On July 5, 2018, the West Virginia Bureau for Public Health sent Health Advisory #148 to health care providers, hospitals and other health care facilities. Local health departments shared it with community partners. The advisory gave guidance on the Voluntary NonOpioid Advanced Directive (VNOAD).
What the directive is
The VNOAD came from Senate Bill 273, the Opioid Reduction Act of 2017, at W.Va. Code §16-54-2. The law lets a person decline, in advance, any treatment that includes opioids. The state Office of Drug Control Policy made the form and posted it on the state health department website.
- A person who does not want opioids, or a prescription for opioids, can fill out and sign the form.
- The person gives the form to a health care practitioner or to emergency medical services (EMS) staff.
- The practitioner must file the form in the medical record. The form moves with the patient to other practitioners and facilities.
- The patient, a medical power of attorney representative or a surrogate can revoke the directive at any time, orally or in writing.
The state encouraged people to fill out the form with their primary care provider or substance use treatment provider. The advisory said this talk was not needed for the form to be valid.
What providers were told to do
- Before they prescribe, give or offer an opioid, practitioners should check the medical record for a filed VNOAD.
- In an emergency, EMS staff should ask the patient or the patient’s representative on the scene if the patient has one.
- Unless the patient revokes it, a signed VNOAD counts as the patient’s refusal of opioid treatment.
A violation of the law can lead to discipline by the practitioner’s licensing board and to civil and criminal liability. A practitioner who does not know about a VNOAD and prescribes an opioid in a medical emergency is not liable, unless there was gross negligence or willful misconduct.
The advisory pointed providers to the CDC guideline for prescribing opioids for chronic pain. Questions went to the Office of Drug Control Policy at (304) 558-0684.
See other health advisories.
This advisory is from July 2018. It is kept here as a record. Check the current form and rules with the state and with your doctor.