The effort to reduce painkiller overdoses and deaths is moving beyond prosecuting so-called pill mills to direct regulation of any physician who prescribes opioids for patients with chronic noncancer pain.

The strictest regulation of opioid prescribing is in Washington state. In July, rules affecting osteopathic physicians and nonphysician prescribers took effect. The rules, which cover allopathic physicians starting in January 2012, include detailed instructions on how to evaluate and care for patients with chronic noncancer pain. Also required are written treatment plans known as “patient contracts” that call for mandatory, periodic urine screenings.

The rules mandate that primary care doctors consult with board-certified pain specialists before prescribing daily morphine-equivalent doses of 120 mg or greater — the first dosage threshold of its kind in the U.S.

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