Minnesota: new state law to protect prescribers against treating chronic pain – with certain limitations

This is a new law that went into effect Aug 1, 2022 in Minnesota. It is designed to protect prescribers who are treating chronic pain pts.  In reading this, it only prohibits the state’s commissioner of health from taking action against any prescriber in the state.  This law also references the MME system – which is know to be highly inaccurate and has no science nor double blind clinical studies supporting its data.

There is also no mention of the DEA in this regulation.  What is to hinder or prevent the DEA from coming in the state of Minnesota and charging a prescriber with violation of the Controlled Substance Act.

Here is a article about DEA recent legal actions against a prescriber  https://doctorsofcourage.org/stanley-charles-evans-do/  after the SCOTUS (9-0 vote) in the Ruan/Kahn case  http://www.pharmaciststeve.com/donald-hyungjoon-kim-md-victory-united-states-motion-dismissed-indictment-9-0-supreme-court-ruling-in-ruan-khan/

It would seem like the DEA is going down the same path that the EPA is taking after the SCOTUS ruled that the they could not create new interpretation of the Environmental Protection Act… that was the function of a legislative body… and the EPS basically told the SCOTUS to stick it up their ass.

Minn. Stat. § 152.125
Section 152.125 – [Effective 8/1/2022] INTRACTABLE PAIN
Subdivision 1. Definitions.
(a) For purposes of this section, the terms in this subdivision have the meanings given.
(b) “Drug diversion” means the unlawful transfer of prescription drugs from their licit
medical purpose to the illicit marketplace.
(c) “Intractable pain” means a pain state in which the cause of the pain cannot be removed
or otherwise treated with the consent of the patient and in which, in the generally accepted
course of medical practice, no relief or cure of the cause of the pain is possible, or none
has been found after reasonable efforts. Conditions associated with intractable pain may
include cancer and the recovery period, sickle cell disease, noncancer pain, rare diseases,
orphan diseases, severe injuries, and health conditions requiring the provision of palliative
care or hospice care. Reasonable efforts for relieving or curing the cause of the pain may
be determined on the basis of, but are not limited to, the following:
(1) when treating a nonterminally ill patient for intractable pain, an evaluation
conducted by the attending physician, advanced practice registered nurse, or physician
assistant and one or more physicians, advanced practice registered nurses, or physician
assistants specializing in pain medicine or the treatment of the area, system, or organ of
the body confirmed or perceived as the source of the intractable pain; or
(2) when treating a terminally ill patient, an evaluation conducted by the attending
physician, advanced practice registered nurse, or physician assistant who does so in
accordance with the standard of care and the level of care, skill, and treatment that
would be recognized by a reasonably prudent physician, advanced practice registered
nurse, or physician assistant under similar conditions and circumstances.
(d) “Palliative care” has the meaning given in section 144A.75, subdivision 12.
(e) “Rare disease” means a disease, disorder, or condition that affects fewer than 200,000
individuals in the United States and is chronic, serious, life altering, or life threatening.
Subd. 1a. Criteria for the evaluation and treatment of intractable pain.
(1) a diagnosis of intractable pain by the treating physician, advanced practice registered
nurse, or physician assistant and either by a physician, advanced practice registered nurse,
or physician assistant specializing in pain medicine or a physician, advanced practice
registered nurse, or physician assistant treating the area, system, or organ of the body that
is the source of the pain is sufficient to meet the definition of intractable pain; and
(2) the cause of the diagnosis of intractable pain must not interfere with medically
necessary treatment, including but not limited to prescribing or administering a controlled
The evaluation and treatment of intractable pain when treating a nonterminally ill patient is
governed by the following criteria:
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substance in Schedules II to V of section 152.02.
Subd. 2.Prescription and administration of controlled substances for intractable pain.
(a) Notwithstanding any other provision of this chapter, a physician, advanced practice
registered nurse, or physician assistant may prescribe or administer a controlled substance
in Schedules II to V of section 152.02 to a patient in the course of the physician’s,
advanced practice registered nurse’s, or physician assistant’s treatment of the patient for a
diagnosed condition causing intractable pain. No physician, advanced practice registered
nurse, or physician assistant shall be subject to disciplinary action by the Board of
Medical Practice or Board of Nursing for appropriately prescribing or administering a
controlled substance in Schedules II to V of section 152.02 in the course of treatment of a
patient for intractable pain, provided the physician, advanced practice registered nurse, or
physician assistant:
(1) keeps accurate records of the purpose, use, prescription, and disposal of controlled
substances, writes accurate prescriptions, and prescribes medications in conformance
with chapter 147 or 148 or in accordance with the current standard of care; and
(2) enters into a patient-provider agreement that meets the criteria in subdivision 5.
(b) No physician, advanced practice registered nurse, or physician assistant, acting in
good faith and based on the needs of the patient, shall be subject to disenrollment or
termination by the commissioner of health solely for prescribing a dosage that equates to
an upward deviation from morphine milligram equivalent dosage recommendations or
thresholds specified in state or federal opioid prescribing guidelines or policies, including
but not limited to the Guideline for Prescribing Opioids for Chronic Pain issued by the
Centers for Disease Control and Prevention and Minnesota opioid prescribing guidelines.
(c) A physician, advanced practice registered nurse, or physician assistant treating
intractable pain by prescribing, dispensing, or administering a controlled substance in
Schedules II to V of section 152.02 that includes but is not limited to opioid analgesics
must not taper a patient’s medication dosage solely to meet a predetermined morphine
milligram equivalent dosage recommendation or threshold if the patient is stable and
compliant with the treatment plan, is experiencing no serious harm from the level of
medication currently being prescribed or previously prescribed, and is in compliance with
the patient-provider agreement as described in subdivision 5.
(d) A physician’s, advanced practice registered nurse’s, or physician assistant’s decision to
taper a patient’s medication dosage must be based on factors other than a morphine
milligram equivalent recommendation or threshold.
(e) No pharmacist, health plan company, or pharmacy benefit manager shall refuse to fill a
prescription for an opiate issued by a licensed practitioner with the authority to prescribe
opiates solely based on the prescription exceeding a predetermined morphine milligram
equivalent dosage recommendation or threshold. Health plan companies that participate in
Minnesota health care programs under chapters 256B and 256L, and pharmacy benefit
managers under contract with these health plan companies, must comply with section
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Section 152.125 – [Effective 8/1/2022] INTRACTABLE PAIN Minn. Stat. § 152.125
1004 of the federal SUPPORT Act, Public Law 115-271, when providing services to
medical assistance and MinnesotaCare enrollees.
Subd. 3.Limits on applicability.
(1) a physician’s, advanced practice registered nurse’s, or physician assistant’s treatment of
a patient for chemical dependency resulting from the use of controlled substances in
Schedules II to V of section 152.02;
(2) the prescription or administration of controlled substances in Schedules II to V of
section 152.02 to a patient whom the physician, advanced practice registered nurse, or
physician assistant knows to be using the controlled substances for nontherapeutic or drug
diversion purposes;
(3) the prescription or administration of controlled substances in Schedules II to V of
section 152.02 for the purpose of terminating the life of a patient having intractable pain;
or
(4) the prescription or administration of a controlled substance in Schedules II to V of
section 152.02 that is not a controlled substance approved by the United States Food and
Drug Administration for pain relief.
Subd. 4.Notice of risks.
Subd. 5. Patient-provider agreement.
(a) Before treating a patient for intractable pain, a physician, advanced practice registered
nurse, or physician assistant and the patient or the patient’s legal guardian, if applicable,
must mutually agree to the treatment and enter into a provider-patient agreement. The
agreement must include a description of the prescriber’s and the patient’s expectations,
responsibilities, and rights according to best practices and current standards of care.
(b) The agreement must be signed by the patient or the patient’s legal guardian, if
applicable, and the physician, advanced practice registered nurse, or physician assistant
and included in the patient’s medical records. A copy of the signed agreement must be
provided to the patient.
(c) The agreement must be reviewed by the patient and the physician, advanced practice
registered nurse, or physician assistant annually. If there is a change in the patient’s
treatment plan, the agreement must be updated and a revised agreement must be signed by
This section does not apply to:
Prior to treating a patient for intractable pain in accordance with subdivision 2, a physician,
advanced practice registered nurse, or physician assistant shall discuss with the patient or
the patient’s legal guardian, if applicable, the risks associated with the controlled substances
in Schedules II to V of section 152.02 to be prescribed or administered in the course of the
physician’s, advanced practice registered nurse’s, or physician assistant’s treatment of a
patient, and document the discussion in the patient’s record as required in the patient-
provider agreement described in subdivision 5.
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Section 152.125 – [Effective 8/1/2022] INTRACTABLE PAIN Minn. Stat. § 152.125
the patient or the patient’s legal guardian. A copy of the revised agreement must be
included in the patient’s medical record and a copy must be provided to the patient.
(d) Absent clear evidence of drug diversion, nonadherence with the agreement must not
be used as the sole reason to stop a patient’s treatment with scheduled drugs. If a patient
experiences difficulty adhering to the agreement, the prescriber must evaluate the patient
for other conditions, including but not limited to substance use disorder, and must ensure
that the patient’s course of treatment is appropriately adjusted to reflect any change in
diagnosis.
(e) A patient-provider agreement is not required in an emergency or inpatient hospital
setting.
Minn. Stat. § 152.125
1997 c 124 s 1
Amended by 2022 Minn. Laws, ch. 98,s 2-2, eff. 8/1/2022.
This section is set out more than once due to postponed, multiple, or conflicting
amendments.
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Section 152.125 – [Effective 8/1/2022] INTRACTABLE PAIN Minn. Stat. § 152.125

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