Evidence status: CURRENT CHRONIC-PAIN MONITORING AND EXEMPTION FRAMEWORK. New Hampshire pairs the written-agreement requirement with recurring treatment review, PDMP review, urine testing, and limited exemptions.

Treatment-plan review

For chronic-pain opioid therapy, the physician rule requires reevaluation of the treatment plan and opioid use at least twice a year.

Prescription Drug Monitoring Program

RSA 318-B:41 requires initial and periodic review of the controlled drug prescription health and safety program, and the professional rules require review at least twice a year during ongoing treatment, subject to specific exceptions.

Urine drug testing

For patients using opioids for longer than 90 days, the professional rules require random and periodic urine drug testing at least annually. Unanticipated findings are to be addressed in a manner that supports the patient’s health.

Specialist-consultation consideration

The prescriber must document consideration of consultation with an appropriate specialist when the patient receives 100 mg morphine equivalent dose for longer than 90 days, is at high risk for abuse or addiction, or has a co-morbid psychiatric disorder.

Narrow exemptions

The rules permit the prescriber to forego the written treatment agreement and periodic drug testing for:

• Residents of long-term, non-rehabilitative nursing-home facilities where medication is administered by licensed staff.
• Patients treated for episodic, intermittent pain who receive no more than 50 opioid dose units in a three-month period.

24/7 clinical coverage

The chronic-pain rules require clinical coverage to be available 24 hours a day, seven days a week to assist in management of chronic-pain patients.

Primary sources

• RSA 318-B:41
• Med 502.05 and Med 502.06
• New Hampshire Opioid Prescribing Checklist

Reviewed: October 4, 2026.