Heacox, Hartman, Koshmrl,
Cosgriff & Johnson, P.A.
November 5, 2015 Seminar
Minnesota Rule 5221.6110 (Long-Term Treatment with Opioid Analgesic Medication)
This section applies to all opioid analgesic medications with the exception of injections and pumps.
It applies any time opioids are prescribed or taken for more than 90 days. In that event the
prescribing healthcare HCP (HCP) is required to follow specific procedures:
1. The employee must be evaluated for assessment of pain and assessment of function (under a
tool validated in peer-reviewed scientific literature) in order to set a baseline.
2. The employee must be found to be medically unable to function at work or in activities of daily
living without long-term use of opioids and all other reasonable medical treatment options have
to have been exhausted. The employee must not have a somatic symptom disorder, a history
of failing to comply with treatment or failing to take medication as prescribed, a current
substance abuse disorder, or a positive drug test (testing required).
3. If the employee has a history of respiratory depression, is pregnant or planning to become
pregnant, has a substance use disorder in remission, has another mental disorder, is a suicide
risk, has poor impulse control, or regularly engages in an activity that could be unsafe for a
patient taking opioids, the HCP must determine whether any of these constitute
contraindications. The HCP may use an appropriate specialty consultation to assist in this
assessment.
4. The employee must be assessed for risk of dependence or abuse and, if found to be at high risk,
must be referred for a second opinion with a pain medicine or addiction medicine specialist
before treatment begins. If long-term treatment is then prescribed, the HCP must review the
employee's prescription history at each visit, and see the patient in clinic every month for the
first six months and every three months thereafter.
5. There must be a signed opioid treatment contract.
6. The HCP must use a fixed schedule of dosing and prescription sufficient to preclude exhaustion
of prescription when the HCP is not available, all prescriptions must be written only by the
treating HCP or a designated proxy and that HCP must also be in control of the treatment plan
and monitoring, dosing, referrals and reports of workability.
7. The HCP must have a written plan for treatment of episodic pain, with specifics outlined, and
must be the prescriber on any such additional medications.
8. If opioid medication is discontinued the HCP must prescribe a schedule of tapering doses or
any ancillary medications and must offer alternative pain management treatment or referral.
9. The opioid treatment contract must have specifics regarding the goals, the program itself, and
planned monitoring. It must include a requirement for compliance, provision for at most only
one replacement in the event of lost or stolen medication, exclusion of early renewals,
disclosure of all other medications being taken by the employee, and must provide for
discontinuance at the discretion of the HCP. The employee must agree to follow a schedule of
regular visits, take medication exactly as prescribed, abstain from illegal drugs, cooperate with
assessments and drug testing and allow the HCP to access the prescription monitoring program
and contact with any other healthcare provider as appropriate and must agree to cooperate with
referrals as requested.
10. The HCP must schedule regular follow-up visits (at least quarterly in the first year and no less
than annually thereafter) and assess and document the success of the program. Success is
defined as improvement in both pain and function within six months after the start with this
improvement maintained in all subsequent follow-up visits. At least semiannually, the HCP
must review the prescription history in the Minnesota prescription monitoring program to
validate correct medication usage. Urine drug testing is discretionary except for high risk
employees and employees taking more than 120 morphine-equivalent milligrams per day.
11. In the event the HCP does not comply with the rules, the insurer cannot use this as a basis to
deny payment for treatment or prescriptions unless the insurer has previously sent the HCP
and the employee a copy of the rules and given the HCP at least 30 days to come into
compliance with the rules. This notice to the HCP and patient is only required to be sent once.