Evidence status: MATERIAL RULE CHANGE EFFECTIVE MAY 21, 2025. Iowa rewrote its physician pain-management rule in 2025. The change softened the treatment-agreement language that had previously operated as a conditional mandate.
Before May 21, 2025
Former 653—13.2 stated that a physician treating chronic pain with opioids shall consider an agreement and that a physician prescribing opioids for more than 90 days shall utilize a pain-management agreement when the physician had reason to believe the patient was at risk of drug abuse or diversion. If the physician chose not to use an agreement, the rule said the physician shall document the reason.
After the 2025 rewrite
ARC 9115C, effective May 21, 2025, changed that language. Current 481—655.2 says physicians should consider agreements, an agreement should be used in the >90-day/risk circumstance, and reasons for nonuse should be documented.
Agency and numbering change
The rule also moved from the former Medicine Board citation 653—13.2 into Department of Inspections, Appeals, and Licensing chapter 481—655.2 as part of Iowa’s professional-licensing rule reorganization.
Why the change matters
The old text supported describing Iowa as having a binding conditional agreement requirement. The current text is materially different and should not be represented as if “shall utilize” remains in force.
Historical and current sources
Reviewed: October 4, 2026.
Correction note: Any Iowa page still describing the current rule as a “shall utilize” mandate is using superseded language and should be updated.