Evidence status: CURRENT STATE STATUTORY REQUIREMENT. West Virginia Code §16-54-4 requires a narcotics contract in conjunction with the third Schedule II opioid prescription within the statute’s scope. The agreement becomes part of the patient’s medical record.
Quick read
West Virginia is unusually specific: the law does not simply tell a clinician to “use an agreement.” It identifies minimum subjects the narcotics contract must contain.
Who is on the other side
The agreement is between the patient and the prescribing practitioner. West Virginia’s statutory definition includes multiple practitioner categories, including physicians, physician assistants with prescriptive authority, APRNs with prescriptive authority, dentists, podiatrists, and optometrists within the law’s scope. The specific individual depends on the patient.
The five statutory minimum contract elements
- Prescriber control: the patient agrees to obtain scheduled medications from the prescribing practitioner.
- Single pharmacy: the patient agrees to fill the prescriptions at one pharmacy, including a pharmacy that has more than one location.
- Emergency notice: the patient agrees to notify the prescriber within 72 hours of an emergency in which scheduled medication is prescribed.
- Consequences of breach: after failure to honor the contract, the practitioner may terminate the relationship or continue treatment without prescribing a Schedule II opioid. Any relationship termination still must comply with applicable law and rules.
- Approved additional physician: the contract must address whether another physician is approved to prescribe to the patient.
Related state controls outside the contract
- A relevant physical examination is required every 90 days during continuing Schedule II opioid treatment.
- At the third prescription the practitioner must consider pain-clinic/pain-specialist referral and discuss the option with the patient.
- If the patient declines referral and prescribing continues, the statute requires recurring review, dependence assessment before renewals, and periodic reasonable efforts to stop/decrease/change treatment unless contraindicated.
- Before starting Schedule II opioid treatment, the statute requires appropriate consideration/referral/prescribing of listed treatment alternatives, but expressly says every alternative need not be exhausted and simultaneous opioid/nonopioid treatment is permitted.
What this statute does not automatically establish
Section 16-54-4 does not by itself prove that an individual clinic’s additional rules on urine-testing frequency, pill-count deadlines, cannabis use, missed appointments, refill fees, mandatory procedures, privacy waivers, or broader discharge policies are state-mandated. Those additions require their own evidence.
Exceptions matter
Article 54 has statutory exceptions, including specified active cancer treatment, hospice/palliative care, long-term-care residents, inpatient medication orders, and certain practitioner-patient relationships with established opioid treatment plans dating from before January 1, 2018. The applicability of the contract requirement must be read with those provisions.
Version history
The original 2018 enacted Opioid Reduction Act used a different contract trigger: a covered Schedule II opioid prescription longer than seven days. In 2019, HB 2768 amended the law so the contract is executed in conjunction with the third Schedule II opioid prescription and added the provision addressing an approved additional physician. This distinction is useful when evaluating older West Virginia forms.
Current-version check
A 2026 bill, SB 743, proposed a limited hospice-related amendment to §16-54-4 but remains pending. It did not become law and does not alter the current contract requirement as of October 4, 2026.
Primary sources
← West Virginia Contract-for-Care Evidence Library
Reviewed: October 4, 2026.
Evidence boundary: This page describes the state-written minimum contract and related statutory duties. It does not attribute additional clinic terms to the state without a supporting source.