NonOpioid Directive

In some cases, patients may not want an Opioid administered as part of their treatment. The form below constitutes the directive that will advise medical practitioners of that decision. A few key notes to take into account:

• An individual who has executed a nonopioid directive on their own behalf may revoke the directive at any time and in any way they are able to communicate their intent to revoke the form
• A guardian or patient’s advocate can revoke at any time by issuing a revocation in writing and providing notice of the revocation to the individual’s health professional or their delegate
• This directive does not apply to:
  • A patient receiving opioids for substance use disorder treatment
  • A patient who is in hospice
  • A patient is being treated at a hospital, or in a setting outside of a hospital in the case of an emergency, and, in the prescriber’s professional opinion, the administration of the opioid is medically necessary to treat the individual