Evidence status: CURRENT AMENDMENTS EFFECTIVE JANUARY 2, 2025. Virginia changed important parts of its chronic-pain opioid rules in 2025.

Drug-testing cadence changed

The current 18VAC85-21-100 requires a urine drug screen or serum medication level at initiation of chronic-pain management and thereafter randomly at the practitioner’s discretion, but at least once a year.

The older rule required follow-up testing at least every three months during the first year and at least every six months thereafter. That older schedule is no longer the current physician rule.

Tapering language changed

The current rule states that if tapering is part of the treatment plan, the taper rate must be individualized based on the patient’s clinical situation. It also states that opioid treatment should not be abruptly stopped without tapering unless the prescriber documents extenuating circumstances.

What remains in place

  • The written treatment agreement requirement remains in 18VAC85-21-90.
  • Clinical review remains required at least every three months.
  • Continued opioid prescribing must be supported by documented continued benefit.
  • Prescription Monitoring Program review remains required at least every three months.
  • Practitioners must regularly evaluate for opioid use disorder and act when treatment is indicated.

Why this matters

Some Virginia practice materials still repeat the former testing schedule. Those documents should be identified as clinic policy or older legal language rather than quoted as the current statewide minimum.

Primary sources

Reviewed: October 4, 2026.