Answers to Physician Questions on Pennsylvania’s Opioid Treatment Agreement Law

Last Updated: Feb 23, 2023

patient-treatment-agreementThe Pennsylvania Department of Health (DOH) has issued new temporary regulations on Pennsylvania’s opioid patient treatment agreement law. The regulations were published in the Pennsylvania Bulletin on March 7, 2020.

The law, known as Act 112 of 2019, requires prescribers to enter into an opioid patient treatment agreement before issuing the first prescription in a single course of treatment for chronic pain using any opioid-containing medication, regardless of whether the dosage is modified during treatment.

Keep in mind that the law:

  • Applies to agreements for patients with chronic pain. It is not intended to be applied in situations involving acute pain (i.e. pain that comes on quickly, may be severe, but lasts a relatively short time and is provoked by a specific condition or injury.)
  • Applies specifically to opioid prescriptions. It does not apply to non-opioid Schedule II drugs.
  • Does not affect opioid treatment agreements that were entered into prior to November 27, 2019.  

Get Answers on the Opioid Treatment Agreement Law & the New Regulations

DOH’s new temporarily regulations provide further clarification on issues like drug testing, terminating the agreement, and penalties under the law.

The Pennsylvania Medical Society’s (PAMED) Quick Consult fact sheet answers frequently asked questions about the law – including exceptions to the law – and has been updated to reflect the state’s new temporary regulations. 

Get the Quick Consult 

Prior to the law’s passage, PAMED did share our opposition to the bill with legislators. While we support initiatives to combat the opioid crisis, we did not support the imposition of mandates on the prescriber-patient relationship. We will continue to work with DOH and other stakeholders in efforts such as developing the state’s voluntary opioid prescribing guidelines. 

Additional Resources: Treatment Agreement Checklist & More

DOH offers a variety of resources on the opioid patient treatment agreement law for both prescribers and patients, including:

Find all of DOH’s resources here.

PAMED members with questions about the opioid treatment agreement law can contact our Knowledge Center at 855-PAMED4U (855-726-3348) or


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  1. Harry Haus | Mar 12, 2020
    There is still no specific guidance  for the urine drug screens. CDC says at least once a year but this law just says periodically do urine drug screens.   Also the CDC 2016 guidelines  gave more details and references  4 years ago.
  2. Kenneth Zahl | Dec 05, 2019

    We loose more than 5000 Pennsylvanians a year due to opioid overdoses, just amazing that this and other States took so long to provide guidance and oversight into the epidemic.  Now in addition to many items in my existing 32 paragraph Narcotic Prescribing Agreement per this regulation have to add something to comply with this aspect of the llaw:   “ The non-opioid treatment options available for treating chronic noncancer pain, if applicable, that are consistent with the best practices per the Pennsylvania Opioid Prescribing Guidelines. “

    According to the Guidelines mentioned above this is what the Commonwealth has published:

    ” Non-Opioid Treatment Options

    A detailed review of non-opioid treatment options goes beyond the scope of this document. Non- opioid medication options include careful use of acetaminophen, non-steroidal anti-inflammatory medications, anti-seizure medications (such as gabapentin, pregabalin, oxcarbazepine, topirmate and others), tricyclic antidepressants, serotonin- norepinephrine reuptake inhibitors and transdermal local anesthetics. In addition, there is growing interest in the use of cannabinoids for the treatment of a variety of chronic pain conditions. It is important to note that non-opioid analgesics confer sustained pain relief that is as good or better than that associated with chronic opioid administration.

    Cognitive-behavioral therapy and mindfulness- based therapy can be very effective as these therapies can provide improved symptom control, physical functioning, adaptive coping and self-efficacy. It is important to note that patients with chronic pain commonly experience depression and anxiety. Appropriate treatment of comorbid depression and anxiety can improve biopsychosocial functioning. Attempts to treat pain without treating these psychosocial comorbidities of pain are not likely to lead to improved pain control.

    Activating physical therapy, including aquatic therapy, is a critical component in improving pain control and physical functioning in most patients. Massage therapy may be effective in some patients. Supportive modalities such as yoga and Tai Chi may be very effective in improving pain and physical functioning in some patients.

    Interventional therapy, such as epidural steroid injections, radiofrequency procedures and spinal cord stimulation, can provide effective pain relief in patients experiencing specific pain disorders. Interventional therapy may allow for improved pain relief that can facilitate participation in activating physical therapy, aquatic therapy and life style changes that may lead to sustained improvement in pain control and physical functioning.”

    My biggest challenge is always the legacy patient previously treated with opioids for e.g. failed back/neck or other orthopedic surgery.

  3. Joseph J. Irwin | Nov 23, 2019

    I read the bill.    It requires certain verbiage in the agreement regarding goals of therapy, shared decision making, and risks associated with chronic opioid treatment.   It requires a UDS at the initiation of treatment.  It does not enshrine guidelines in the legislation but instead refers to the Pa Opioid Prescribing Guidelines which clearly evolve.  It excludes hospice, emergency, and cancer pain.  

    I think the one issue to worry about will be the regulatory burden that have not been delineated yet.  Page 7: "Temporary regulations under subsection (a) shall expire on the promulgation of final-form regulations, or two years following the effective date of this section, whichever is later."   Will prescribers be audited for compliance?  Will they have to submit some type of documentation? What are the penalties/sanctions for noncompliance?   All of these issues are left for future legislation but are part of this bill.  

  4. Steve Karp | Nov 22, 2019
    Once again the state legislature practices medicine. The only way to know how medical legislation will work is to be a practicing physician who treats people who the legislation targets. Do any of the legislators fit this bill? (pun intended) Where does a cancer patient fit in the 'chronic pain' situation? Is malignant pain an exemption? I've had plenty of cancer patients live for years with chronic pain. Once again we have evidence of the do something approach when doing nothing may be more appropriate.

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