As I have written elsewhere, the United States is now embroiled in a highly contentious debate concerning the causes of the so-called “opioid crisis.” Prescribing guidelines updated in 2022 by the Centers for Disease Control and Prevention (CDC) and Veterans Administration (VA) have become the basis for continuing scientifically unsupported restrictions on patient access to long-term prescription opioid therapy. Doctors are leaving pain management practice, and patients denied pain care are committing suicide.

Against this background, it is increasingly recognized that public health care policy for pain management is harming both patients and their clinicians. At least seven U.S. states have enacted laws protecting doctors who treat pain from legal action. Arizona has enacted two. These include:

• New Hampshire (HB1639 – 2020): “All decisions” regarding treatment are to be made by the treating practitioner, who is required to treat chronic pain “without fear of reprimand or discipline.” Doctors in the state are also allowed to exceed the MME limit, provided the dose is “the lowest amount necessary to control pain” and “there are no signs of a patient abusing their opioid medication.”

• Rhode Island (S1384 – 2021): “A practitioner, in good faith… may prescribe, administer, and dispense controlled substances… without regard to the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain.”

• Oklahoma (SB57 – 2021): “Nothing in the Anti-Drug Diversion Act shall be construed to require a practitioner to limit or forcibly taper a patient on opioid therapy. The standard of care requires effective and individualized treatment for each patient as deemed appropriate by the prescribing practitioner without an administrative or codified limit on dose or quantity that is more restrictive than approved by the Food and Drug Administration.”

• Arizona (SB1162 and SB1469 – 2022): “The ninety Morphine Milligram Equivalents per day limit prescribed in this section does not apply to a patient with chronic intractable pain once the patient has an established health professional-patient relationship and the patient has tried doses of less than ninety Morphine Milligram Equivalents that have been ineffective at addressing the patient’s pain.” Arizona also now explicitly restricts law enforcement from arresting practitioners suspected of inappropriate prescribing, instead referring investigations to the State Medical Board. Law enforcement may access the State Prescription Drug Management Program (PDMP) only with a valid search warrant.

• Minnesota (HF4065 – 2022): “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.” Minnesota also prohibits prescribers from tapering patient medication dosage and pharmacists from refusing to fill prescriptions solely to meet a predetermined dose threshold if that patient is otherwise stable.

• Colorado (SB144 – 2023): “The prescribing health-care provider is not subject to disciplinary action by the appropriate regulator for prescribing a dosage of a drug that is equal to or more than a morphine milligram equivalent dosage recommendation or threshold specified in state or federal opioid prescribing guidelines or policies.”

• Illinois (HB5373 – 2025): Prevents a health care provider from being required to taper a patient’s medication dosage solely to meet a predetermined dosage recommendation or threshold if the patient is stable, compliant with treatment, and not experiencing serious harm. As in Arizona, the act also requires a valid court order or subpoena before granting access to information in the state PDMP.

It is clear from this legislative record that U.S. state legislatures are increasingly recognizing that the CDC opioid prescribing guidelines do not provide a “consensus standard of care” for pain management and may in fact be substantially fraudulent.

Moreover, the margins by which these legislative acts have been passed are startling:

• There was only one state senate nay vote recorded in opposition to all eight bills.
• In four of the laws summarized above, the legislation was passed unanimously.
• In Arizona, SB562 received five nay votes to 80 yays.
• The Minnesota House passed HF4065 narrowly, while the state senate passed it unanimously.

It is also evident that state legislatures are “getting the message” sounded in 2019 by six U.S. national clinical professional associations representing over 560,000 physicians and medical students: “Frontline physicians call on politicians to end political interference in the delivery of evidence-based medicine.”

Richard A. Lawhern is a patient advocate.