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Maryland Senate Bill SB865

Maryland 2022 Regular Session

Maryland Senate Bill SB865 Compare Versions

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33 EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
44 [Brackets] indicate matter deleted from existing law.
55 *sb0865*
66
77 SENATE BILL 865
88 J2, J1 2lr0478
99
1010 By: Senator Ready
1111 Introduced and read first time: February 7, 2022
1212 Assigned to: Education, Health, and Environmental Affairs
1313
1414 A BILL ENTITLED
1515
1616 AN ACT concerning 1
1717
1818 Controlled Dangerous Substances and Treatment of Chronic Pain and 2
1919 Long–Term Oxygen Use Patients 3
2020 (Continuity of Care Act of 2022) 4
2121
2222 FOR the purpose of altering certain requirements related to the provision of information 5
2323 regarding opioid use disorder by the Maryland Department of Health , the 6
2424 prescribing of opioids, and the filling of prescriptions for monitored prescription 7
2525 drugs; establishing certain civil and criminal immunity; requiring a health care 8
2626 provider to make a good–faith effort to maintain the previous dosage of and regimen 9
2727 for a controlled dangerous substance and make certain referrals for a certain patient; 10
2828 providing that a patient who experiences and is diagnosed with chronic pain or 11
2929 receives long–term oxygen therapy may be administered ongoing treatment by 12
3030 certain practitioners or providers; establishing requirements for prescribers who 13
3131 treat patients who experience chronic pain or receive long–term oxygen therapy; and 14
3232 generally relating to controlled dangerous substances and the treatment of chronic 15
3333 pain and long–term oxygen use patients. 16
3434
3535 BY repealing and reenacting, with amendments, 17
3636 Article – Health – General 18
3737 Section 8–407(a)(1) and 21–2A–04.2(e) and (f) 19
3838 Annotated Code of Maryland 20
3939 (2019 Replacement Volume and 2021 Supplement) 21
4040
4141 BY adding to 22
4242 Article – Health – General 23
4343 Section 21–2A–04.2(f) 24
4444 Annotated Code of Maryland 25
4545 (2019 Replacement Volume and 2021 Supplement) 26
4646
4747 BY repealing and reenacting, with amendments, 27
4848 Article – Health Occupations 28 2 SENATE BILL 865
4949
5050
5151 Section 1–223 1
5252 Annotated Code of Maryland 2
5353 (2021 Replacement Volume) 3
5454
5555 BY adding to 4
5656 Article – Health Occupations 5
5757 Section 1–223.1; and 1–1101 through 1–1103 to be under the new subtitle “Subtitle 6
5858 11. Requirements for Prescribing Opioids for Chronic Pain and Long–Term 7
5959 Oxygen Therapy” 8
6060 Annotated Code of Maryland 9
6161 (2021 Replacement Volume) 10
6262
6363 SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 11
6464 That the Laws of Maryland read as follows: 12
6565
6666 Article – Health – General 13
6767
6868 8–407. 14
6969
7070 (a) The Department shall identify up–to–date, evidence–based, written 15
7171 information about opioid use disorder that: 16
7272
7373 (1) Has been reviewed, USING THE CURRENT VE RSION OF THE 17
7474 AMERICAN PSYCHIATRIC ASSOCIATION’S “DIAGNOSTIC AND STATISTICAL MANUAL 18
7575 OF MENTAL DISORDERS”, by medical experts and national and local organizations 19
7676 specializing in the treatment of opioid use disorder; 20
7777
7878 21–2A–04.2. 21
7979
8080 (e) If a pharmacist or pharmacist delegate has a reasonable belief that a patient 22
8181 may be seeking a monitored prescription drug for any purpose other than the treatment of 23
8282 an existing medical condition: 24
8383
8484 (1) (I) Before dispensing a monitored prescription drug to the patient, 25
8585 the pharmacist or pharmacist delegate shall request prescription monitoring data to 26
8686 determine if the patient has received other prescriptions that indicate misuse, abuse, or 27
8787 diversion of a monitored prescription drug; [and] 28
8888
8989 (II) AFTER REVIEW OF THE PRESCR IPTION MONITORING DA TA, 29
9090 IF THE PHARMACIST OR PHARMACIST DELEGATE HAS A REASONABLE BEL IEF THAT 30
9191 A PATIENT MAY BE SEE KING A MONITORED PRESCRIP TION DRUG FOR MISUSE, 31
9292 ABUSE, OR DIVERSION , THE PHARMACIST OR PH ARMACIST DELEGATE SH ALL 32
9393 CONTACT THE PRESCRIB ER TO VERIFY AND COMMUN ICATE ANY POSSIBLE 33
9494 CONCERNS; AND 34
9595
9696 (III) IF THE PRESCRIB ER CONFIRMS THAT THE PRESCRIPTION 35 SENATE BILL 865 3
9797
9898
9999 WAS FOR THE PURPOSE OF THE TREATMENT OF AN EXISTING MEDICAL CONDITION, 1
100100 THE PHARMACIST OR PH ARMACIST DELEGATE SH ALL FILL THE PRESCRI PTION AS 2
101101 WRITTEN; AND 3
102102
103103 (2) The pharmacist shall have the responsibility described in 21 C.F.R. § 4
104104 1306.04. 5
105105
106106 (F) A PHARMACI ST OR LICENSED PHARM ACY MAY NOT BE HELD LIABLE IN 6
107107 A CIVIL OR CRIMINAL ACTION SOLELY FOR DI SPENSING AN OPIOID I F THE 7
108108 PHARMACIST OR LICENS ED PHARMACY COMPLIED WITH THE REQUIREMENTS OF 8
109109 THIS SECTION. 9
110110
111111 [(f)] (G) The Secretary may adopt regulations to provide additional clinical, 10
112112 technical, or administrative exemptions based on new standards of practice. 11
113113
114114 Article – Health Occupations 12
115115
116116 1–223. 13
117117
118118 (a) In this section, “controlled dangerous substance” has the meaning stated in § 14
119119 5–101 of the Criminal Law Article. 15
120120
121121 (b) On treatment for pain, a health care provider, based on the clinical judgment 16
122122 of the health care provider, shall prescribe: 17
123123
124124 (1) The lowest effective dose of an opioid; and 18
125125
126126 (2) A quantity that is no greater than the quantity needed for the expected 19
127127 duration of pain severe enough to require an opioid that is a controlled dangerous substance 20
128128 unless the opioid is prescribed to treat: 21
129129
130130 (i) A substance–related disorder; 22
131131
132132 (ii) Pain associated with a cancer diagnosis; 23
133133
134134 (iii) Pain experienced while the patient is receiving end–of–life, 24
135135 hospice, or palliative care services; or 25
136136
137137 (iv) Chronic pain. 26
138138
139139 (c) The dosage, quantity, and duration of an opioid prescribed under subsection 27
140140 (b) of this section shall be based on [an evidence–based clinical guideline for prescribing 28
141141 controlled dangerous substances] THE PRESCRIBER ’S CLINICAL JUDGMENT AFTER 29
142142 CONSIDERATION OF AN EVIDENCE–BASED CLINICAL GUIDE LINE that is appropriate 30
143143 for: 31
144144 4 SENATE BILL 865
145145
146146
147147 (1) The health care service delivery setting for the patient; 1
148148
149149 (2) The type of health care services required by the patient; and 2
150150
151151 (3) The age and health status of the patient. 3
152152
153153 (d) (1) When a patient is prescribed an opioid under subsection (b) of this 4
154154 section, the patient shall be advised of the benefits and risks associated with the opioid. 5
155155
156156 (2) When a patient is co–prescribed a benzodiazepine with an opioid that 6
157157 is prescribed under subsection (b) of this section, the patient shall be advised of the benefits 7
158158 and risks associated with the benzodiazepine and the co –prescription of the 8
159159 benzodiazepine. 9
160160
161161 (e) A violation of subsection (b) or (d) of this section is grounds for POSSIBLE 10
162162 disciplinary action [by] AT THE DISCRETION OF the health occupations board that 11
163163 regulates the health care provider who commits the ALLEGED violation. 12
164164
165165 1–223.1. 13
166166
167167 (A) IN THIS SECTION , “CONTROLLED DANGEROUS SUBSTANCE” HAS THE 14
168168 MEANING STATED IN § 5–101 OF THE CRIMINAL LAW ARTICLE. 15
169169
170170 (B) A HEALTH CARE PROVIDER SHALL MAKE A GOOD –FAITH EFFORT TO 16
171171 MAINTAIN A PREVIOUSLY PRESCRIBED DOSAGE OF AND REGIMEN FOR A 17
172172 CONTROLLED DANGEROUS SUBSTANCE AND MAKE ANY TIMELY REFE RRALS 18
173173 NECESSARY TO ENSURE A PATIENT’S CONTINUED CARE FOR A PATIENT WHO : 19
174174
175175 (1) LOSES ACCESS TO THE P ATIENT’S HEALTH CARE PROVID ER WHO 20
176176 MANAGES THE PATIENT ’S CONTROLLED DANGERO US SUBSTANCE ; AND 21
177177
178178 (2) SEEKS A CONTINUANCE O F A PRESCRIPTIO N. 22
179179
180180 (C) A HEALTH CARE PROVIDER MAY ACCESS INFORMATI ON RELATING TO 23
181181 ANY PREVIOUS DOSAGES AND REGIMENS FOR CON TROLLED DANGEROUS 24
182182 SUBSTANCES BY REVIEW ING PRESCRIPTION MON ITORING DATA IF: 25
183183
184184 (1) ELECTRONIC OR PHYSICAL RECORDS , INCLUDING 26
185185 DOCUMENTATION OF PREVIOUS DOSAGES , ARE UNAVAILABLE; AND 27
186186
187187 (2) A REGIMEN FOR CONTROLLE D DANGEROUS SUBSTANC ES IS 28
188188 NECESSARY. 29
189189
190190 (D) A REFERRAL MADE UNDER SUB SECTION (B) OF THIS SECTION MAY 30 SENATE BILL 865 5
191191
192192
193193 INCLUDE: 1
194194
195195 (1) MENTAL HEALTH MEDICAT ION MANAGEMENT ; 2
196196
197197 (2) PAIN MEDICATION MANAG EMENT; AND 3
198198
199199 (3) A REFERRAL TO A NEW HEALTH CARE PROVIDER . 4
200200
201201 (E) A HEALTH CARE PROVIDER WHO PROVIDES TREATME NT UNDER THIS 5
202202 SECTION MAY NOT BE HELD LIAB LE IN A CIVIL OR CRIMINAL ACTION IF THE HEALTH 6
203203 CARE PROVIDER MAKES A GOOD–FAITH EFFORT TO COMPLY WITH THE P ROVISIONS 7
204204 OF THIS SECTION FOR 90 DAYS AFTER THE DAY OF THE FIRST VISIT OF T HE PATIENT 8
205205 AT WHICH THE HEALTH CARE PROVIDER IS CONTINUING PREVIO US DOSES OF OR A 9
206206 REGIMEN FOR A CONTROLLED DANGERO US SUBSTANCE . 10
207207
208208 SUBTITLE 11. REQUIREMENTS FOR PRESCRIBING OPIOIDS FOR CHRONIC PAIN 11
209209 AND LONG–TERM OXYGEN THERAPY. 12
210210
211211 1–1101. 13
212212
213213 (A) IN THIS SUBTITLE THE FOLLOWING WORDS HAVE THE MEANINGS 14
214214 INDICATED. 15
215215
216216 (B) (1) “CHRONIC PAIN” MEANS A CONDITION: 16
217217
218218 (I) IN WHICH A PATIENT ’S PAIN PERSISTS BEYO ND THE USUAL 17
219219 COURSE OF AN ACUTE D ISEASE OR HEALING OF AN INJURY; OR 18
220220
221221 (II) THAT MAY OR MAY NOT B E ASSOCIATED WITH AN ACUTE OR 19
222222 CHRONIC PATHOLOGIC P ROCESS THAT CAUSES C ONTINUOUS OR INTERMI TTENT 20
223223 PAIN OVER MONTHS OR YEA RS. 21
224224
225225 (2) “CHRONIC PAIN” INCLUDES: 22
226226
227227 (I) INTERMITTENT EPISODIC PAIN THAT MIGHT REQU IRE 23
228228 PERIODIC TREATMENT ; AND 24
229229
230230 (II) PAIN DESCRIBED AS : 25
231231
232232 1. CHRONIC EPISODIC ; 26
233233
234234 2. CHRONIC RELAPSING ; 27
235235 6 SENATE BILL 865
236236
237237
238238 3. HIGH IMPACT; OR 1
239239
240240 4. INTRACTABLE . 2
241241
242242 (3) “CHRONIC PAIN ” DOES NOT INCLUDE TRE ATMENT FOR PAIN 3
243243 FROM TERMINAL ILLNES S, AS DEFINED IN § 21–2A–01 OF THIS ARTICLE. 4
244244
245245 (C) “PRESCRIBER” MEANS A LICENSED HEA LTH CARE PRACTITIONE R WHO 5
246246 IS AUTHORIZED UNDER LAW TO PRESCRIBE AN OPIOID. 6
247247
248248 1–1102. 7
249249
250250 (A) (1) A PATIENT WHO EXPERIEN CES CHRONIC PAIN OR RECEIVES 8
251251 LONG–TERM OXYGEN THERAPY MAY BE ADMINISTERED ONGOING TREATMENT BY : 9
252252
253253 (I) A HEALTH CARE PRACTITI ONER WHO SPECIALIZES IN THE 10
254254 TREATMENT OF CHRONIC PAIN OR LONG–TERM OXYGEN THERAPY ; 11
255255
256256 (II) A LICENSED HEALTH CARE PRACTITIONER WHO 12
257257 SPECIALIZES IN THE I LLNESS OR INJURY FRO M WHICH THE PATIENT SUFFERS; OR 13
258258
259259 (III) THE PATIENT’S PRIMARY CARE PROVI DER. 14
260260
261261 (2) A PRIMARY CARE PROVIDE R WHO ADMINISTERS TR EATMENT FOR 15
262262 A PATIENT’S CHRONIC PAIN OR LONG–TERM OXYGEN THERAPY UNDER PARAGRAPH 16
263263 (1) OF THIS SUBSECTION S HALL DOCUMENT WHETHE R THE PRIMARY CARE 17
264264 PROVIDER CONSULTED W ITH A HEALTH CARE PR ACTITIONER WHO SPECI ALIZES IN 18
265265 THE TREATMENT OF THE PATIENT’S SPECIFIC ILLNESS O R INJURY OR A PAIN 19
266266 MANAGEMENT PRACTITIO NER. 20
267267
268268 (B) A DIAGNOSIS OF CHRONIC PAIN MADE BY A PRESC RIBER AND 21
269269 SUPPORTED BY WRITTEN DOCUMENTATION OF THE DIAGNOSIS BY THE TRE ATING 22
270270 PRESCRIBER SHALL BE CONSIDERED PROOF THA T A PATIENT SUFFERS FROM 23
271271 CHRONIC PAIN. 24
272272
273273 (C) A PRESCRIBER WHO PROVI DES TREATMENT TO A PATIENT WHO 25
274274 EXPERIENCES CHRONIC PAIN OR RECEIVES LONG–TERM OXYGEN THERAPY : 26
275275
276276 (1) SHALL MAKE ALL DECISIONS REGARD ING THE TREATMENT OF A 27
277277 PATIENT EXPERIENCING CHRONIC PAIN OR RECEIVING LONG–TERM OXYGEN 28
278278 THERAPY, INCLUDING THE DECISI ON OF WHETHER THE TR EATMENT REQUIRES THE 29
279279 PRESCRIPTION OF OPIO IDS; 30
280280 SENATE BILL 865 7
281281
282282
283283 (2) SHALL ADMINISTER CARE SUFFICIENT TO TREAT A PATIENT 1
284284 BASED ON ONGOING , OBJECTIVE EVALUATION S OF A PATIENT WITHO UT FEAR OF 2
285285 REPRIMAND OR DISCIPL INE; AND 3
286286
287287 (3) MAY NOT MAKE A DETERMINA TION BASED ON SPECIF IC 4
288288 MORPHINE MILLIGRAM E QUIVALENT GUIDELINES WHEN ORDERING , PRESCRIBING, 5
289289 DISPENSING, ADMINISTERING , OR PURCHASING CONTRO LLED DANGEROUS 6
290290 SUBSTANCES, INCLUDING OPIOIDS . 7
291291
292292 (D) A PRESCRIBER WHO PROVI DES TREATMENT TO A P ATIENT WHO 8
293293 EXPERIENCES CHRONIC PAIN OR RECEIVES LONG–TERM OXYGEN THERAPY SHALL: 9
294294
295295 (1) DOCUMENT IN THE PATIE NT’S MEDICAL RECORD THE PATIENT’S 10
296296 MEDICAL CONDITION AN D TREATMENT ; 11
297297
298298 (2) IF OPIOIDS ARE ADMINI STERED, ADMINISTER THE OPIOI DS IN 12
299299 THE LOWEST AMOUNT NE CESSARY TO CONTROL T HE PATIENT’S CHRONIC PAIN; 13
300300
301301 (3) IF OPIOIDS ARE PRESCR IBED: 14
302302
303303 (I) PRESCRIBE THE OPIOIDS IN A MEASURED AND MO NITORED 15
304304 MANNER; 16
305305
306306 (II) CLOSELY MONITOR THE P ATIENT’S PRESCRIPTION ; AND 17
307307
308308 (III) TITRATE THE PATIENT ’S PRESCRIPTION TO THE LOWEST 18
309309 EFFECTIVE DOSE OF TH E PRESCRIPTION FOR THE DURATION OF THE PATIENT’S 19
310310 CHRONIC PAIN OR LONG–TERM OXYGEN THERAPY , AS NECESSARY , THROUGH 20
311311 ONGOING, OBJECTIVE EVALUATION S TO ACHIEVE ONGOING , SUCCESSFUL 21
312312 TREATMENT ; AND 22
313313
314314 (4) CONTINUE TREATMENT FO R A PATIENT WHO: 23
315315
316316 (I) IS ON A MANAGED AND M ONITORED REGIMEN OF OPIOID 24
317317 TREATMENT ; 25
318318
319319 (II) HAS INCREASED FUNCTIO NALITY AND QUALITY O F LIFE AS 26
320320 A RESULT OF THE TREA TMENT; AND 27
321321
322322 (III) SHOWS NO INDICATION O F MISUSE OR DIVERSIO N. 28
323323
324324 (E) A PRESCRIBER WHO PROVI DES TREATMENT UNDER THIS SECTION MAY 29
325325 NOT BE HELD LIABLE I N A CIVIL OR CRIMINA L ACTION IF THE PRESCRIBER MA KES A 30 8 SENATE BILL 865
326326
327327
328328 GOOD–FAITH EFFORT TO COMPLY WITH THIS SECTION. 1
329329
330330 1–1103. 2
331331
332332 (A) ON OR BEFORE JANUARY 1, 2023, THE DEPARTMENT SHALL ADOP T 3
333333 REGULATIONS TO CARRY O UT THIS SUBTITLE. 4
334334
335335 (B) THE REGULATIONS ADOPT ED BY THE DEPARTMENT UNDER 5
336336 SUBSECTION (A) OF THIS SECTION SHAL L: 6
337337
338338 (1) TAKE INTO CONSIDERATI ON THE INDIVIDUALIZE D NEEDS OF 7
339339 PATIENTS WHO RECEIVE TREATMENT IN ACCORDA NCE WITH THIS SUBTIT LE; 8
340340
341341 (2) REQUIRE PRESCRIBERS W HO ACT IN GOOD FAITH TO USE THEIR 9
342342 BEST JUDGMENT , NOTWITHSTANDING ANY STATUTE OR RULE TO T HE CONTRARY , TO 10
343343 MANAGE A PATIENT ’S CHRONIC PAIN; 11
344344
345345 (3) ENSURE THAT PATIENTS WHO RECEIVE TREATMEN T IN 12
346346 ACCORDANCE WITH THIS SUBTITLE ARE TRE ATED WITH DIGNITY AN D NOT UNDULY 13
347347 DENIED THE MEDICATIO NS NEEDED TO TREAT T HE PATIENT’S CHRONIC PAIN; AND 14
348348
349349 (4) ENSURE THAT PRESCRIBE RS MAY CO–PRESCRIBE 15
350350 BENZODIAZEPINE AS ME DICALLY APPROPRIATE IN ADDITION TO TREATMENT IN 16
351351 ACCORDANCE WITH THIS SUBTITLE. 17
352352
353353 SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect 18
354354 October 1, 2022. 19
355355