The Pennsylvania Patient Non-Opioid Directive – What Is It and How Is It Used?

Opioids-Pills-PrescriptionsDid you know that Pennsylvania patients and physicians can access a voluntary patient non-opioid directive (PNOD) that allows patients to refuse the offer, supply, prescription, or administration of any controlled substance containing an opioid?

A Pa. law passed in 2016 – Act 126, known as the Safe Opioid Prescribing Education and Voluntary Non-Opioid Directive Act – required the Department of Health (DOH) to draft and publish the PNOD form, along with guidelines for health care professionals. The form is available on the DOH website – Get the PNOD form here.

Patients who are in recovery for substance use disorder may find the PNOD form a useful tool to help prevent a relapse. The directive can also help prescribers begin the conversation concerning SUD history.

Here is how the form is executed:

  • A patient must sign this form in the presence of the practitioner, a designee of the practitioner, or other person authorized by the Secretary of Health.
  • The practitioner, designee, or other authorized person is required to sign the form in the presence of the patient, provide a signed copy of the form to the patient, and note in the patient’s medical record, or the patient’s interoperable electronic medical record if available, that the form was signed. In the case of a patient who is unable to execute the form, the patient may designate a guardian or health care proxy to execute and file the form.

The PNOD form is specific to each practitioner. As a result, if the patient would like the form to be in effect for multiple practitioners, they must sign a form for each practitioner.

In its guidelines for health care professionals, DOH says that the PNOD form should be reviewed at least annually and a new form completed if parties with the authority to revoke the PNOD choose to exercise that ability. The patient or patient’s surrogate may revoke the PNOD form for any reason by written or oral means.

DOH also notes that practitioners or employees of practitioners acting in good faith shall not be subject to criminal or civil liability or be considered to have engaged in unprofessional conduct for failing to offer or administer a prescription or medication order for a controlled substance containing an opioid under the voluntary PNOD form.

For more information on Pennsylvania’s opioids laws, including Act 126, check out the Pennsylvania’s Quick Consult fact sheet “A Physician’s Guide to Pennsylvania’s Opioid Laws.”


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