Before the department or self-insurer authorizes payment for chronic opioid therapy for a catastrophic injury (see WAC 296-20-03030 for the definition of catastrophic injury), the provider must perform, verify, and document the following:

• A current signed pain treatment agreement; and

• A consultation with a pain management specialist must take place before the worker's dose is increased above 120mg/d morphine equivalent dose or consistent with exceptions in DOH's pain management rules; and

• The worker has no contraindication to the use of opioids including, but not limited to, current substance use disorders (excluding nicotine) or a history of opioid use disorder; and

• The dose is stable and the worker has no evidence of or is not at high risk for serious adverse outcomes from opioid use; and

• The worker has no pattern of recurrent (more than one) aberrant behavior identified by the prescription monitoring program database, urine drug testing or other source.

Catastrophic injuries are exempt from the requirement of clinically meaningful improvement in function with opioid use.