EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
*sb0865*
SENATE BILL 865
J2, J1 2lr0478
By: Senator Ready
Introduced and read first time: February 7, 2022
Assigned to: Education, Health, and Environmental Affairs
A BILL ENTITLED
AN ACT concerning 1
Controlled Dangerous Substances and Treatment of Chronic Pain and 2
Long–Term Oxygen Use Patients 3
(Continuity of Care Act of 2022) 4
FOR the purpose of altering certain requirements related to the provision of information 5
regarding opioid use disorder by the Maryland Department of Health , the 6
prescribing of opioids, and the filling of prescriptions for monitored prescription 7
drugs; establishing certain civil and criminal immunity; requiring a health care 8
provider to make a good–faith effort to maintain the previous dosage of and regimen 9
for a controlled dangerous substance and make certain referrals for a certain patient; 10
providing that a patient who experiences and is diagnosed with chronic pain or 11
receives long–term oxygen therapy may be administered ongoing treatment by 12
certain practitioners or providers; establishing requirements for prescribers who 13
treat patients who experience chronic pain or receive long–term oxygen therapy; and 14
generally relating to controlled dangerous substances and the treatment of chronic 15
pain and long–term oxygen use patients. 16
BY repealing and reenacting, with amendments, 17
Article – Health – General 18
Section 8–407(a)(1) and 21–2A–04.2(e) and (f) 19
Annotated Code of Maryland 20
(2019 Replacement Volume and 2021 Supplement) 21
BY adding to 22
Article – Health – General 23
Section 21–2A–04.2(f) 24
Annotated Code of Maryland 25
(2019 Replacement Volume and 2021 Supplement) 26
BY repealing and reenacting, with amendments, 27
Article – Health Occupations 28 2 SENATE BILL 865
Section 1–223 1
Annotated Code of Maryland 2
(2021 Replacement Volume) 3
BY adding to 4
Article – Health Occupations 5
Section 1–223.1; and 1–1101 through 1–1103 to be under the new subtitle “Subtitle 6
11. Requirements for Prescribing Opioids for Chronic Pain and Long–Term 7
Oxygen Therapy” 8
Annotated Code of Maryland 9
(2021 Replacement Volume) 10
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 11
That the Laws of Maryland read as follows: 12
Article – Health – General 13
8–407. 14
(a) The Department shall identify up–to–date, evidence–based, written 15
information about opioid use disorder that: 16
(1) Has been reviewed, USING THE CURRENT VE RSION OF THE 17
AMERICAN PSYCHIATRIC ASSOCIATION’S “DIAGNOSTIC AND STATISTICAL MANUAL 18
OF MENTAL DISORDERS”, by medical experts and national and local organizations 19
specializing in the treatment of opioid use disorder; 20
21–2A–04.2. 21
(e) If a pharmacist or pharmacist delegate has a reasonable belief that a patient 22
may be seeking a monitored prescription drug for any purpose other than the treatment of 23
an existing medical condition: 24
(1) (I) Before dispensing a monitored prescription drug to the patient, 25
the pharmacist or pharmacist delegate shall request prescription monitoring data to 26
determine if the patient has received other prescriptions that indicate misuse, abuse, or 27
diversion of a monitored prescription drug; [and] 28
(II) AFTER REVIEW OF THE PRESCR IPTION MONITORING DA TA, 29
IF THE PHARMACIST OR PHARMACIST DELEGATE HAS A REASONABLE BEL IEF THAT 30
A PATIENT MAY BE SEE KING A MONITORED PRESCRIP TION DRUG FOR MISUSE, 31
ABUSE, OR DIVERSION , THE PHARMACIST OR PH ARMACIST DELEGATE SH ALL 32
CONTACT THE PRESCRIB ER TO VERIFY AND COMMUN ICATE ANY POSSIBLE 33
CONCERNS; AND 34
(III) IF THE PRESCRIB ER CONFIRMS THAT THE PRESCRIPTION 35 SENATE BILL 865 3
WAS FOR THE PURPOSE OF THE TREATMENT OF AN EXISTING MEDICAL CONDITION, 1
THE PHARMACIST OR PH ARMACIST DELEGATE SH ALL FILL THE PRESCRI PTION AS 2
WRITTEN; AND 3
(2) The pharmacist shall have the responsibility described in 21 C.F.R. § 4
1306.04. 5
(F) A PHARMACI ST OR LICENSED PHARM ACY MAY NOT BE HELD LIABLE IN 6
A CIVIL OR CRIMINAL ACTION SOLELY FOR DI SPENSING AN OPIOID I F THE 7
PHARMACIST OR LICENS ED PHARMACY COMPLIED WITH THE REQUIREMENTS OF 8
THIS SECTION. 9
[(f)] (G) The Secretary may adopt regulations to provide additional clinical, 10
technical, or administrative exemptions based on new standards of practice. 11
Article – Health Occupations 12
1–223. 13
(a) In this section, “controlled dangerous substance” has the meaning stated in § 14
5–101 of the Criminal Law Article. 15
(b) On treatment for pain, a health care provider, based on the clinical judgment 16
of the health care provider, shall prescribe: 17
(1) The lowest effective dose of an opioid; and 18
(2) A quantity that is no greater than the quantity needed for the expected 19
duration of pain severe enough to require an opioid that is a controlled dangerous substance 20
unless the opioid is prescribed to treat: 21
(i) A substance–related disorder; 22
(ii) Pain associated with a cancer diagnosis; 23
(iii) Pain experienced while the patient is receiving end–of–life, 24
hospice, or palliative care services; or 25
(iv) Chronic pain. 26
(c) The dosage, quantity, and duration of an opioid prescribed under subsection 27
(b) of this section shall be based on [an evidence–based clinical guideline for prescribing 28
controlled dangerous substances] THE PRESCRIBER ’S CLINICAL JUDGMENT AFTER 29
CONSIDERATION OF AN EVIDENCE–BASED CLINICAL GUIDE LINE that is appropriate 30
for: 31
4 SENATE BILL 865
(1) The health care service delivery setting for the patient; 1
(2) The type of health care services required by the patient; and 2
(3) The age and health status of the patient. 3
(d) (1) When a patient is prescribed an opioid under subsection (b) of this 4
section, the patient shall be advised of the benefits and risks associated with the opioid. 5
(2) When a patient is co–prescribed a benzodiazepine with an opioid that 6
is prescribed under subsection (b) of this section, the patient shall be advised of the benefits 7
and risks associated with the benzodiazepine and the co –prescription of the 8
benzodiazepine. 9
(e) A violation of subsection (b) or (d) of this section is grounds for POSSIBLE 10
disciplinary action [by] AT THE DISCRETION OF the health occupations board that 11
regulates the health care provider who commits the ALLEGED violation. 12
1–223.1. 13
(A) IN THIS SECTION , “CONTROLLED DANGEROUS SUBSTANCE” HAS THE 14
MEANING STATED IN § 5–101 OF THE CRIMINAL LAW ARTICLE. 15
(B) A HEALTH CARE PROVIDER SHALL MAKE A GOOD –FAITH EFFORT TO 16
MAINTAIN A PREVIOUSLY PRESCRIBED DOSAGE OF AND REGIMEN FOR A 17
CONTROLLED DANGEROUS SUBSTANCE AND MAKE ANY TIMELY REFE RRALS 18
NECESSARY TO ENSURE A PATIENT’S CONTINUED CARE FOR A PATIENT WHO : 19
(1) LOSES ACCESS TO THE P ATIENT’S HEALTH CARE PROVID ER WHO 20
MANAGES THE PATIENT ’S CONTROLLED DANGERO US SUBSTANCE ; AND 21
(2) SEEKS A CONTINUANCE O F A PRESCRIPTIO N. 22
(C) A HEALTH CARE PROVIDER MAY ACCESS INFORMATI ON RELATING TO 23
ANY PREVIOUS DOSAGES AND REGIMENS FOR CON TROLLED DANGEROUS 24
SUBSTANCES BY REVIEW ING PRESCRIPTION MON ITORING DATA IF: 25
(1) ELECTRONIC OR PHYSICAL RECORDS , INCLUDING 26
DOCUMENTATION OF PREVIOUS DOSAGES , ARE UNAVAILABLE; AND 27
(2) A REGIMEN FOR CONTROLLE D DANGEROUS SUBSTANC ES IS 28
NECESSARY. 29
(D) A REFERRAL MADE UNDER SUB SECTION (B) OF THIS SECTION MAY 30 SENATE BILL 865 5
INCLUDE: 1
(1) MENTAL HEALTH MEDICAT ION MANAGEMENT ; 2
(2) PAIN MEDICATION MANAG EMENT; AND 3
(3) A REFERRAL TO A NEW HEALTH CARE PROVIDER . 4
(E) A HEALTH CARE PROVIDER WHO PROVIDES TREATME NT UNDER THIS 5
SECTION MAY NOT BE HELD LIAB LE IN A CIVIL OR CRIMINAL ACTION IF THE HEALTH 6
CARE PROVIDER MAKES A GOOD–FAITH EFFORT TO COMPLY WITH THE P ROVISIONS 7
OF THIS SECTION FOR 90 DAYS AFTER THE DAY OF THE FIRST VISIT OF T HE PATIENT 8
AT WHICH THE HEALTH CARE PROVIDER IS CONTINUING PREVIO US DOSES OF OR A 9
REGIMEN FOR A CONTROLLED DANGERO US SUBSTANCE . 10
SUBTITLE 11. REQUIREMENTS FOR PRESCRIBING OPIOIDS FOR CHRONIC PAIN 11
AND LONG–TERM OXYGEN THERAPY. 12
1–1101. 13
(A) IN THIS SUBTITLE THE FOLLOWING WORDS HAVE THE MEANINGS 14
INDICATED. 15
(B) (1) “CHRONIC PAIN” MEANS A CONDITION: 16
(I) IN WHICH A PATIENT ’S PAIN PERSISTS BEYO ND THE USUAL 17
COURSE OF AN ACUTE D ISEASE OR HEALING OF AN INJURY; OR 18
(II) THAT MAY OR MAY NOT B E ASSOCIATED WITH AN ACUTE OR 19
CHRONIC PATHOLOGIC P ROCESS THAT CAUSES C ONTINUOUS OR INTERMI TTENT 20
PAIN OVER MONTHS OR YEA RS. 21
(2) “CHRONIC PAIN” INCLUDES: 22
(I) INTERMITTENT EPISODIC PAIN THAT MIGHT REQU IRE 23
PERIODIC TREATMENT ; AND 24
(II) PAIN DESCRIBED AS : 25
1. CHRONIC EPISODIC ; 26
2. CHRONIC RELAPSING ; 27
6 SENATE BILL 865
3. HIGH IMPACT; OR 1
4. INTRACTABLE . 2
(3) “CHRONIC PAIN ” DOES NOT INCLUDE TRE ATMENT FOR PAIN 3
FROM TERMINAL ILLNES S, AS DEFINED IN § 21–2A–01 OF THIS ARTICLE. 4
(C) “PRESCRIBER” MEANS A LICENSED HEA LTH CARE PRACTITIONE R WHO 5
IS AUTHORIZED UNDER LAW TO PRESCRIBE AN OPIOID. 6
1–1102. 7
(A) (1) A PATIENT WHO EXPERIEN CES CHRONIC PAIN OR RECEIVES 8
LONG–TERM OXYGEN THERAPY MAY BE ADMINISTERED ONGOING TREATMENT BY : 9
(I) A HEALTH CARE PRACTITI ONER WHO SPECIALIZES IN THE 10
TREATMENT OF CHRONIC PAIN OR LONG–TERM OXYGEN THERAPY ; 11
(II) A LICENSED HEALTH CARE PRACTITIONER WHO 12
SPECIALIZES IN THE I LLNESS OR INJURY FRO M WHICH THE PATIENT SUFFERS; OR 13
(III) THE PATIENT’S PRIMARY CARE PROVI DER. 14
(2) A PRIMARY CARE PROVIDE R WHO ADMINISTERS TR EATMENT FOR 15
A PATIENT’S CHRONIC PAIN OR LONG–TERM OXYGEN THERAPY UNDER PARAGRAPH 16
(1) OF THIS SUBSECTION S HALL DOCUMENT WHETHE R THE PRIMARY CARE 17
PROVIDER CONSULTED W ITH A HEALTH CARE PR ACTITIONER WHO SPECI ALIZES IN 18
THE TREATMENT OF THE PATIENT’S SPECIFIC ILLNESS O R INJURY OR A PAIN 19
MANAGEMENT PRACTITIO NER. 20
(B) A DIAGNOSIS OF CHRONIC PAIN MADE BY A PRESC RIBER AND 21
SUPPORTED BY WRITTEN DOCUMENTATION OF THE DIAGNOSIS BY THE TRE ATING 22
PRESCRIBER SHALL BE CONSIDERED PROOF THA T A PATIENT SUFFERS FROM 23
CHRONIC PAIN. 24
(C) A PRESCRIBER WHO PROVI DES TREATMENT TO A PATIENT WHO 25
EXPERIENCES CHRONIC PAIN OR RECEIVES LONG–TERM OXYGEN THERAPY : 26
(1) SHALL MAKE ALL DECISIONS REGARD ING THE TREATMENT OF A 27
PATIENT EXPERIENCING CHRONIC PAIN OR RECEIVING LONG–TERM OXYGEN 28
THERAPY, INCLUDING THE DECISI ON OF WHETHER THE TR EATMENT REQUIRES THE 29
PRESCRIPTION OF OPIO IDS; 30
SENATE BILL 865 7
(2) SHALL ADMINISTER CARE SUFFICIENT TO TREAT A PATIENT 1
BASED ON ONGOING , OBJECTIVE EVALUATION S OF A PATIENT WITHO UT FEAR OF 2
REPRIMAND OR DISCIPL INE; AND 3
(3) MAY NOT MAKE A DETERMINA TION BASED ON SPECIF IC 4
MORPHINE MILLIGRAM E QUIVALENT GUIDELINES WHEN ORDERING , PRESCRIBING, 5
DISPENSING, ADMINISTERING , OR PURCHASING CONTRO LLED DANGEROUS 6
SUBSTANCES, INCLUDING OPIOIDS . 7
(D) A PRESCRIBER WHO PROVI DES TREATMENT TO A P ATIENT WHO 8
EXPERIENCES CHRONIC PAIN OR RECEIVES LONG–TERM OXYGEN THERAPY SHALL: 9
(1) DOCUMENT IN THE PATIE NT’S MEDICAL RECORD THE PATIENT’S 10
MEDICAL CONDITION AN D TREATMENT ; 11
(2) IF OPIOIDS ARE ADMINI STERED, ADMINISTER THE OPIOI DS IN 12
THE LOWEST AMOUNT NE CESSARY TO CONTROL T HE PATIENT’S CHRONIC PAIN; 13
(3) IF OPIOIDS ARE PRESCR IBED: 14
(I) PRESCRIBE THE OPIOIDS IN A MEASURED AND MO NITORED 15
MANNER; 16
(II) CLOSELY MONITOR THE P ATIENT’S PRESCRIPTION ; AND 17
(III) TITRATE THE PATIENT ’S PRESCRIPTION TO THE LOWEST 18
EFFECTIVE DOSE OF TH E PRESCRIPTION FOR THE DURATION OF THE PATIENT’S 19
CHRONIC PAIN OR LONG–TERM OXYGEN THERAPY , AS NECESSARY , THROUGH 20
ONGOING, OBJECTIVE EVALUATION S TO ACHIEVE ONGOING , SUCCESSFUL 21
TREATMENT ; AND 22
(4) CONTINUE TREATMENT FO R A PATIENT WHO: 23
(I) IS ON A MANAGED AND M ONITORED REGIMEN OF OPIOID 24
TREATMENT ; 25
(II) HAS INCREASED FUNCTIO NALITY AND QUALITY O F LIFE AS 26
A RESULT OF THE TREA TMENT; AND 27
(III) SHOWS NO INDICATION O F MISUSE OR DIVERSIO N. 28
(E) A PRESCRIBER WHO PROVI DES TREATMENT UNDER THIS SECTION MAY 29
NOT BE HELD LIABLE I N A CIVIL OR CRIMINA L ACTION IF THE PRESCRIBER MA KES A 30 8 SENATE BILL 865
GOOD–FAITH EFFORT TO COMPLY WITH THIS SECTION. 1
1–1103. 2
(A) ON OR BEFORE JANUARY 1, 2023, THE DEPARTMENT SHALL ADOP T 3
REGULATIONS TO CARRY O UT THIS SUBTITLE. 4
(B) THE REGULATIONS ADOPT ED BY THE DEPARTMENT UNDER 5
SUBSECTION (A) OF THIS SECTION SHAL L: 6
(1) TAKE INTO CONSIDERATI ON THE INDIVIDUALIZE D NEEDS OF 7
PATIENTS WHO RECEIVE TREATMENT IN ACCORDA NCE WITH THIS SUBTIT LE; 8
(2) REQUIRE PRESCRIBERS W HO ACT IN GOOD FAITH TO USE THEIR 9
BEST JUDGMENT , NOTWITHSTANDING ANY STATUTE OR RULE TO T HE CONTRARY , TO 10
MANAGE A PATIENT ’S CHRONIC PAIN; 11
(3) ENSURE THAT PATIENTS WHO RECEIVE TREATMEN T IN 12
ACCORDANCE WITH THIS SUBTITLE ARE TRE ATED WITH DIGNITY AN D NOT UNDULY 13
DENIED THE MEDICATIO NS NEEDED TO TREAT T HE PATIENT’S CHRONIC PAIN; AND 14
(4) ENSURE THAT PRESCRIBE RS MAY CO–PRESCRIBE 15
BENZODIAZEPINE AS ME DICALLY APPROPRIATE IN ADDITION TO TREATMENT IN 16
ACCORDANCE WITH THIS SUBTITLE. 17
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect 18
October 1, 2022. 19