Evidence status: CURRENT TRIGGER AND MONITORING FRAMEWORK. Indiana’s treatment-agreement rule activates only after specific chronic-opioid thresholds are met.

Trigger thresholds

Under 844 IAC 5-6-3, the chronic-pain rule applies when a patient has been prescribed one of the following:

  • More than 60 opioid-containing pills per month for more than three consecutive months.
  • More than 15 morphine-equivalent milligrams per day for more than three consecutive months.
  • A transdermal opioid patch for more than three consecutive months.
  • Tramadol at more than 60 morphine-equivalent milligrams per day for more than three consecutive months, when tramadol is controlled under Indiana law.
  • An extended-release opioid medication that is not in an abuse-deterrent form when an FDA-approved abuse-deterrent form is available.

Exemptions

The chronic-pain rule does not apply in the same way to terminal patients, residents of licensed health facilities, hospice patients, or patients enrolled in qualifying inpatient or outpatient palliative-care programs.

Scheduled visits

For a stable medication regimen and treatment plan, face-to-face visits must occur at least every four months. When medication or treatment changes are being made, visits must occur at least every two months until the regimen is stabilized.

INSPECT review

At the outset of the opioid treatment plan and at least annually thereafter, the physician must obtain an INSPECT report and document whether it is consistent with the physician’s knowledge of the patient’s controlled-substance history.

Drug monitoring

The rule requires drug-monitoring testing when the physician determines testing is medically necessary. The physician considers factors including suspected nonadherence or diversion, lack of therapeutic effect, undisclosed substances, multiple opioid sources, early-refill requests, repeated lost/stolen prescriptions, irregular INSPECT information, and concerning prior test results.

If testing reveals inconsistent medication use or illicit substances, the current treatment plan must be reviewed and the revised plan and patient discussion documented.

Higher-dose review

When the opioid dose exceeds 60 morphine-equivalent milligrams per day, the rule requires a face-to-face review of the treatment plan and patient evaluation, including consideration of specialist referral. Continued treatment above that level requires a revised assessment and documented treatment plan addressing increased risk.

Primary sources

Reviewed: October 4, 2026.