Part I. General Provisions
18VAC85-21-10. Applicability.
A. This chapter shall apply to doctors of medicine, osteopathic medicine, and podiatry and to physician assistants.
B. This chapter shall not apply to:
1. The treatment of acute or chronic pain related to (i) cancer, (ii) sickle cell, (iii) a patient in hospice care, or (iv) a patient in palliative care;
2. The treatment of acute or chronic pain during an inpatient hospital admission or in a nursing home or an assisted living facility that uses a sole source pharmacy; or
3. A patient enrolled in a clinical trial as authorized by state or federal law.
Statutory Authority
§§ 54.1-2400 and 54.1-2928.2 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 34, Issue 23, eff. August 8, 2018.
18VAC85-21-20. Definitions.
The following words and terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise:
"Acute pain" means pain that occurs within the normal course of a disease or condition or as the result of surgery for which controlled substances may be prescribed for no more than three months.
"Board" means the Virginia Board of Medicine.
"Chronic pain" means nonmalignant pain that goes beyond the normal course of a disease or condition for which controlled substances may be prescribed for a period greater than three months.
"Controlled substance" means drugs listed in The Drug Control Act (§ 54.1-3400 et seq. of the Code of Virginia) in Schedules II through IV.
"FDA" means the U.S. Food and Drug Administration.
"MME" means morphine milligram equivalent.
"Prescription Monitoring Program" means the electronic system within the Department of Health Professions that monitors the dispensing of certain controlled substances.
"SAMHSA" means the federal Substance Abuse and Mental Health Services Administration.
Statutory Authority
§§ 54.1-2400 and 54.1-2928.2 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 34, Issue 23, eff. August 8, 2018.
18VAC85-21-21. Electronic prescribing.
A. Beginning July 1, 2020, a prescription for a controlled substance that contains an opioid shall be issued as an electronic prescription consistent with § 54.1-3408.02 of the Code of Virginia, unless the prescription qualifies for an exemption as set forth in subsection C of § 54.1-3408.02.
B. Upon written request, the board may grant a one-time waiver of the requirement of subsection A of this section for a period not to exceed one year due to demonstrated economic hardship, technological limitations that are not reasonably within the control of the prescriber, or other exceptional circumstances demonstrated by the prescriber.
Statutory Authority
§§ 54.1-2400 and 54.1-2928.2 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 37, Issue 19, eff. June 9, 2021.
18VAC85-21-22. Patient counseling.
A. Prior to issuing a prescription for an opioid to treat acute or chronic pain, practitioners must provide patient counseling on the following:
1. The risks of addiction and overdose associated with opioid drugs and the dangers of taking opioid drugs with alcohol, benzodiazepines, and other central nervous system depressants;
2. The reasons why the prescription is necessary;
3. Alternative treatments that may be available; and
4. Risks associated with the use of the drugs being prescribed, specifically that opioids are highly addictive even when taken as prescribed, that there is a risk of developing a physical or psychological dependence on the controlled dangerous substance, and that the risks of taking more opioids than prescribed or mixing sedatives, benzodiazepines, or alcohol with opioids can result in fatal respiratory depression.
Such patient counseling shall be documented in the patient's medical record.
B. Patient counseling as described in subsection A of this section shall not be a requirement for patients who are (i) in active treatment for cancer, (ii) receiving hospice care from a licensed hospice or palliative care, (iii) residents of a long-term care facility, (iv) being prescribed an opioid in the course of treatment for substance abuse or opioid dependence, or (v) receiving treatment for sickle cell disease.
Statutory Authority
§§ 54.1-2400 and 54.1-2928.2 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 41, Issue 4, eff. November 6, 2024.