N.H. Code Admin. R. Vet 1001.01 – Opioid Management by Veterinarians

Veterinarians shall not be obligated to prescribe opioids, and as required by RSA 318-B:10 I and II, licensees shall adhere to the following rules regarding prescribing of opioids for pain:

(a) Conduct and document a detailed patient history and physical exam in response to a complaint of pain or anticipated pain;
(b) Complete and document a risk assessment to determine whether a patient is a medically appropriate candidate for a schedule II, III, or IV opioid. Examples of acceptable risk assessment processes may be found in the 2022 AAHA/AAFP Pain Management Guidelines for Dogs and Cats, and the WSAVA Guidelines for Recognition, Assessment, and Treatment of Pain, June 2014 edition which are both available as noted in Appendix II;
(c) Establish and document a pain treatment plan for the patient that includes the lowest effective dosage of opioids for the fewest days possible as well as consideration of non-pharmacological modalities and non-opioid therapy. Examples of acceptable treatment plan considerations may be found in the 2022 AAHA/AAFP Pain Management Guidelines for Dogs and Cats, and the WSAVA Guidelines for Recognition, Assessment, and Treatment of Pain, June 2014 edition which are both available as noted in Appendix II;
(d) Document informed consent of the owner including:
1. (1) The risk of side effects for the patient;
2. (2) The risks of keeping unused medication;
3. (3) Options for safely securing and disposing of unused medication; and
4. (4) That prior to any query of the prescription drug monitoring program (PDMP) as required, the owner’s personal history of prescription access may be checked by the veterinarian, pursuant to RSA 126-A:92, in addition to the prescribing history for the patient;
(e) Prescribers required to register with the PDMP pursuant to RSA 126-A:91, or their designee, shall query the PDMP to obtain a history of schedule II-IV controlled substances dispensed to a patient, prior to the prescriber prescribing an initial schedule II, III, and IV opioids for the management or treatment of the patient’s pain, and then periodically, and but no less than twice per year, except when:
1. (1) Opioids are administered to patients in a health care setting;
2. (2) Treating acute pain associated with serious traumatic injury, post-operatively, or with an acute medical condition, with clear objective findings by the licensee, for no more than 7 days supply of schedule III, IV, or V substances; or
3. (3) When the PDMP database is inaccessible or not functioning properly the specific reason why there was no query of the database shall be documented in the patient’s medical record;
(f) If opioids are indicated and appropriate for prescription for acute pain, in addition to the requirements in Vet 501.04 (b), prescribing licensees shall not prescribe for more than 7 days supply of schedule III, IV, or V substances; and
(g) If opioids are indicated and appropriate for prescription for chronic pain, in addition to the requirements in Vet 501.04 (b) when opioids are prescribed for more than 90 days within any 6-month period, the prescribing veterinarian shall create and discuss a written treatment plan with the owner which includes but not be limited to:
1. (1) The goals of treatment, in terms of pain management and restoration of function;
2. (2) The owner's agreement to give the medications to the patient at the dose and frequency prescribed;
3. (3) The risk of side effects for the patient;
4. (4) Time course for treatment, including periodic evaluation of the patient by the veterinarian to ascertain whether or not a change to, or discontinuance of, opioid therapy, is warranted;
5. (5) Specific conduct that triggers the discontinuation or tapering of opioids;
6. (6) The owner’s obligation to provide safe medication use and storage;
7. (7) The owner’s legal requirement of obtaining opioid prescriptions from a single veterinary practice which shall be dispensed by a single pharmacy, if possible; and
8. (8) Any other provisions to which the owner and the veterinarian agree.
  Source. #13576, eff 5-15-23
  APPENDIX I
  Rule
  Specific State Statute Which the Rule Implements
  Vet 101.01 thru 101.02
  RSA 332-B:1-a; RSA 332-B:7, I, II, & IV
  Vet 102.01
  RSA 332-B:1
  Vet 103.01
  RSA 332-B:3, I
  Vet 103.02 thru 103.03
  RSA 332-B:5; RSA 332-B:7, VI
  Vet 103.04
  RSA 332-B:7, VI
  Vet 104.01
  RSA 91-A:4
  Vet 104.02
  RSA 332-B:7-a, VII
  Vet 201.01
  RSA 332-B:7-a, IX and XII
  Vet 201.02
  RSA 541-A:22, IV
  Vet 301.01
  RSA 332-B:9; RSA 318-B:41
  Vet 301.01(c)
  RSA 126-A:91
  Vet 301.02
  RSA 332-B:7-a, I
  Vet 302.01
  RSA 332-B:9
  Vet 302.02
  RSA 332-B:9 & RSA 332-B:11
  Vet 302.03
  RSA 332-B:9
  Vet 303.01
  RSA 332-B:10
  Vet 303.02
  RSA 332-B:10
  Vet 304
  2024, 327:274, VI; RSA 310:17
  Vet 304.01
  RSA 332-B:11
  Vet 304.02
  RSA 332-B:12
  Vet 305.01 thru 305.03
  RSA 332-B:12; RSA 332-B:7, III
  Vet 306.01
  RSA 332-B:13, I
  Vet 306.02 thru 306.03
  RSA 332-B:7, III
  Vet 307
  RSA 332-B:11
  Vet 401.01
  RSA 332-B:7-a, V, RSA 332-B:13, I, II, & III
  Vet 401.02
  RSA 332-B:13, III
  Vet 402.01 through 402.08
  RSA 332-B:14, II, & III
  Vet 403.01
  RSA 332-B:13, III
  Vet 403.02
  RSA 332-B:13, III
  Vet 404.01 and 404.02
  RSA 332-B:13, I
  Vet 405.01
  RSA 332-B:7-a, X
  Vet 406
  RSA 332-B:7-a, II, RSA 332-B:17
  Vet 501.01
  RSA 332-B:9
  Vet 501.02
  RSA 332-B:9
  Vet 501.03
  RSA 332-B:7-a, II
  Vet 501.04
  RSA 332-B:7-a, XII
  Vet 502.01
  RSA 332-B:7-a, VI
  Vet 502.02
  RSA 332-B:7-a, XII
  Vet 503.01
  RSA 332-B:7-a, VI
  Vet 601 thru 604
  RSA 332-B:1, III
  Vet 700
  RSA 332-B:7-a, XII
  Vet 800
  RSA 332-B:7-a, X, RSA 541-A:16,I(b)
  Vet 802.01
  RSA 332-B:7-a, X
  Vet 901.01
  RSA 332-B:7-a, II
  Vet 901.02
  RSA 332-B:7-a, II
  Vet 901.03
  RSA 332-B:7-a, II
  Vet 1000
  RSA 332-B:7-a, XV
  APPENDIX II
  Rule
  Material Incorporated
  How Materials May Be Obtained
  Vet 501.01 thru 501.02
  Principles of Veterinary Medical Ethics of the AVMA, August 2019
  Electronic via AVMA website, https://www.avma.org/resources-tools/avma-policies/principles-veterinary-medical-ethics-avma
  Vet 503.01
  AVMA Guidelines for the Euthanasia of Animals: 2020 Edition
  Electronic via AVMA website, https://olaw.nih.gov/avma-guidelines-2020.htm
  Vet 1001.01, (b) + (c)
  2022 AAHA Pain Management Guidelines for Dogs and Cats, Mar/April 2022
  The document is available for download at no cost at AAHA/AAFP https://www.aaha.org/globalassets/02-guidelines/2022-pain-management/resources/2022-aaha-pain-management-guidelines-for-dog-and-cats_updated_060622.pdf
  Vet 1001.01, (b) + (c)
  WSAVA Guidelines for Recognition, Assessment, and Treatment of Pain, June 2014
  Electronic via https://ivapm.org/wp-content/uploads/2017/03/Mathews_et_al-2014-Journal_of_Small_Animal_Practice-WSAVA-03.10.17.pdf