New Mexico

No opioid laws

• New Mexico Clinical Guidelines on Prescribing Opioids for Treatment of Pain – 2011: Summary of Recommendations
  • Opioid Treatment of Acute Pain:
    • Opioid medications should only be used for treatment of acute pain when the severity of the pain warrants that choice and after determining that other non-opioid pain medications or therapies will not provide adequate pain relief.
    • When opioid medications are prescribed for treatment of acute pain, the number dispensed should be no more than the number of doses needed based on the usual duration of pain severe enough to require opioids for that condition.
    • When opioid medications are prescribed for treatment of acute pain, the patient should be counseled to store the medications securely, to not share with others, and to dispose of medications properly when the pain has resolved in order to prevent non-medical use of the medications.
    • Long duration-of-action opioids should not be used for treatment of acute pain, including post-operative pain, except in situations where monitoring and assessment for adverse effects can be conducted. Methadone is rarely, if ever, indicated for treatment of acute pain.
    • The use of opioids should be re-evaluated carefully, including assessing the potential for abuse, if persistence of pain suggests the need to continue opioids beyond the anticipated time period of acute pain treatment for that condition.
  • Opioid Treatment for Chronic Pain:
    • A comprehensive evaluation (including the pathophysiologic causation, risk for abuse, and other co-morbid conditions) should be performed before initiating opioid treatment for chronic pain.
    • Alternatives to opioid treatment should be tried (or an adequate trial of such treatment by a previous provider documented) before initiating opioid treatment.
    • The provider should screen for risk of abuse or addiction before initiating opioid treatment.
    • When opioids are to be used for treatment of chronic pain, a written treatment plan should be established that includes measurable goals for reduction of pain and improvement of function.
    • The patient should be informed of the risks and benefits and any conditions for continuation of opioid treatment, ideally using a written and signed treatment agreement.
    • Opioid treatment for chronic pain should be initiated as a treatment trial, usually using short-acting opioid medications.
    • Regular visits with evaluation of progress against goals should be scheduled during the period when the dose of opioids is being adjusted (titration period).
    • Once a stable dose has been established (stable chronic dose period), regular monitoring should be conducted at face-to-face visits during which treatment goals, analgesia, activity, adverse effects are monitored. Patients should be monitored for aberrant behavior (tools include drug screening and prescription drug monitoring program report surveillance).
    • Continuing opioid treatment after the treatment trial should be a deliberate decision that considers the risks and benefits of chronic opioid treatment for that patient. A second opinion or consult may be useful in making that decision.
    • An opioid treatment trial should be discontinued if the goals are not met and opioid treatment should be discontinued at any point if adverse effects outweigh benefits or if dangerous or illegal behaviors are demonstrated.
    • Clinicians treating patients with opioids for chronic pain should maintain records documenting the evaluation of the patient, treatment plan, discussion of risks and benefits, informed consent, treatments prescribed, results of treatment and any aberrant behavior observed.
    • Clinicians should consider consultation for patients with complex pain conditions, patients with serious co-morbidities including mental illness, patients who have a history or evidence of current drug addiction or abuse, or when the provider is not confident of his or her abilities to manage the treatment.
    • Methadone should only be prescribed by clinicians who are familiar with its risks and appropriate use, and who are prepared to conduct the necessary careful monitoring.
    • Clinicians should be aware of the potential toxicity of acetaminophen in opioid-acetaminophen combination products, warn patients not to exceed the maximum daily dose of acetaminophen and monitor acetaminophen doses in the patient‘s known medication regimen.