family members or other caregivers
  • Any changes and why, including tapering or discontinuing 
  • Periodically review information from any department-based information exchange, available prescription monitoring program or ED


More information regarding the pain management laws and subsequent rules, as well as guidance and resources are available via the medical commissions web page at: http://www.doh.wa.gov/LicensesPermitsandCertificates/MedicalCommission/MedicalResources/PainManagement.aspx, and the Department of Health’s web page at: http://www.doh.wa.gov/hsqa/Professions/PainManagement/

General Resources