SENATE BILL 23-144
BY SENATOR(S) Ginal, Marchman, Buckner, Fields, Gardner, Kirkmeyer,
Liston, Lundeen, Pelton R., Rich, Smallwood, Will, Zenzinger;
also REPRESENTATIVE(S) Mabrey and Young, Bacon, Bird,
Boesenecker, Duran, Epps, Froelich, Garcia, Gonzales-Gutierrez, Hamrick,
Herod, Jodeh, Joseph, Kipp, Lieder, Lindsay, Ortiz, Parenti, Snyder, Story,
Titone, Velasco, Willford.
C
ONCERNING PRESCRIPTION DRUGS FOR THE TREATMENT OF CHRONIC PAIN .
Be it enacted by the General Assembly of the State of Colorado:
SECTION 1. In Colorado Revised Statutes, add 12-30-109.5 as
follows:
12-30-109.5. Prescription drugs for treatment of chronic pain -
patients - prescribers - definitions. (1) A
S USED IN THIS SECTION, UNLESS
THE CONTEXT OTHERWISE REQUIRES
:
(a) "C
ARRIER" HAS THE SAME MEANING AS SET FORTH IN 10-16-102
(8).
(b) (I) "C
HRONIC PAIN" MEANS A PAIN THAT TYPICALLY LASTS THREE
NOTE: This bill has been prepared for the signatures of the appropriate legislative
officers and the Governor. To determine whether the Governor has signed the bill
or taken other action on it, please consult the legislative status sheet, the legislative
history, or the Session Laws.
________
Capital letters or bold & italic numbers indicate new material added to existing law; dashes
through words or numbers indicate deletions from existing law and such material is not part of
the act. MONTHS OR LONGER AND MAY BE THE RESULT OF AN UNDERLYING MEDICAL
DISEASE OR CONDITION
, INJURY, MEDICAL TREATMENT, INFLAMMATION, OR
UNKNOWN CAUSE
. "CHRONIC PAIN" IS A PAIN STATE IN WHICH THE CAUSE OF
THE PAIN OFTEN CANNOT BE REMOVED WITH REAS ONABLE MEDICAL EFFORTS
AT THE CONSENT OF THE PATIENT
, OR PAIN FOR WHICH NO CURE CAN BE
FOUND AFTER REASONABLE MEDICAL EFFORTS
. CHRONIC PAIN MAY RESTRICT
THE ABILITY OF INDIVIDUALS TO WORK
, CARE FOR THEMSELVES , AND
ENGAGE IN BASIC LIFE
, SOCIAL, AND PHYSICAL ACTIVITIES.
(II) C
ONDITIONS ASSOCIATED WITH CHRONIC PAIN MAY INCLUDE ,
BUT ARE NOT LIMITED TO, CANCER AND THE RECOVERY PERIOD, SICKLE CELL
DISEASE
, NONCANCER PAIN, RARE DISEASES, SEVERE INJURIES, AND HEALTH
CONDITIONS REQUIRING THE PROVISION OF PALLIATIVE CARE OR HOSPICE
CARE
.
(III) R
EASONABLE EFFORTS FOR RELIEVING OR CURING THE CAUSE OF
THE CHRONIC PAIN MAY BE DETERMINED ON THE BASIS OF
, BUT ARE NOT
LIMITED TO
, THE FOLLOWING:
(A) W
HEN TREATING A NONTERMINALLY ILL PATIENT FOR CHRONIC
PAIN
, AN EVALUATION CONDUCTED BY THE TREATING HEALTH -CARE
PROVIDER OR A HEALTH
-CARE PROVIDER SPECIALIZING IN PAIN MEDICINE OR
TREATMENT OF THE AREA
, SYSTEM, OR ORGAN OF THE BODY CONFIRMED OR
PERCEIVED AS THE SOURCE OF THE CHRONIC PAIN
; OR
(B) WHEN TREATING A TERMINALLY ILL PATIENT , AN EVALUATION
CONDUCTED BY THE TREATING HEALTH
-CARE PROVIDER WHO CONDUCTS THE
EVALUATION IN ACCORDANCE WITH THE STANDARD OF CARE AND THE LEVEL
OF CARE
, SKILL, AND TREATMENT THAT WOULD BE RECOGNIZED BY A
HEALTH
-CARE PROVIDER UNDER SIMILAR CONDITIONS AND CIRCUMSTANCES .
(c) "D
RUG DIVERSION" MEANS THE UNLAWFUL TRANSFER OF
PRESCRIPTION DRUGS FROM A LICIT MEDICAL PURPOSE TO THE ILLICIT
MARKETPLACE
.
(d) "H
EALTH-CARE PROVIDER" MEANS A PHYSICIAN, A PHYSICIAN
ASSISTANT
, OR AN ADVANCED PRACTICE REGISTERED NURSE LICENSED
PURSUANT TO THIS TITLE
12.
(e) "R
ARE DISEASE" MEANS A DISEASE, DISORDER, OR CONDITION
PAGE 2-SENATE BILL 23-144 THAT AFFECTS FEWER THAN TWO HUNDRED THOUSAND INDIVIDUALS IN THE
UNITED STATES AND IS CHRONIC , SERIOUS, LIFE-ALTERING, OR
LIFE
-THREATENING.
(f) "S
CHEDULE II, III, IV, OR V CONTROLLED SUBSTANCE" MEANS A
CONTROLLED SUBSTANCE AS DESCRIBED IN SECTION
18-18-204, 18-18-205,
18-18-206,
OR 18-18-207, RESPECTIVELY.
(2) Criteria for the evaluation and treatment of chronic pain.
W
HEN TREATING A NONTERMINALLY ILL PATIENT , THE EVALUATION OF THE
PATIENT AND THE TREATMENT OF THE PATIENT
'S CHRONIC PAIN IS GOVERNED
BY THE FOLLOWING CRITERIA
:
(a) A
DIAGNOSIS OF A CONDITION CAUSING CHRONIC PAIN BY THE
TREATING HEALTH
-CARE PROVIDER OR A HEALTH -CARE PROVIDER
SPECIALIZING IN PAIN MEDICINE OR TREATMENT OF THE AREA
, SYSTEM, OR
ORGAN OF THE BODY CONFIRMED OR PERCEIVED AS THE SOURCE OF THE PAIN
THAT IS SUFFICIENT TO MEET THE DEFINITION OF CHRONIC PAIN
; AND
(b) THE CAUSE OF THE DIAGNOSIS OF CHRONIC PAIN MUST NOT
INTERFERE WITH MEDICALLY NECESSARY TREATMENT
, INCLUDING BUT NOT
LIMITED TO PRESCRIBING OR ADMINISTERING A SCHEDULE
II, III, IV, OR V
CONTROLLED SUBSTANCE .
(3) Prescription and administration of controlled substances for
chronic pain. (a) N
OTWITHSTANDING ANY OTHER PROVISION OF LAW , A
HEALTH
-CARE PROVIDER MAY PRESCRIBE , DISPENSE, OR ADMINISTER A
SCHEDULE
II, III, IV, OR V CONTROLLED SUBSTANCE TO A PATIENT IN THE
COURSE OF THE HEALTH
-CARE PROVIDER'S TREATMENT OF THE PATIENT FOR
A DIAGNOSED CONDITION CAUSING CHRONIC PAIN
. A HEALTH-CARE
PROVIDER IS NOT SUBJECT TO DISCIPLINARY ACTION BY THE REGULATOR FOR
APPROPRIATELY PRESCRIBING
, DISPENSING, OR ADMINISTERING A SCHEDULE
II, III, IV, OR V CONTROLLED SUBSTANCE IN THE COURSE OF TREATMENT OF
A PATIENT FOR CHRONIC PAIN IF THE HEALTH
-CARE PROVIDER KEEPS
ACCURATE RECORDS OF THE PURPOSE
, USE, PRESCRIPTION, AND DISPOSAL OF
THE CONTROLLED SUBSTANCE
, WRITES ACCURATE PRESCRIPTIONS , AND
PRESCRIBES MEDICATIONS IN ACCORDANCE WITH LEGITIMATE MEDICAL
PURPOSE IN THE USUAL COURSE OF PROFESSIONAL PRACTICE
.
(b) A
HEALTH-CARE PROVIDER ACTING IN GOOD FAITH AND BASED ON
PAGE 3-SENATE BILL 23-144 THE NEEDS OF THE PATIENT WITH A DIAGNOSED CONDITION CAUSING
CHRONIC PAIN IS NOT SUBJECT TO DISCIPLINE FROM THE REGULATOR SOLELY
FOR PRESCRIBING A DOSAGE THAT EQUATES TO AN UPWARD DEVIATION FROM
MORPHINE MILLIGRAM EQUIVALENT DOSAGE RECOMMENDATIONS OR FROM
THRESHOLDS SPECIFIED IN STATE OR FEDERAL OPIOID PRESCRIBING
GUIDELINES OR POLICIES
.
(c) A
HEALTH-CARE PROVIDER TREATING A PATIENT WITH CHRONIC
PAIN BY PRESCRIBING
, DISPENSING, OR ADMINISTERING ONE OR MORE
SCHEDULE
II, III, IV, OR V CONTROLLED SUBSTANCES THAT INCLUDE , BUT
ARE NOT LIMITED TO
, OPIOID ANALGESICS SHALL NOT BE REQUIRED TO TAPER
A PATIENT
'S MEDICATION DOSAGE SOLELY TO MEET A PREDETERMINED
MORPHINE MILLIGRAM EQUIVALENT DOSAGE RECOMMENDATION OR
THRESHOLD IF THE PATIENT IS STABLE AND COMPLIANT WITH THE
TREATMENT PLAN AND IS NOT EXPERIENCING SERIOUS HARM FROM THE
LEVEL OF MEDICATION CURRENTLY BEING PRESCRIBED OR PREVIOUSLY
PRESCRIBED
. A DECISION TO TAPER OR MAINTAIN MEDICATION MUST
INCLUDE AN INDIVIDUALIZED ASSESSMENT OF THE PATIENT
'S CURRENT
MEDICAL CONDITION AND TREATMENT PLAN
, THE RISKS AND BENEFITS OF
MAINTAINING OR TAPERING THE PATIENT
'S MEDICATION, AND A DISCUSSION
WITH THE PATIENT
.
(d) (I) A
PHARMACY, CARRIER, OR PHARMACY BENEFIT MANAGER
SHALL NOT HAVE A POLICY IN PLACE THAT REQUIRES THE PHARMACIST TO
REFUSE TO FILL A PRESCRIPTION FOR AN OPIATE ISSUED BY A HEALTH
-CARE
PROVIDER WITH THE AUTHORITY TO PRESCRIBE OPIATES SOLELY BECAUSE
THE PRESCRIPTION IS FOR AN OPIATE OR BECAUSE THE PRESCRIPTION ORDER
EXCEEDS A PREDETERMINED MORPHINE MILLIGRAM EQUIVALENT DOSAGE
RECOMMENDATION OR THRESHOLD
.
(II) A
HEALTH-CARE PRACTICE OR CLINIC IN WHICH A HEALTH-CARE
PROVIDER IS AUTHORIZED TO PRESCRIBE SCHEDULE
II, III, IV, OR V
CONTROLLED SUBSTANCES SHALL NOT HAVE A POLICY IN PLACE THAT
REQUIRES THE HEALTH
-CARE PROVIDER TO REFUSE TO PRESCRIBE ,
ADMINISTER, OR DISPENSE A PRESCRIPTION FOR AN OPIATE SOLELY BECAUSE
THE PRESCRIPTION EXCEEDS A PREDETERMINED MORPHINE MILLIGRAM
EQUIVALENT DOSAGE RECOMMENDATION OR THRESHOLD
.
(e) B
EFORE TREATING A PATIENT FOR CHRONIC PAIN IN ACCORDANCE
WITH THIS SUBSECTION
(3), A HEALTH-CARE PROVIDER SHALL DISCUSS WITH
PAGE 4-SENATE BILL 23-144 THE PATIENT OR THE PATIENT'S LEGAL GUARDIAN, IF APPLICABLE, THE RISKS
ASSOCIATED WITH THE SCHEDULE
II, III, IV, OR V CONTROLLED SUBSTANCE
TO BE PRESCRIBED OR ADMINISTERED IN THE COURSE OF THE HEALTH
-CARE
PROVIDER
'S TREATMENT OF THE PATIENT AND DOCUMENT THE DISCUSSION
IN THE PATIENT
'S RECORD.
(4) Limits on applicability. (a) T
HIS SECTION DOES NOT APPLY TO:
(I) A
HEALTH-CARE PROVIDER'S TREATMENT OF A PATIENT FOR A
SUBSTANCE USE DISORDER RESULTING FROM THE USE OF A SCHEDULE
II, III,
IV,
OR V CONTROLLED SUBSTANCE;
(II) T
HE PRESCRIPTION OR ADMINISTRATION OF A SCHEDULE II, III,
IV,
OR V CONTROLLED SUBSTANCE TO A PATIENT WHOM THE HEALTH -CARE
PROVIDER KNOWS TO BE USING THE CONTROLLED SUBSTANCE FOR
NONTHERAPEUTIC OR DRUG DIVERSION PURPOSES
;
(III) T
HE PRESCRIPTION, DISPENSING, OR ADMINISTRATION OF A
SCHEDULE
II, III, IV, OR V CONTROLLED SUBSTANCE FOR THE PURPOSE OF
TERMINATING THE LIFE OF A PATIENT WITH CHRONIC PAIN
; OR
(IV) THE PRESCRIPTION, DISPENSING, OR ADMINISTRATION OF A
SCHEDULE
II, III, IV, OR V CONTROLLED SUBSTANCE THAT IS NOT A
CONTROLLED SUBSTANCE APPROVED BY THE FEDERAL FOOD AND DRUG
ADMINISTRATION FOR PAIN RELIEF
.
(b) T
HIS SECTION DOES NOT LIMIT THE POWERS AND DUTIES OF THE
COLORADO MEDICAL BOARD PURSUANT TO SECTION 12-240-106 OR THE
STATE BOARD OF NURSING PURSUANT TO SECTION
12-255-107.
SECTION 2. Safety clause. The general assembly hereby finds,
PAGE 5-SENATE BILL 23-144 determines, and declares that this act is necessary for the immediate
preservation of the public peace, health, or safety.
____________________________ ____________________________
Steve Fenberg
Julie McCluskie
PRESIDENT OF SPEAKER OF THE HOUSE
THE SENATE OF REPRESENTATIVES
____________________________ ____________________________
Cindi L. Markwell Robin Jones
SECRETARY OF CHIEF CLERK OF THE HOUSE
THE SENATE OF REPRESENTATIVES
APPROVED________________________________________
(Date and Time)
_________________________________________
Jared S. Polis
GOVERNOR OF THE STATE OF COLORADO
PAGE 6-SENATE BILL 23-144