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Health Advisory 148 Voluntary NonOpioid Advanced Directive

While the information contained in this news article was current and accurate when we posted it, it may not necessarily represent current WVOEMS policy or procedure. If you have any questions, please contact our office at 304-558-3956.

Posted: Friday, July 6, 2018 7:18 AM

TO:                 West Virginia Healthcare Providers, Hospitals and other Healthcare Facilities

FROM:            Rahul Gupta, MD, MPH, MBA, FACP - Commissioner and State Health Officer WVDHHR, Bureau for Public Health

DATE:            July 5, 2018




The purpose of this Health Advisory is to provide guidance regarding the Voluntary NonOpioid Advanced Directive (VNOAD) form as established in Senate Bill 273, the Opioid Reduction Act of 2017 ("Act"), specifically W.Va. Code §16-54-2.


The Act sets out a process enabling individuals to decline, in advance, any treatment option that includes opioids. The West Virginia Department of Health and Human Resources (WVDHHR) is actively working with the Office of Drug Control Policy (ODCP) to ensure West Virginia residents and the substance use disorder (SUD) treatment communities are aware that this new resource is available in the fight to eliminate opioid misuse.

Under the Act, the ODCP is responsible for creating the VNOAD and publishing the form on the WVDHHR website for public use. Any person who wishes to decline future treatment with opioids may complete the VNOAD and give it to their health care practitioner or responding emergency medical services (EMS) personnel, who must file it in the patient's medical record. The patient, a medical power of attorney representative, or a surrogate may revoke the Directive, orally or in writing, for any reason.

Voluntary NonOpioid Advanced Directive (VNOAD) Form

The VNOAD form, developed by the ODCP, is attached to this Health Advisory. It is also available on the WVDHHR website at If a person does not want opioids to be administered to him/her or offered a prescription or medication order for an opioid, he/she may complete and present the signed VNOAD form to a health care practitioner or responding EMS personnel at any time.

The ODCP encourages patients to complete the VNOAD in consultation with their primary care provider or SUD treatment provider. However, consultation is not necessary to the validity of the VNOAD.

Provider Responsibilities

If a health care practitioner receives a signed VNOAD form, it must be filed in the patient's medical record and

shall be transferred with the patient from one practitioner to another or from one health care facility to another.

This message was directly distributed by the West Virginia Bureau for Public Health to local health departments and professional associations. Receiving entities are responsible for

further disseminating the information as appropriate to the target audience.

Categories of Health Alert messages:

Health Alert: Conveys the highest level of importance. Warrants immediate action or attention.

Health Advisory: Provides important information for a specific incident or situation. May not require immediate action.

Health Update: Provides updated information regarding an incident or situation. Unlikely to require immediate action.

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West Virginia Health Advisory Number WV148-07-05-2018


Prior to prescribing, administering, or offering an opioid drug product to a patient, a practitioner should check the patient's medical record to determine whether a VNOAD has been filed. In the case of response to an emergency situation, EMS personnel should ask the patient or patient's on-scene representative(s) if the patient has such. Unless revoked by the patient verbally or in writing, a provider should consider a signed VNOAD as the patient's non-consent to opioid treatment.

Any violation of the Act is grounds for disciplinary action by the board that regulates the health care practitioner who commits the violation and may subject the health care practitioner to civil and criminal liability.


A practitioner, without actual knowledge of a VNOAD and who prescribes an opioid in a medical emergency situation, is not civilly or criminally liable for failing to act in accordance with the VNOAD unless the act or omission was the result of the practitioner's gross negligence or willful misconduct. A medical emergency situation is an acute injury or illness that poses an immediate risk to a person's life or long-term health.

Contact Information

All questions or concerns regarding this information should be directed to the ODCP at (304) 558-0684.


CDC Guideline Information for Prescribers:

CDC Guideline for Prescribing Opioids for Chronic Pain:

File attachment

han 148 voluntary nonopioid advanced directive vnoad 07.05.2018 - final.pdf

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