Before the department or self-insurer authorizes continued payment for chronic opioid therapy, the provider must routinely, at least every ninety days or more frequently, according to the worker's risk, review the effects of opioids to determine whether therapy should continue and document the following best practices:

• Clinically meaningful improvement in function or pain interference with function score of ≤ 4 on the two item graded chronic pain scale is maintained with stable dosing. If opioid dose is increased, clinically meaningful improvement in function must be demonstrated in response to the dose change; and

• A current signed pain treatment agreement; and

• The worker has no contraindication to the use of opioids including, but not limited to, current substance use disorders (excluding nicotine) or a history of opioid use disorder; and

• The worker has no evidence of or is not at high risk for serious adverse outcomes from opioid use; and

• A consultation with a pain management specialist must take place before the worker's dose is increased above 120mg/d morphine equivalent dose or consistent with exceptions in DOH's pain management rules. Additional appropriate consultations are recommended if the worker has a comorbid substance use or poorly controlled mental health disorder; and

• The worker has no pattern of recurrent (more than one) aberrant behavior identified by the prescription monitoring program database, urine drug testing or other source.

Workers receiving chronic opioid therapy should be managed by a single prescribing provider. If the prescribing provider is unavailable, then refills should be addressed by the covering provider and allowed on a limited basis only. See WAC 296-20-03060, Episodic care for pain, regarding unscheduled visits to emergency departments or urgent care facilities for pain management.