Under the STEP Act, the Department of Public Health (“DPH” or “the Department”) is responsible for creating a Voluntary Non-Opioid Directive form (“Directive”) and publishing it on the Department’s website for public use. Any person who wishes to decline future treatment with opioids may fill out the form and give it to their care provider, who will record it in the patient’s electronic health record (“EHR”), or medical record if the patient does not have an EHR, or responding emergency medical services (“EMS”) personnel. The patient, or the patient’s guardian or health care proxy, may revoke the Directive, orally or in writing, for any reason, at any time.
Non-Opioid Directive Form
The Directive developed by DPH is available on the Department’s website.
If a person does not want opioids to be administered to them or offered as a treatment option, they may fill out and present the signed Directive to a care provider or responding EMS personnel at any time.
DPH encourages patients to complete the Directive in consultation with their primary care provider or SUD treatment provider. However, consultation it is not necessary to the validity of the Directive.
If a care provider receives a signed Directive, it must be recorded in the patient’s EHR, or medical record if the patient does not have an EHR.
Prior to prescribing, administering, or offering an opioid drug product to a patient, a provider should check the individual’s medical record to determine whether a Directive has been recorded. In the case of an EMS response, EMS personnel should ask the patient or patient’s on-scene representative(s) if the patient has such a Directive. Unless revoked by the patient verbally or in writing, a provider should consider a signed Directive as the patient’s non-consent to opioid treatment. The existence of a signed Directive does not prohibit offering, prescribing or administering opioid medications for the purpose of medication assisted SUD treatment, as approved for such use by the FDA.
If the patient has filed a Directive, or otherwise expresses his or her wish not to be treated with opioids, the provider is encouraged to consult the List of Non-Opioid Drug Products for Pain Management, as developed by the Drug Formulary Commission, for alternative pharmacological treatment options, available on the Department’s website at http://www.mass.gov/eohhs/docs/dph/quality/drugcontrol/drugformulary/non-opioid-drug-list-and-letter-july2016.pdf .
In the case of an EMS response, EMS personnel may consult with their service’s medical control physician. Any board of professional licensure may limit, condition, or suspend the license of, or assess fines against a licensee who recklessly or negligently fails to comply with a person’s Directive.
Health Care Professionals
No health care provider or employee of a health care provider acting in good faith, using appropriate clinical judgement, shall be subject to criminal or civil liability or be considered to have engaged in unprofessional conduct if they do not offer or administer a prescription or medication order for an opioid pursuant to a person’s Directive.
If an individual is unconscious or otherwise incapacitated, and consultation with a guardian, health care agent, or the medical record would impede the provision of timely emergency care or provides no evidence that a voluntary non-opioid directive form has been filed, emergency administration of an opioid drug product will not be considered a violation of the law. Contact Information Questions or concerns regarding this information should be directed to the Drug Control Program: firstname.lastname@example.org.