FIRST REGULAR SESSION
SENATE BILL NO. 17
103RD GENERAL ASSEMBLY
INTRODUCED BY SENATOR MAY.
0105S.01I KRISTINA MARTIN, Secretary
AN ACT
To repeal section 195.080, RSMo, and to enact in lieu thereof one new section relating to opioid
prescriptions.
Be it enacted by the General Assembly of the State of Missouri, as follows:
Section A. Section 195.080, RSMo, is repealed and one ne w 1
section enacted in lieu thereof, to be known as section 195.080, 2
to read as follows:3
195.080. 1. Except as otherwise provided in this 1
chapter and chapter 579, this chapter and chapter 579 shall 2
not apply to the following cases: prescribing, 3
administering, dispensing or selling at retail of liniments, 4
ointments, and other preparations that are susceptible of 5
external use only and that contain controlled substances in 6
such combinations of drugs as to prevent the drugs from 7
being readily extracted from such liniments, ointments, or 8
preparations, except that this chapter and chapter 579 shall 9
apply to all liniments, ointments, and other preparations 10
that contain coca leaves in any quantity or combination. 11
2. Unless otherwise provided i n sections 334.037, 12
334.104, and 334.747, a practitioner, other than a 13
veterinarian, shall not issue an initial prescription for 14
more than a seven-day supply of any opioid controlled 15
substance upon the initial consultation and treatment of a 16
patient for acute pain. Upon any subsequent consultation 17
for the same pain, the practitioner may issue any 18 SB 17 2
appropriate renewal, refill, or new prescription in 19
compliance with the general provisions of this chapter and 20
chapter 579. Prior to issuing an initial prescription for 21
an opioid controlled substance, a practitioner shall consult 22
with the patient regarding the quantity of the opioid and 23
the patient's option to fill the prescription in a lesser 24
quantity and shall inform the patient of the risks 25
associated with the opioid prescribed. If, in the 26
professional medical judgment of the practitioner, more than 27
a seven-day supply is required to treat the patient's acute 28
pain, the practitioner may issue a prescription for the 29
quantity needed to treat the p atient; provided, that the 30
practitioner shall document in the patient's medical record 31
the condition triggering the necessity for more than a seven - 32
day supply and that a nonopioid alternative was not 33
appropriate to address the patient's condition. The 34
provisions of this subsection shall not apply to 35
prescriptions for opioid controlled substances for a patient 36
who is currently undergoing treatment for cancer or sickle 37
cell disease, is receiving hospice care from a hospice 38
certified under chapter 19 7 or palliative care, is a 39
resident of a long-term care facility licensed under chapter 40
198, or is receiving treatment for substance abuse or opioid 41
dependence. 42
3. A pharmacist or pharmacy shall not be subject to 43
disciplinary action or other civi l or criminal liability for 44
dispensing or refusing to dispense medication in good faith 45
pursuant to an otherwise valid prescription that exceeds the 46
prescribing limits established by subsection 2 of this 47
section. 48
4. Unless otherwise provided in t his section, the 49
quantity of Schedule II controlled substances prescribed or 50 SB 17 3
dispensed at any one time shall be limited to a thirty -day 51
supply. The quantity of Schedule III, IV or V controlled 52
substances prescribed or dispensed at any one time shall b e 53
limited to a ninety-day supply and shall be prescribed and 54
dispensed in compliance with the general provisions of this 55
chapter and chapter 579. The supply limitations provided in 56
this subsection may be increased up to three months if the 57
physician describes on the prescription form or indicates 58
via telephone, fax, or electronic communication to the 59
pharmacy to be entered on or attached to the prescription 60
form the medical reason for requiring the larger supply. 61
The supply limitations provided i n this subsection shall not 62
apply if: 63
(1) The prescription is issued by a practitioner 64
located in another state according to and in compliance with 65
the applicable laws of that state and the United States and 66
dispensed to a patient located in anot her state; or 67
(2) The prescription is dispensed directly to a member 68
of the United States Armed Forces serving outside the United 69
States. 70
5. The partial filling of a prescription for a 71
Schedule II substance is permissible as defined by 72
regulation by the department of health and senior services. 73
6. (1) Prior to issuing an initial prescription for a 74
Schedule II controlled substance or any other opioid pain 75
reliever in a course of treatment for acute or chronic pain 76
and prior to issuing a third prescription of the same in the 77
same course of treatment, a practitioner shall discuss with 78
the patient, or the patient's parent or guardian if the 79
patient is under eighteen years of age and is not 80
emancipated, the risks associated with the drugs being 81
prescribed, including, but not limited to, the following: 82 SB 17 4
(a) The risks of addiction and overdose associated 83
with opioid drugs and the dangers of taking opioid drugs 84
with alcohol, benzodiazepines, and other central nervous 85
system depressants; 86
(b) The reasons why the prescription is necessary; 87
(c) Alternative treatments that may be available; and 88
(d) The risks associated with the use of the drugs 89
prescribed, specifically that opioids are highly addictive, 90
even when taken as prescribed; that there is a risk of 91
developing a physical or psychological dependence on the 92
controlled substance; and that the risks of taking more 93
opioids than prescribed, or mixing sedatives, 94
benzodiazepines, or alcohol with opioids, may res ult in 95
fatal respiratory depression. 96
(2) The practitioner shall include a note in the 97
patient's medical record that the patient or the patient's 98
parent or guardian has discussed with the practitioner the 99
risks of developing a physical or psycholo gical dependence 100
on the controlled substance and alternative treatments that 101
may be available. The consultation described in this 102
subsection shall satisfy the consultation requirements of 103
subsection 2 of this section for initial prescriptions for 104
more than a seven-day supply of any opioid controlled 105
substance. 106
(3) The provisions of this subsection shall not apply 107
to a prescription for a patient who is in active treatment 108
for cancer, receiving hospice care from a hospice certified 109
under chapter 197 or palliative care, is a resident of a 110
long-term care facility licensed under chapter 198, or is 111
receiving treatment for substance abuse or opioid dependence. 112