Arkansas opioid prescribing guidelines cap an initial acute-pain prescription at seven days, flag chronic-pain prescribing above 50 morphine milligram equivalents (MME) per day as “excessive” without detailed documentation, require a Prescription Drug Monitoring Program check before every Schedule II or III opioid prescription, and force prescribers to co-prescribe naloxone for several higher-risk patient groups. The core rule is 17 CAR 85-109, enforced by the Arkansas State Medical Board, with parallel rules at the dental board and under the APRN prescriptive-authority statute.
Who the Rules Cover
Every licensed Arkansas practitioner with controlled-substance authority falls under some version of these rules. Physicians and physician assistants work under 17 CAR 85-109. Dentists follow a parallel rule through the State Board of Dental Examiners, capped at seven days’ worth of the maximum recommended daily dose for any Schedule II or III opiate.1Legal Information Institute. 038.00.18 Ark. Code R. 005 – Article XX Advanced practice registered nurses operate under their own prescriptive-authority statute, which holds them to a tighter five-day ceiling on Schedule II opioids; after that, the patient must be referred to a physician.2Justia. Arkansas Code 17-87-310 – Prescriptive Authority
On the patient side, these limits apply to pain that is not cancer-related or part of end-of-life treatment. If you are being treated for a broken bone, post-surgical pain, back pain, or another non-terminal condition, the rules below shape your care. Patients in a handful of exempt settings sit outside the “excessive” thresholds entirely: active cancer treatment, hospice, palliative care, end-of-life care, nursing home or assisted living residence, hospital inpatient care, and genuine emergencies.3Code of Arkansas Rules. 17 CAR 85-109 – Prescribing and Dispensing Schedule II Narcotics Even in those settings, PMP checks and sound clinical judgment are still required.
The Seven-Day Limit for Acute Pain
Any initial opioid prescription over seven days for an acute-pain episode is treated as “excessive” unless the prescriber writes a specific medical justification into your chart.3Code of Arkansas Rules. 17 CAR 85-109 – Prescribing and Dispensing Schedule II Narcotics The seven-day count applies to the first prescription for that specific pain episode, not to every opioid you have ever taken.
If pain outlasts that first supply, your prescriber can write more, but only after re-evaluating you and documenting why continued opioid therapy is still medically necessary. The regulation also tells clinicians to start at the lowest effective dose. Long-acting or extended-release formulations are generally wrong for acute pain and should not be the first prescription.
If an APRN is handling your care, remember the five-day Schedule II cap. Past that point, you need a physician to continue the prescription.2Justia. Arkansas Code 17-87-310 – Prescriptive Authority
The PMP Check Before Every Prescription
Before writing any Schedule II or Schedule III opioid prescription, a prescriber in Arkansas is required by law to check the Prescription Drug Monitoring Program. It is not discretionary, and it applies every time one of those prescriptions is issued.4Justia. Arkansas Code 20-7-604 – Requirements for Prescription Drug Monitoring Program For benzodiazepines, a PMP check is required at least the first time the medication is prescribed to a new patient.
The PMP is a statewide database tracking controlled substance prescriptions filled at Arkansas pharmacies. It lets a prescriber see whether you already have active opioid prescriptions from someone else, whether you are refilling at an unusual pace, or whether another pattern suggests misuse. Every licensing board with controlled-substance jurisdiction has to adopt rules enforcing the check.
Chronic Opioid Therapy and the 50 MME Threshold
Once prescribing shifts from short-term acute care to ongoing chronic-pain management, the rules tighten. Writing a chronic-pain prescription above 50 MME per day is defined as “excessive” unless the prescriber documents each of the following in your record:3Code of Arkansas Rules. 17 CAR 85-109 – Prescribing and Dispensing Schedule II Narcotics
- Objective diagnostic findings such as imaging, labs, nerve conduction studies, or biopsies showing a pain-generating condition.
- A specific, patient-level reason that 50 MME or more per day is necessary.
- Non-opioid treatments that were tried and either failed or proved inadequate.
- A risk-factor assessment, including informing you of the addiction risk and evaluating the potential for abuse or diversion.
- Proof that the PMP was checked before the prescription was issued.
- A detailed clinical rationale for continuing the prescription.
Chronic-therapy patients must also be seen in person at least once every 90 days so the prescriber can reassess whether the treatment is still working and still needed.
Treatment Agreements and Drug Screening
Before chronic opioid therapy starts, you have to sign a written pain treatment agreement. It covers the addictive nature of the medication, the expectations for both you and the prescriber, your consent to periodic urine drug screens and random pill counts, and the circumstances that would end your opioid therapy.
The urine screens do two things: confirm that you are actually taking the drug (rather than diverting it) and check for non-prescribed substances. Baseline testing happens when chronic therapy begins, with at least annual follow-up testing consistent with CDC guidelines. Prescribers can test more often when they have reason to.
When Naloxone Must Be Co-Prescribed
Arkansas Code § 20-13-1805 requires a prescriber to co-prescribe naloxone, an opioid antagonist, when the opioid prescription meets any one of these criteria:
- The dosage is 50 MME per day or higher.
- The patient has been prescribed a benzodiazepine previously or will receive one concurrently.
- The patient has a documented history of opioid use disorder or overdose.
A prescriber who believes naloxone is not in your best interest can decline, but that decision has to be documented in your record. Failing to co-prescribe when required can trigger a referral to the appropriate licensing board for discipline.5Justia. Arkansas Code 20-13-1805 – Opioid Antagonist Patients in hospice or end-of-life care are exempt from the co-prescribing rule.
If you are being prescribed 50 MME or more per day for chronic pain, you should be handed a naloxone prescription at the same visit. If that didn’t happen, ask. Naloxone can reverse an opioid overdose within minutes, and the CDC recommends that higher-risk patients keep it on hand.6Centers for Disease Control and Prevention. Lifesaving Naloxone
Partial Fills Are Available on Request
If you are worried about leftover opioids in the house, federal law lets you request a partial fill of a Schedule II prescription. Under 21 U.S.C. § 829(f), you or your prescriber can ask the pharmacy to dispense less than the written quantity.7Office of the Law Revision Counsel. 21 USC 829 – Prescriptions The rest can be filled within 30 days of the date on the prescription, and the total across all partial fills cannot exceed what was originally written.
The request does not have to be in person. A phone call, a signed note, or a caregiver holding medical power of attorney can make it for you.
What Happens When a Prescriber Breaks the Rules
Violating Arkansas opioid prescribing rules counts as unprofessional conduct under the Arkansas Medical Practices Act. The statute’s definition includes violating any rule of the Medical Board, violating federal or state controlled substance laws, and grossly negligent malpractice.8Justia. Arkansas Code 17-95-409 – Denial, Suspension, or Revocation of License An “excessive” prescription without the required documentation fits the board-rule-violation category directly.
Available board penalties include license revocation, suspension, probation, mandatory counseling or treatment, and public or private reprimand. The dental board and nursing board have comparable tools for the prescribers they oversee.
Federal consequences can be heavier. The DEA can suspend or revoke a prescriber’s controlled substance registration if the state license is suspended or revoked, if the prescriber is convicted of a controlled substance felony, if they are excluded from federal healthcare programs, or if they engage in conduct inconsistent with the public interest.9Office of the Law Revision Counsel. 21 USC 824 – Denial, Revocation, or Suspension of Registration Losing a DEA registration ends the ability to prescribe any controlled substance anywhere in the country.