In July 2023, the Medical Board of California released updated Guidelines for Prescribing Controlled Substances for Pain. While these updates respond to years of policy shifts, patient outcomes, and prescriber concerns, they also offer practical, provider-focused tools to improve pain management while minimizing legal and regulatory risk.
At Simas & Associates, we believe these guidelines are not just helpful—they’re essential. For any provider treating patients with acute or chronic pain, the new guidance offers clarity, flexibility, and most importantly, protection when paired with strong documentation and thoughtful decision-making.
A New Tone: Support, Not Punishment
The updated guidelines represent a marked shift in tone from earlier versions and from the 2016 CDC guidelines, which many providers felt discouraged them from treating pain altogether. The Medical Board now explicitly recognizes the “chilling effect” those guidelines created—and the harm it caused when patients were abruptly cut off from care.
The 2023 update acknowledges the complexity of pain management and empowers physicians to use clinical judgment while emphasizing patient-centered care. The message is clear: when opioids are medically necessary and thoughtfully prescribed, providers should not fear disciplinary action—so long as they document appropriately.
Documentation Is Your Strongest Legal Defense
One of the most valuable aspects of the new guidelines is their emphasis on documentation. The Board repeatedly states that treatment decisions should be individualized and supported by clear, accurate medical records.
Providers should document:
- Thorough pain evaluations and diagnoses
- Use of risk screening tools (e.g., SOAPP-R, TAPS, PEG scale)
- CURES reports and urine drug screenings
- Treatment plans, goals, and rationale for ongoing therapy
- Informed consent and pain management agreements
- Tapering plans, if applicable
The guidelines even provide a detailed example (Appendix 2) showing how to document chronic pain treatment, from initial assessment to treatment plan. We strongly recommend clinicians integrate these practices into their EMRs and charting habits.
High-Risk Areas for Prescribers
From our experience defending healthcare professionals, we’ve seen common pitfalls that now have clearer guidance in the 2023 update:
Tapering and Termination of Care
Providers must avoid abrupt discontinuation of opioids. A slow, patient-centered taper with clear communication and referrals to specialists is now the expected standard. Failure to follow these protocols can open the door to complaints and even legal liability for patient abandonment.
Patients with SUD or Co-prescribed Benzodiazepines
The guidelines address the elevated risks of prescribing to patients with substance use disorders or concurrent benzodiazepine use. Prescribers must now offer naloxone in many of these cases and document conversations around overdose risks.
Inherited/Legacy Patients
If you’ve taken on a patient who was previously on long-term opioid therapy, the Board encourages continuity of care. Immediate discontinuation without an evaluation or taper is strongly discouraged.
Tools for Risk Mitigation
The Board outlines several tools providers should incorporate into their workflow:
- Validated assessment tools (e.g., PROMIS Pain Interference, PHQ-9, GAD-7)
- Routine CURES checks (mandatory at least every 6 months)
- Annual urine drug screenings, with more frequent testing for high-risk patients
- Naloxone prescribing for patients on ≥90 MMEs, co-prescribed sedatives, or at risk of overdose
- Pain management agreements for long-term therapy
Providers who skip these steps—or fail to document why they didn’t use them—may be at higher risk for audit or disciplinary review.
What This Means for You
These updated guidelines provide more than clinical advice—they provide implementable standards upon which to base a defense when used correctly. The Medical Board has made it clear that it will evaluate prescribing complaints in context, through a review of the provider’s documentation, decision-making, and compliance with these recommendations.
At Simas & Associates, we represent providers across California who face licensing board investigations, audits, and compliance reviews. We encourage our clients to be proactive—review your charting practices, consent forms, agreements, and protocols now to align with the new expectations.
Need Help Navigating These Changes?
If you’re unsure whether your pain management practices meet the updated standards, or if you’d like help implementing documentation protocols to protect yourself and your license, we’re here to help.