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Missouri Senate Bill SB292

Missouri 2025 Regular Session

Missouri Senate Bill SB292 Compare Versions

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1-1298S.03C
2- 1
3-SENATE COMMITTEE SUBSTITUTE
4-FOR
1+
2+EXPLANATION-Matter enclosed in bold-faced brackets [thus] in this bill is not enacted
3+and is intended to be omitted in the law.
4+FIRST REGULAR SESSION
55 SENATE BILL NO. 292
6+103RD GENERAL ASSEMBLY
7+INTRODUCED BY SENATOR CRAWFORD.
8+1298S.01I KRISTINA MARTIN, Secretary
69 AN ACT
7-To repeal sections 195.010, 195.030, 195.070,
8-334.031, 334.035, and 338.165, RSMo, and to enact in
9-lieu thereof six new sections relating to health care
10-providers.
10+To repeal sections 195.010, 195.030, 195.070, 334.031, 334.035, and 338.165, RSMo, and to enact
11+in lieu thereof six new sections relating to health care providers.
1112
1213 Be it enacted by the General Assembly of the State of Missouri, as follows:
13- Section A. Sections 195.010, 195.030, 195.070, 334.031,
14-334.035, and 338.165, RSMo, are repealed and six new sections
15-enacted in lieu thereof, to be known as sections 195.010,
16-195.030, 195.070, 334.031, 334.035, and 338.165, to read as
17-follows:
18- 195.010. The following words and phrases as used in
19-this chapter and chapter 579, unless the context otherwise
20-requires, mean:
21- (1) "Acute pain", pain, whether resulting from
22-disease, accidental or intentional trauma, or other causes,
23-that the practitioner reasonably expects to last only a
24-short period of time. Acute pain shall not include chronic
25-pain, pain being treated as part of cancer care, hospice or
26-other end-of-life care, or medication -assisted treatment for
27-substance use disorders;
28- (2) "Addict", a person who habitually uses one or more
29-controlled substances to such an extent as to create a
30-tolerance for such drugs, and who does not have a medical
31-need for such drugs, or who is so far addicted to the use of
32-such drugs as to have lost the power of self -control with
33-reference to his or her addiction;
34- (3) "Administer", to apply a controlled substance,
35-whether by injection, inhalation, ingestion, or any other
36- 2
37-means, directly to the body of a patient or research subject
38-by:
39- (a) A practitioner (or, in his or her presence, by his
40-or her authorized agent); or
41- (b) The patient or research subject at the direction
42-and in the presence of the practitioner;
43- (4) "Agent", an authorized person who acts on behalf
44-of or at the direction of a manufacturer, distributor, or
45-dispenser. The term does not include a common or contract
46-carrier, public warehouseman, or employee of the carrier or
47-warehouseman while acting in the usual and lawful course of
48-the carrier's or warehouseman's business;
49- (5) "Attorney for the state", any prosecuting
50-attorney, circuit attorney, or attorney general authorized
51-to investigate, commence and prosecute an action under this
52-chapter;
53- (6) "Controlled substance", a drug, subs tance, or
54-immediate precursor in Schedules I through V listed in this
55-chapter;
56- (7) "Controlled substance analogue", a substance the
57-chemical structure of which is substantially similar to the
58-chemical structure of a controlled substance in Schedu le I
59-or II and:
60- (a) Which has a stimulant, depressant, or
61-hallucinogenic effect on the central nervous system
62-substantially similar to the stimulant, depressant, or
63-hallucinogenic effect on the central nervous system of a
64-controlled substance in cluded in Schedule I or II; or
65- (b) With respect to a particular individual, which
66-that individual represents or intends to have a stimulant,
67-depressant, or hallucinogenic effect on the central nervous
68-system substantially similar to the stimulant, depressant,
69-or hallucinogenic effect on the central nervous system of a
70- 3
71-controlled substance included in Schedule I or II. The term
72-does not include a controlled substance; any substance for
73-which there is an approved new drug application; any
74-substance for which an exemption is in effect for
75-investigational use, for a particular person, under Section
76-505 of the federal Food, Drug and Cosmetic Act (21 U.S.C.
77-Section 355) to the extent conduct with respect to the
78-substance is pursuant to the exemp tion; or any substance to
79-the extent not intended for human consumption before such an
80-exemption takes effect with respect to the substance;
81- (8) "Counterfeit substance", a controlled substance
82-which, or the container or labeling of which, without
83-authorization, bears the trademark, trade name, or other
84-identifying mark, imprint, number or device, or any likeness
85-thereof, of a manufacturer, distributor, or dispenser other
86-than the person who in fact manufactured, distributed, or
87-dispensed the substance;
88- (9) "Deliver" or "delivery", the actual, constructive,
89-or attempted transfer from one person to another of drug
90-paraphernalia or of a controlled substance, or an imitation
91-controlled substance, whether or not there is an agency
92-relationship, and includes a sale;
93- (10) "Dentist", a person authorized by law to practice
94-dentistry in this state;
95- (11) "Depressant or stimulant substance":
96- (a) A drug containing any quantity of barbituric acid
97-or any of the salts of barbituric acid or any derivative of
98-barbituric acid which has been designated by the United
99-States Secretary of Health and Human Services as habit
100-forming under 21 U.S.C. Section 352(d);
101- (b) A drug containing any quantity of:
102- a. Amphetamine or any of its isomers;
103- 4
104- b. Any salt of amphetamine or any salt of an isomer of
105-amphetamine; or
106- c. Any substance the United States Attorney General,
107-after investigation, has found to be, and by regulation
108-designated as, habit forming because of its sti mulant effect
109-on the central nervous system;
110- (c) Lysergic acid diethylamide; or
111- (d) Any drug containing any quantity of a substance
112-that the United States Attorney General, after
113-investigation, has found to have, and by regulation
114-designated as having, a potential for abuse because of its
115-depressant or stimulant effect on the central nervous system
116-or its hallucinogenic effect;
117- (12) "Dispense", to deliver a narcotic or controlled
118-dangerous drug to an ultimate user or research subjec t by or
119-pursuant to the lawful order of a practitioner including the
120-prescribing, administering, packaging, labeling, or
121-compounding necessary to prepare the substance for such
122-delivery. "Dispenser" means a practitioner who dispenses;
123- (13) "Distribute", to deliver other than by
124-administering or dispensing a controlled substance;
125- (14) "Distributor", a person who distributes;
126- (15) "Drug":
127- (a) Substances recognized as drugs in the official
128-United States Pharmacopoeia, Official Ho meopathic
129-Pharmacopoeia of the United States, or Official National
130-Formulary, or any supplement to any of them;
131- (b) Substances intended for use in the diagnosis,
132-cure, mitigation, treatment or prevention of disease in
133-humans or animals;
134- (c) Substances, other than food, intended to affect
135-the structure or any function of the body of humans or
136-animals; and
137- 5
138- (d) Substances intended for use as a component of any
139-article specified in this subdivision. It does not include
140-devices or their components, parts or accessories;
141- (16) "Drug-dependent person", a person who is using a
142-controlled substance and who is in a state of psychic or
143-physical dependence, or both, arising from the use of such
144-substance on a continuous basis. Drug dependence is
145-characterized by behavioral and other responses which
146-include a strong compulsion to take the substance on a
147-continuous basis in order to experience its psychic effects
148-or to avoid the discomfort caused by its absence;
149- (17) "Drug enforcement agency", the Drug Enforcement
150-Administration in the United States Department of Justice,
151-or its successor agency;
152- (18) "Drug paraphernalia", all equipment, products,
153-substances and materials of any kind which are used,
154-intended for use, or designed for use, in planting,
155-propagating, cultivating, growing, harvesting,
156-manufacturing, compounding, converting, producing,
157-processing, preparing, storing, containing, concealing,
158-injecting, ingesting, inhaling, or otherwise introducing
159-into the human body a controlled substance or an imitation
160-controlled substance in violation of this chapter or chapter
161-579. It includes, but is not limited to:
162- (a) Kits used, intended for use, or designed for use
163-in planting, propagating, cultivating, growing or harvesting
164-of any species of plant which is a controlled substance or
165-from which a controlled substance can be derived;
166- (b) Kits used, intended for use, or designed for use
167-in manufacturing, compounding, converting, producing,
168-processing, or preparing controlled substances or imitation
169-controlled substances;
170- 6
171- (c) Isomerization devices used, intended for use, or
172-designed for use in increasing the potency of any species of
173-plant which is a controlled substance or an imitation
174-controlled substance;
175- (d) Testing equipment used, intended for use, or
176-designed for use in identifying, or in analyzing the
177-strength, effectiveness or purity of controlled substances
178-or imitation controlled substances;
179- (e) Scales and balances u sed, intended for use, or
180-designed for use in weighing or measuring controlled
181-substances or imitation controlled substances;
182- (f) Dilutents and adulterants, such as quinine
183-hydrochloride, mannitol, mannite, dextrose and lactose,
184-used, intended for use, or designed for use in cutting
185-controlled substances or imitation controlled substances;
186- (g) Separation gins and sifters used, intended for
187-use, or designed for use in removing twigs and seeds from,
188-or in otherwise cleaning or refining, mar ijuana;
189- (h) Blenders, bowls, containers, spoons and mixing
190-devices used, intended for use, or designed for use in
191-compounding controlled substances or imitation controlled
192-substances;
193- (i) Capsules, balloons, envelopes and other containers
194-used, intended for use, or designed for use in packaging
195-small quantities of controlled substances or imitation
196-controlled substances;
197- (j) Containers and other objects used, intended for
198-use, or designed for use in storing or concealing controlled
199-substances or imitation controlled substances;
200- (k) Hypodermic syringes, needles and other objects
201-used, intended for use, or designed for use in parenterally
202-injecting controlled substances or imitation controlled
203-substances into the human body;
204- 7
205- (l) Objects used, intended for use, or designed for
206-use in ingesting, inhaling, or otherwise introducing
207-marijuana, cocaine, hashish, or hashish oil into the human
208-body, such as:
209- a. Metal, wooden, acrylic, glass, stone, plastic, or
210-ceramic pipes with or without screens, permanent screens,
211-hashish heads, or punctured metal bowls;
212- b. Water pipes;
213- c. Carburetion tubes and devices;
214- d. Smoking and carburetion masks;
215- e. Roach clips meaning objects used to hold burning
216-material, such as a marijuana cigarette, that has become too
217-small or too short to be held in the hand;
218- f. Miniature cocaine spoons and cocaine vials;
219- g. Chamber pipes;
220- h. Carburetor pipes;
221- i. Electric pipes;
222- j. Air-driven pipes;
223- k. Chillums;
224- l. Bongs;
225- m. Ice pipes or chillers;
226- (m) Substances used, intended for use, or designed for
227-use in the manufacture of a controlled substance.
228-In determining whether an object, product, substance or
229-material is drug paraphernalia, a court or other authority
230-should consider, in addition to all other logically relevant
231-factors, the following:
232- a. Statements by an owner or by anyone in control of
233-the object concerning its use;
234- b. Prior convictions, if any, o f an owner, or of
235-anyone in control of the object, under any state or federal
236-law relating to any controlled substance or imitation
237-controlled substance;
238- 8
239- c. The proximity of the object, in time and space, to
240-a direct violation of this chapter or chapter 579;
241- d. The proximity of the object to controlled
242-substances or imitation controlled substances;
243- e. The existence of any residue of controlled
244-substances or imitation controlled substances on the object;
245- f. Direct or circumstant ial evidence of the intent of
246-an owner, or of anyone in control of the object, to deliver
247-it to persons who he or she knows, or should reasonably
248-know, intend to use the object to facilitate a violation of
249-this chapter or chapter 579; the innocence of an owner, or
250-of anyone in control of the object, as to direct violation
251-of this chapter or chapter 579 shall not prevent a finding
252-that the object is intended for use, or designed for use as
253-drug paraphernalia;
254- g. Instructions, oral or written, p rovided with the
255-object concerning its use;
256- h. Descriptive materials accompanying the object which
257-explain or depict its use;
258- i. National or local advertising concerning its use;
259- j. The manner in which the object is displayed for
260-sale;
261- k. Whether the owner, or anyone in control of the
262-object, is a legitimate supplier of like or related items to
263-the community, such as a licensed distributor or dealer of
264-tobacco products;
265- l. Direct or circumstantial evidence of the ratio of
266-sales of the object to the total sales of the business
267-enterprise;
268- m. The existence and scope of legitimate uses for the
269-object in the community;
270- n. Expert testimony concerning its use;
271- 9
272- o. The quantity, form or packaging of the produc t,
273-substance or material in relation to the quantity, form or
274-packaging associated with any legitimate use for the
275-product, substance or material;
276- (19) "Federal narcotic laws", the laws of the United
277-States relating to controlled substances;
278- (20) "Hospital", a place devoted primarily to the
279-maintenance and operation of facilities for the diagnosis,
280-treatment or care, for not less than twenty -four hours in
281-any week, of three or more nonrelated individuals suffering
282-from illness, disease, injury, deformity or other abnormal
283-physical conditions; or a place devoted primarily to
284-provide, for not less than twenty -four consecutive hours in
285-any week, medical or nursing care for three or more
286-nonrelated individuals. The term hospital does not include
287-convalescent, nursing, shelter or boarding homes as defined
288-in chapter 198, but shall include outpatient facilities
289-owned and operated by a hospital ;
290- (21) "Illegal industrial hemp":
291- (a) All nonseed parts and varieties of the Cannabis
292-sativa L. plant, growing or not, that contain an average
293-delta-9 tetrahydrocannabinol (THC) concentration exceeding
294-three-tenths of one percent on a dry weight basis;
295- (b) Illegal industrial hemp shall be destroyed in the
296-most effective manner p ossible, and such destruction shall
297-be verified by the Missouri state highway patrol;
298- (22) "Immediate precursor", a substance which:
299- (a) The state department of health and senior services
300-has found to be and by rule designates as being the
301-principal compound commonly used or produced primarily for
302-use in the manufacture of a controlled substance;
303- 10
304- (b) Is an immediate chemical intermediary used or
305-likely to be used in the manufacture of a controlled
306-substance; and
307- (c) The control of which is necessary to prevent,
308-curtail or limit the manufacture of the controlled substance;
309- (23) "Imitation controlled substance", a substance
310-that is not a controlled substance, which by dosage unit
311-appearance (including color, shape, size a nd markings), or
312-by representations made, would lead a reasonable person to
313-believe that the substance is a controlled substance. In
314-determining whether the substance is an imitation controlled
315-substance the court or authority concerned should conside r,
316-in addition to all other logically relevant factors, the
317-following:
318- (a) Whether the substance was approved by the federal
319-Food and Drug Administration for over -the-counter
320-(nonprescription or nonlegend) sales and was sold in the
321-federal Food and Drug Administration -approved package, with
322-the federal Food and Drug Administration -approved labeling
323-information;
324- (b) Statements made by an owner or by anyone else in
325-control of the substance concerning the nature of the
326-substance, or its us e or effect;
327- (c) Whether the substance is packaged in a manner
328-normally used for illicit controlled substances;
329- (d) Prior convictions, if any, of an owner, or anyone
330-in control of the object, under state or federal law related
331-to controlled substances or fraud;
332- (e) The proximity of the substances to controlled
333-substances;
334- (f) Whether the consideration tendered in exchange for
335-the noncontrolled substance substantially exceeds the
336-reasonable value of the substance considering the actual
337- 11
338-chemical composition of the substance and, where applicable,
339-the price at which over -the-counter substances of like
340-chemical composition sell. An imitation controlled
341-substance does not include a placebo or registered
342-investigational drug eit her of which was manufactured,
343-distributed, possessed or delivered in the ordinary course
344-of professional practice or research;
345- (24) "Industrial hemp":
346- (a) All nonseed parts and varieties of the Cannabis
347-sativa L. plant, growing or not, that contain an average
348-delta-9 tetrahydrocannabinol (THC) concentration that does
349-not exceed three-tenths of one percent on a dry weight basis
350-or the maximum concentration allowed under federal law,
351-whichever is greater;
352- (b) Any Cannabis sativa L. seed that is part of a
353-growing crop, retained by a grower for future planting, or
354-used for processing into or use as agricultural hemp seed;
355- (c) Industrial hemp includes industrial hemp
356-commodities and products and topical or ingestible animal
357-and consumer products derived from industrial hemp with a
358-delta-9 tetrahydrocannabinol concentration of not more than
359-three-tenths of one percent on a dry weight basis;
360- (25) "Initial prescription", a prescription issued to
361-a patient who has never pre viously been issued a
362-prescription for the drug or its pharmaceutical equivalent
363-or who was previously issued a prescription for the drug or
364-its pharmaceutical equivalent, but the date on which the
365-current prescription is being issued is more than five
366-months after the date the patient last used or was
367-administered the drug or its equivalent;
368- (26) "Laboratory", a laboratory approved by the
369-department of health and senior services as proper to be
370-entrusted with the custody of controlled substan ces but does
371- 12
372-not include a pharmacist who compounds controlled substances
373-to be sold or dispensed on prescriptions;
374- (27) "Manufacture", the production, preparation,
375-propagation, compounding or processing of drug paraphernalia
376-or of a controlled s ubstance, or an imitation controlled
377-substance, either directly or by extraction from substances
378-of natural origin, or independently by means of chemical
379-synthesis, or by a combination of extraction and chemical
380-synthesis, and includes any packaging or repackaging of the
381-substance or labeling or relabeling of its container. This
382-term does not include the preparation or compounding of a
383-controlled substance or an imitation controlled substance or
384-the preparation, compounding, packaging or labeling o f a
385-narcotic or dangerous drug:
386- (a) By a practitioner as an incident to his or her
387-administering or dispensing of a controlled substance or an
388-imitation controlled substance in the course of his or her
389-professional practice; or
390- (b) By a practitioner or his or her authorized agent
391-under his or her supervision, for the purpose of, or as an
392-incident to, research, teaching or chemical analysis and not
393-for sale;
394- (28) "Marijuana", all parts of the plant genus
395-Cannabis in any species or form thereof, including, but not
396-limited to Cannabis Sativa L., except industrial hemp,
397-Cannabis Indica, Cannabis Americana, Cannabis Ruderalis, and
398-Cannabis Gigantea, whether growing or not, the seeds
399-thereof, the resin extracted from any part of the p lant; and
400-every compound, manufacture, salt, derivative, mixture, or
401-preparation of the plant, its seeds or resin. It does not
402-include the mature stalks of the plant, fiber produced from
403-the stalks, oil or cake made from the seeds of the plant,
404-any other compound, manufacture, salt, derivative, mixture
405- 13
406-or preparation of the mature stalks (except the resin
407-extracted therefrom), fiber, oil or cake, or the sterilized
408-seed of the plant which is incapable of germination;
409- (29) "Methamphetamine prec ursor drug", any drug
410-containing ephedrine, pseudoephedrine, phenylpropanolamine,
411-or any of their salts, optical isomers, or salts of optical
412-isomers;
413- (30) "Narcotic drug", any of the following, whether
414-produced directly or indirectly by extracti on from
415-substances of vegetable origin, or independently by means of
416-chemical synthesis, or by a combination of extraction and
417-chemical analysis:
418- (a) Opium, opiate, and any derivative, of opium or
419-opiate, including their isomers, esters, ethers, salts, and
420-salts of isomers, esters, and ethers, whenever the existence
421-of the isomers, esters, ethers, and salts is possible within
422-the specific chemical designation. The term does not
423-include the isoquinoline alkaloids of opium;
424- (b) Coca leaves, but not including extracts of coca
425-leaves from which cocaine, ecgonine, and derivatives of
426-ecgonine or their salts have been removed;
427- (c) Cocaine or any salt, isomer, or salt of isomer
428-thereof;
429- (d) Ecgonine, or any derivative, salt, isome r, or salt
430-of isomer thereof;
431- (e) Any compound, mixture, or preparation containing
432-any quantity of any substance referred to in paragraphs (a)
433-to (d) of this subdivision;
434- (31) "Official written order", an order written on a
435-form provided for that purpose by the United States
436-Commissioner of Narcotics, under any laws of the United
437-States making provision therefor, if such order forms are
438-authorized and required by federal law, and if no such order
439- 14
440-form is provided, then on an official for m provided for that
441-purpose by the department of health and senior services;
442- (32) "Opiate" or "opioid", any substance having an
443-addiction-forming or addiction -sustaining liability similar
444-to morphine or being capable of conversion into a drug
445-having addiction-forming or addiction -sustaining liability.
446-The term includes its racemic and levorotatory forms. It
447-does not include, unless specifically controlled under
448-section 195.017, the dextrorotatory isomer of 3 -methoxy-n-
449-methyl-morphinan and its salts (dextromethorphan);
450- (33) "Opium poppy", the plant of the species Papaver
451-somniferum L., except its seeds;
452- (34) "Over-the-counter sale", a retail sale licensed
453-pursuant to chapter 144 of a drug other than a controlled
454-substance;
455- (35) "Person", an individual, corporation, government
456-or governmental subdivision or agency, business trust,
457-estate, trust, partnership, joint venture, association, or
458-any other legal or commercial entity;
459- (36) "Pharmacist", a licensed pharmacist as defined by
460-the laws of this state, and where the context so requires,
461-the owner of a store or other place of business where
462-controlled substances are compounded or dispensed by a
463-licensed pharmacist; but nothing in this chapter shall be
464-construed as conferring on a person who is not registered
465-nor licensed as a pharmacist any authority, right or
466-privilege that is not granted to him by the pharmacy laws of
467-this state;
468- (37) "Poppy straw", all parts, except the seeds, of
469-the opium poppy, aft er mowing;
470- (38) "Possessed" or "possessing a controlled
471-substance", a person, with the knowledge of the presence and
472-nature of a substance, has actual or constructive possession
473- 15
474-of the substance. A person has actual possession if he has
475-the substance on his or her person or within easy reach and
476-convenient control. A person who, although not in actual
477-possession, has the power and the intention at a given time
478-to exercise dominion or control over the substance either
479-directly or through anot her person or persons is in
480-constructive possession of it. Possession may also be sole
481-or joint. If one person alone has possession of a substance
482-possession is sole. If two or more persons share possession
483-of a substance, possession is joint;
484- (39) "Practitioner", a physician, dentist,
485-optometrist, podiatrist, veterinarian, scientific
486-investigator, pharmacy, hospital or other person licensed,
487-registered or otherwise permitted by this state to
488-distribute, dispense, conduct research with resp ect to or
489-administer or to use in teaching or chemical analysis, a
490-controlled substance in the course of professional practice
491-or research in this state, or a pharmacy, hospital or other
492-institution licensed, registered, or otherwise permitted to
493-distribute, dispense, conduct research with respect to or
494-administer a controlled substance in the course of
495-professional practice or research;
496- (40) "Production", includes the manufacture, planting,
497-cultivation, growing, or harvesting of drug parapher nalia or
498-of a controlled substance or an imitation controlled
499-substance;
500- (41) "Registry number", the number assigned to each
501-person registered under the federal controlled substances
502-laws;
503- (42) "Sale", includes barter, exchange, or gift, or
504-offer therefor, and each such transaction made by any
505-person, whether as principal, proprietor, agent, servant or
506-employee;
507- 16
508- (43) "State" when applied to a part of the United
509-States, includes any state, district, commonwealth,
510-territory, insular possession thereof, and any area subject
511-to the legal authority of the United States of America;
512- (44) "Synthetic cannabinoid", includes unless
513-specifically excepted or unless listed in another schedule,
514-any natural or synthetic material, compound , mixture, or
515-preparation that contains any quantity of a substance that
516-is a cannabinoid receptor agonist, including but not limited
517-to any substance listed in paragraph (ll) of subdivision (4)
518-of subsection 2 of section 195.017 and any analogues;
519-homologues; isomers, whether optical, positional, or
520-geometric; esters; ethers; salts; and salts of isomers,
521-esters, and ethers, whenever the existence of the isomers,
522-esters, ethers, or salts is possible within the specific
523-chemical designation, however , it shall not include any
524-approved pharmaceutical authorized by the United States Food
525-and Drug Administration;
526- (45) "Ultimate user", a person who lawfully possesses
527-a controlled substance or an imitation controlled substance
528-for his or her own use or for the use of a member of his or
529-her household or immediate family, regardless of whether
530-they live in the same household, or for administering to an
531-animal owned by him or by a member of his or her household.
532-For purposes of this section, the phrase "immediate family"
533-means a husband, wife, parent, child, sibling, stepparent,
534-stepchild, stepbrother, stepsister, grandparent, or
535-grandchild;
536- (46) "Wholesaler", a person who supplies drug
537-paraphernalia or controlled substances or imitatio n
538-controlled substances that he himself has not produced or
539-prepared, on official written orders, but not on
540-prescriptions.
541- 17
542- 195.030. 1. The department of health and senior
543-services upon public notice and hearing pursuant to this
544-section and chapter 536 may promulgate rules and charge
545-reasonable fees relating to the registration and control of
546-the manufacture, distribution and dispensing of controlled
547-substances within this state. No rule or portion of a rule
548-promulgated pursuant to the authority of this chapter shall
549-become effective unless it has been promulgated pursuant to
550-the provisions of section 536.024.
551- 2. No person shall manufacture, compound, mix,
552-cultivate, grow, or by any other process produce or prepare,
553-distribute, dispense or prescribe any controlled substance
554-and no person as a wholesaler shall supply the same, without
555-having first obtained a registration issued by the
556-department of health and senior services in accordance with
557-rules and regulations pr omulgated by it. No registration
558-shall be granted for a term exceeding three years.
559- 3. Persons registered by the department of health and
560-senior services pursuant to this chapter to manufacture,
561-distribute, or dispense or conduct research with co ntrolled
562-substances are authorized to possess, manufacture,
563-distribute or dispense such substances, including any such
564-activity in the conduct of research, to the extent
565-authorized by their registration and in conformity with
566-other provisions of this chapter and chapter 579.
567- 4. The following persons shall not be required to
568-register and may lawfully possess controlled substances
569-pursuant to this chapter and chapter 579:
570- (1) An agent or employee, excluding physicians,
571-dentists, optometris ts, podiatrists or veterinarians, of any
572-registered manufacturer, distributor, or dispenser of any
573-controlled substance if such agent is acting in the usual
574-course of his or her business or employment;
575- 18
576- (2) A common or contract carrier or warehouse man, or
577-an employee thereof, whose possession of any controlled
578-substance is in the usual course of business or employment;
579- (3) An ultimate user or a person in possession of any
580-controlled substance pursuant to a lawful order of a
581-practitioner or in lawful possession of a Schedule V
582-substance.
583- 5. The department of health and senior services may,
584-by regulation, waive the requirement for registration of
585-certain manufacturers, distributors, or dispensers if it
586-finds it consistent with the p ublic health and safety.
587- 6. A separate registration shall be required at each
588-principal place of business or professional practice where
589-the applicant manufactures, distributes, or dispenses
590-controlled substances. A hospital may obtain a separate
591-registration for each outpatient facility owned or operated
592-by the hospital in which behavioral health or substance
593-abuse services are delivered. Such outpatient facility may
594-distribute or dispense drugs to the extent allowed under a
595-hospital registration.
596- 7. The department of health and senior services is
597-authorized to inspect the establishment of a registrant or
598-applicant in accordance with the provisions of this chapter.
599- 195.070. 1. A physician, podiatrist, dentist, a
600-registered optometrist certified to administer
601-pharmaceutical agents as provided in section 336.220, or an
602-assistant physician in accordance with section 334.037 or a
603-physician assistant in accordance with section 334.747 in
604-good faith and in the course of his or her professional
605-practice only, may prescribe, administer, and dispense
606-controlled substances or he or she may cause the same to be
607-administered or dispensed by an individual as authorized by
608-statute.
609- 19
610- 2. An advanced practice registered nurse, as defined
611-in section 335.016, but not a certified registered nurse
612-anesthetist as defined in subdivision (8) of section
613-335.016, who holds a certificate of controlled substance
614-prescriptive authority from the board of nursing under
615-section 335.019 and who is delegated the authority to
616-prescribe controlled substances under a collaborative
617-practice arrangement under section 334.104 may prescribe any
618-controlled substances listed in Schedules III, IV, and V of
619-section 195.017, and may have rest ricted authority in
620-Schedule II. Prescriptions for Schedule II medications
621-prescribed by an advanced practice registered nurse who has
622-a certificate of controlled substance prescriptive authority
623-are restricted to only those medications containing
624-hydrocodone and Schedule II controlled substances for
625-hospice patients pursuant to the provisions of section
626-334.104. However, no such certified advanced practice
627-registered nurse shall prescribe controlled substance for
628-his or her own self or family. Schedule III narcotic
629-controlled substance and Schedule II - hydrocodone
630-prescriptions shall be limited to a one hundred twenty -hour
631-supply without refill.
632- 3. A veterinarian, in good faith and in the course of
633-the veterinarian's professional prac tice only, and not for
634-use by a human being, may prescribe, administer, and
635-dispense controlled substances and the veterinarian may
636-cause them to be administered by an assistant or orderly
637-under his or her direction and supervision.
638- 4. A practitioner shall not accept any portion of a
639-controlled substance unused by a patient, for any reason, if
640-such practitioner did not originally dispense the drug,
641-except:
642- 20
643- (1) When the controlled substance is delivered to the
644-practitioner to administer t o the patient for whom the
645-medication is prescribed [as authorized by federal law ].
646-Practitioners shall maintain records and secure the
647-medication as required by this chapter and regulations
648-promulgated pursuant to this chapter; or
649- (2) As provided in section 195.265.
650- 5. An individual practitioner shall not prescribe or
651-dispense a controlled substance for such practitioner's
652-personal use except in a medical emergency.
653- 334.031. 1. Candidates for licenses as physicians and
654-surgeons shall furnish [satisfactory evidence of their good
655-moral character, and their preliminary qualifications, to
656-wit: a certificate of graduation from an accredited high
657-school or its equivalent, and satisfactory evidence of
658-completion of prepro fessional education consisting of a
659-minimum of sixty semester hours of college credits in
660-acceptable subjects leading towards the degree of bachelor
661-of arts or bachelor of science from an accredited college or
662-university. They shall also furnish satis factory evidence
663-of having attended throughout at least four terms of thirty -
664-two weeks of actual instructions in each term and of having
665-received a diploma from some reputable medical college or
666-osteopathic college that enforces requirements of four te rms
667-of thirty-two weeks for actual instruction in each term,
668-including, in addition to class work, such experience in
669-operative and hospital work during the last two years of
670-instruction as is required by the American Medical
671-Association and the Ameri can Osteopathic Association before
672-the college is approved and accredited as reputable. Any
673-medical college approved and accredited as reputable by the
674-American Medical Association or the Liaison Committee on
675-Medical Education and any osteopathic coll ege approved and
676- 21
677-accredited as reputable by the American Osteopathic
678-Association is deemed to have complied with the requirements
679-of this subsection]:
680- (1) Evidence of good moral character by submitting to
681-a criminal background check as provided i n section 43.540;
682- (2) A diploma and academic transcripts from a school
683-accredited by the Liaison Committee on Medical Education,
684-the Commission on Osteopathic College Accreditation, the
685-Educational Commission for Foreign Medical Graduates
686-(ECFMG), or a similar accrediting agency; and
687- (3) A certificate demonstrating that the applicant has
688-satisfied the requirements of section 334.035. An applicant
689-who holds a valid certificate issued by the ECFMG shall
690-submit satisfactory evidence of succ essful completion of two
691-years of such training. Except as provided in subsection 3
692-of this section, the board shall not require applicants to
693-provide information regarding the internship or resident
694-training in addition to what the applicant is requi red to
695-furnish by this subsection .
696- 2. In determining the qualifications necessary for
697-licensure as a qualified physician and surgeon, the board,
698-by rule and regulation, may accept the certificate of the
699-National Board of Medical Examiners of the United States,
700-chartered pursuant to the laws of the District of Columbia,
701-of the National Board of Examiners for Osteopathic
702-Physicians and Surgeons chartered pursuant to the laws of
703-the state of Indiana, or of the Licentiate of the Medical
704-Counsel of Canada (LMCC) in lieu of and as equivalent to its
705-own professional examination. Every applicant for a license
706-on the basis of such certificate, upon making application
707-showing necessary qualifications as provided in subsection 1
708-of this section, sha ll be required to pay the same fee
709- 22
710-required of applicants to take the examination before the
711-board.
712- 3. The board may require applicants to list all
713-licenses to practice as a physician currently or previously
714-held in any other state, territory, or country and to
715-disclose any past or pending investigations, discipline, or
716-sanctions against each such license.
717- 4. In addition to the criminal background screening
718-required by this section, the board may obtain a report on
719-the applicant from the National Practitioner Data Bank or
720-the Federation of State Medical Boards.
721- 334.035. 1. For purposes of this section, the
722-following terms mean:
723- (1) "ACGME", the Accreditation Council for Graduate
724-Medical Education;
725- (2) "Applicant", an applicant for a permanent license
726-as a physician and surgeon;
727- (3) "Hospital", the same meaning given to the term in
728-section 197.020.
729- 2. Except as otherwise provided in section 334.036,
730-every applicant [for a permanent license as a physician and
731-surgeon] shall provide the board with satisfactory evidence
732-of having successfully completed such postgraduate training
733-in hospitals or medical or osteopathic colleges as the board
734-may prescribe by rule.
735- 3. Any applicant who has c ompleted unaccredited
736-postgraduate training in a medical subspecialty for which no
737-program accredited by ACGME exists shall be deemed to have
738-satisfactorily completed the training requirements of 20
739-C.S.R. 2150-2.004(2) or any successor regulation if s uch
740-unaccredited postgraduate training occurred in a teaching
741-hospital accredited by ACGME. The training period shall be
742- 23
743-equal to or exceed an accredited postgraduate training
744-program.
745- 4. The board shall waive the training requirements of
746-20 C.S.R. 2150-2.004(2) or any successor regulation for any
747-applicant who is licensed as a physician in good standing in
748-another state and has been in good standing more than three
749-years.
750- 338.165. 1. As used in this section, the following
751-terms mean:
752- (1) "Board", the Missouri board of pharmacy;
753- (2) "Hospital", a hospital as defined in section
754-197.020;
755- (3) "Hospital clinic or facility", a clinic or
756-facility under the common control, management, or ownership
757-of the same hospital or hospital system;
758- (4) "Medical staff committee", the committee or other
759-body of a hospital or hospital system responsible for
760-formulating policies regarding pharmacy services and
761-medication management;
762- (5) "Medication order", an or der for a legend drug or
763-device that is:
764- (a) Authorized or issued by an authorized prescriber
765-acting within the scope of his or her professional practice
766-or pursuant to a protocol or standing order approved by the
767-medical staff committee; and
768- (b) To be distributed or administered to the patient
769-by a health care practitioner or lawfully authorized
770-designee at a hospital or a hospital clinic or facility;
771- (6) "Patient", an individual receiving medical
772-diagnosis, treatment or care at a hospital or a hospital
773-clinic or facility.
774- 2. The department of health and senior services shall
775-have sole authority and responsibility for the inspection
776- 24
777-and licensure of hospitals as provided by chapter 197
778-including, but not limited to all par ts, services,
779-functions, support functions and activities which contribute
780-directly or indirectly to patient care of any kind
781-whatsoever. However, the board may inspect a class B
782-pharmacy or any portion thereof that is not under the
783-inspection authority vested in the department of health and
784-senior services by chapter 197 to determine compliance with
785-this chapter or the rules of the board. This section shall
786-not be construed to bar the board from conducting an
787-investigation pursuant to a public o r governmental complaint
788-to determine compliance by an individual licensee or
789-registrant of the board with any applicable provisions of
790-this chapter or the rules of the board.
791- 3. The department of health and senior services shall
792-have the sole authority to promulgate rules governing
793-pharmacy services in hospitals, but may promulgate rules in
794-conjunction with the board governing medication distribution
795-and the provision of medication therapy services , as
796-described in section 338.010, by a pharmacist at or within a
797-hospital. [Rules may include, but are not limited to,
798-medication management, preparation, compounding,
799-administration, storage, distribution, packaging and
800-labeling. Until such rules are jointly promulgated,
801-hospitals shall comp ly with all applicable state law and
802-department of health and senior services rules governing
803-pharmacy services and medication management in hospitals. ]
804-The board shall have the sole authority to promulgate rules
805-governing inspection and licensure of c lass B pharmacies.
806-The rulemaking authority granted herein to the department of
807-health and senior services shall not include the dispensing
808-of medication by prescription.
809- 25
810- 4. All pharmacists providing medication therapy
811-services shall obtain a ce rtificate of medication
812-therapeutic plan authority as provided by rule of the
813-board. Medication therapy services may be provided by a
814-pharmacist for patients of a hospital pursuant to a
815-protocol with a physician as required by section 338.010 or
816-pursuant to a protocol approved by the medical staff
817-committee. However, the medical staff protocol shall
818-include a process whereby an exemption to the protocol for a
819-patient may be granted for clinical efficacy should the
820-patient's physician make such r equest. The medical staff
821-protocol shall also include an appeals process to request a
822-change in a specific protocol based on medical evidence
823-presented by a physician on staff.
824- 5. Medication may be dispensed by a class B hospital
825-pharmacy pursuant to a prescription or a medication order.
826- 6. A drug distributor license shall not be required to
827-transfer medication from a class B hospital pharmacy to a
828-hospital clinic or facility for patient care or treatment.
829- 7. Medication dispensed by a class A pharmacy located
830-in a hospital to a hospital patient for use or
831-administration outside of the hospital under a medical staff -
832-approved protocol for medication therapy shall be dispensed
833-only by a prescription order for medication therapy from an
834-individual physician for a specific patient.
835- 8. Medication dispensed by a hospital to a hospital
836-patient for use or administration outside of the hospital
837-shall be labeled as provided by rules jointly promulgated by
838-the department of health a nd senior services and the board
839-including medication distributed for administration by or
840-under the supervision of a health care practitioner at a
841-hospital clinic or facility.
842- 26
843- 9. This section shall not be construed to preempt any
844-law or rule governing controlled substances.
845- 10. Any rule, as that term is defined in section
846-536.010, that is created under the authority delegated in
847-this section shall only become effective if it complies with
848-and is subject to all of the provisions of chapte r 536 and,
849-if applicable, section 536.028. This section and chapter
850-536 are nonseverable and if any of the powers vested with
851-the general assembly under chapter 536 to review, to delay
852-the effective date, or to disapprove and annul a rule are
853-subsequently held unconstitutional, then the grant of
854-rulemaking authority and any rule proposed or adopted after
855-August 28, 2014, shall be invalid and void.
856- 11. The board shall appoint an advisory committee to
857-review and make recommendations to the boar d on the merit of
858-all rules and regulations to be jointly promulgated by the
859-board and the department of health and senior services
860-pursuant to the joint rulemaking authority granted by this
861-section. The advisory committee shall consist of:
862- (1) Two representatives designated by the Missouri
863-Hospital Association, one of whom shall be a pharmacist;
864- (2) One pharmacist designated by the Missouri Society
865-of Health System Pharmacists;
866- (3) One pharmacist designated by the Missouri Pharmacy
867-Association;
868- (4) One pharmacist designated by the department of
869-health and senior services from a hospital with a licensed
870-bed count that does not exceed fifty beds or from a critical
871-access hospital as defined by the department of social
872-services for purposes of MO HealthNet reimbursement;
873- (5) One pharmacist designated by the department of
874-health and senior services from a hospital with a licensed
875-bed count that exceeds two hundred beds; and
876- 27
877- (6) One pharmacist designated by the bo ard with
878-experience in the provision of hospital pharmacy services.
879- 12. Nothing in this section shall be construed to
880-limit the authority of a licensed health care provider to
881-prescribe, administer, or dispense medications and
882-treatments within the scope of their professional practice.
14+ Section A. Sections 195.010, 195.030, 195.070, 334.031, 1
15+334.035, and 338.165, RSMo, are repealed and six new sections 2
16+enacted in lieu thereof, to be known as sections 195.010, 3
17+195.030, 195.070, 334.031, 334.035, and 338.165, to read as 4
18+follows:5
19+ 195.010. The following words and phrases as used in 1
20+this chapter and chapter 579, unless the context otherwise 2
21+requires, mean: 3
22+ (1) "Acute pain", pain, whether resulting from 4
23+disease, accidental or intentional trauma, or other causes, 5
24+that the practitioner reasonably expects to last only a 6
25+short period of time. Acute pain shall not include chronic 7
26+pain, pain being trea ted as part of cancer care, hospice or 8
27+other end-of-life care, or medication -assisted treatment for 9
28+substance use disorders; 10
29+ (2) "Addict", a person who habitually uses one or more 11
30+controlled substances to such an extent as to create a 12
31+tolerance for such drugs, and who does not have a medical 13
32+need for such drugs, or who is so far addicted to the use of 14
33+such drugs as to have lost the power of self -control with 15
34+reference to his or her addiction; 16 SB 292 2
35+ (3) "Administer", to apply a controlled substa nce, 17
36+whether by injection, inhalation, ingestion, or any other 18
37+means, directly to the body of a patient or research subject 19
38+by: 20
39+ (a) A practitioner (or, in his or her presence, by his 21
40+or her authorized agent); or 22
41+ (b) The patient or research subject at the direction 23
42+and in the presence of the practitioner; 24
43+ (4) "Agent", an authorized person who acts on behalf 25
44+of or at the direction of a manufacturer, distributor, or 26
45+dispenser. The term does not include a common or contract 27
46+carrier, public warehouseman, or employee of the carrier or 28
47+warehouseman while acting in the usual and lawful course of 29
48+the carrier's or warehouseman's business; 30
49+ (5) "Attorney for the state", any prosecuting 31
50+attorney, circuit attorney, or attorney general a uthorized 32
51+to investigate, commence and prosecute an action under this 33
52+chapter; 34
53+ (6) "Controlled substance", a drug, substance, or 35
54+immediate precursor in Schedules I through V listed in this 36
55+chapter; 37
56+ (7) "Controlled substance analogue", a sub stance the 38
57+chemical structure of which is substantially similar to the 39
58+chemical structure of a controlled substance in Schedule I 40
59+or II and: 41
60+ (a) Which has a stimulant, depressant, or 42
61+hallucinogenic effect on the central nervous system 43
62+substantially similar to the stimulant, depressant, or 44
63+hallucinogenic effect on the central nervous system of a 45
64+controlled substance included in Schedule I or II; or 46
65+ (b) With respect to a particular individual, which 47
66+that individual represents or intends to have a stimulant, 48 SB 292 3
67+depressant, or hallucinogenic effect on the central nervous 49
68+system substantially similar to the stimulant, depressant, 50
69+or hallucinogenic effect on the central nervous system of a 51
70+controlled substance included in Schedule I or II. The term 52
71+does not include a controlled substance; any substance for 53
72+which there is an approved new drug application; any 54
73+substance for which an exemption is in effect for 55
74+investigational use, for a particular person, under Section 56
75+505 of the federal Foo d, Drug and Cosmetic Act (21 U.S.C. 57
76+Section 355) to the extent conduct with respect to the 58
77+substance is pursuant to the exemption; or any substance to 59
78+the extent not intended for human consumption before such an 60
79+exemption takes effect with respect to t he substance; 61
80+ (8) "Counterfeit substance", a controlled substance 62
81+which, or the container or labeling of which, without 63
82+authorization, bears the trademark, trade name, or other 64
83+identifying mark, imprint, number or device, or any likeness 65
84+thereof, of a manufacturer, distributor, or dispenser other 66
85+than the person who in fact manufactured, distributed, or 67
86+dispensed the substance; 68
87+ (9) "Deliver" or "delivery", the actual, constructive, 69
88+or attempted transfer from one person to another of drug 70
89+paraphernalia or of a controlled substance, or an imitation 71
90+controlled substance, whether or not there is an agency 72
91+relationship, and includes a sale; 73
92+ (10) "Dentist", a person authorized by law to practice 74
93+dentistry in this state; 75
94+ (11) "Depressant or stimulant substance": 76
95+ (a) A drug containing any quantity of barbituric acid 77
96+or any of the salts of barbituric acid or any derivative of 78
97+barbituric acid which has been designated by the United 79 SB 292 4
98+States Secretary of Health and Human Service s as habit 80
99+forming under 21 U.S.C. Section 352(d); 81
100+ (b) A drug containing any quantity of: 82
101+ a. Amphetamine or any of its isomers; 83
102+ b. Any salt of amphetamine or any salt of an isomer of 84
103+amphetamine; or 85
104+ c. Any substance the United Sta tes Attorney General, 86
105+after investigation, has found to be, and by regulation 87
106+designated as, habit forming because of its stimulant effect 88
107+on the central nervous system; 89
108+ (c) Lysergic acid diethylamide; or 90
109+ (d) Any drug containing any quantity of a substance 91
110+that the United States Attorney General, after 92
111+investigation, has found to have, and by regulation 93
112+designated as having, a potential for abuse because of its 94
113+depressant or stimulant effect on the central nervous system 95
114+or its hallucinogenic effect; 96
115+ (12) "Dispense", to deliver a narcotic or controlled 97
116+dangerous drug to an ultimate user or research subject by or 98
117+pursuant to the lawful order of a practitioner including the 99
118+prescribing, administering, packaging, labeling, or 100
119+compounding necessary to prepare the substance for such 101
120+delivery. "Dispenser" means a practitioner who dispenses; 102
121+ (13) "Distribute", to deliver other than by 103
122+administering or dispensing a controlled substance; 104
123+ (14) "Distributor", a person who dis tributes; 105
124+ (15) "Drug": 106
125+ (a) Substances recognized as drugs in the official 107
126+United States Pharmacopoeia, Official Homeopathic 108
127+Pharmacopoeia of the United States, or Official National 109
128+Formulary, or any supplement to any of them; 110 SB 292 5
129+ (b) Substances intended for use in the diagnosis, 111
130+cure, mitigation, treatment or prevention of disease in 112
131+humans or animals; 113
132+ (c) Substances, other than food, intended to affect 114
133+the structure or any function of the body of humans or 115
134+animals; and 116
135+ (d) Substances intended for use as a component of any 117
136+article specified in this subdivision. It does not include 118
137+devices or their components, parts or accessories; 119
138+ (16) "Drug-dependent person", a person who is using a 120
139+controlled substance and who is in a state of psychic or 121
140+physical dependence, or both, arising from the use of such 122
141+substance on a continuous basis. Drug dependence is 123
142+characterized by behavioral and other responses which 124
143+include a strong compulsion to take the substance on a 125
144+continuous basis in order to experience its psychic effects 126
145+or to avoid the discomfort caused by its absence; 127
146+ (17) "Drug enforcement agency", the Drug Enforcement 128
147+Administration in the United States Department of Justice, 129
148+or its successor agency; 130
149+ (18) "Drug paraphernalia", all equipment, products, 131
150+substances and materials of any kind which are used, 132
151+intended for use, or designed for use, in planting, 133
152+propagating, cultivating, growing, harvesting, 134
153+manufacturing, compounding, converting, produci ng, 135
154+processing, preparing, storing, containing, concealing, 136
155+injecting, ingesting, inhaling, or otherwise introducing 137
156+into the human body a controlled substance or an imitation 138
157+controlled substance in violation of this chapter or chapter 139
158+579. It includes, but is not limited to: 140
159+ (a) Kits used, intended for use, or designed for use 141
160+in planting, propagating, cultivating, growing or harvesting 142 SB 292 6
161+of any species of plant which is a controlled substance or 143
162+from which a controlled substance can be deriv ed; 144
163+ (b) Kits used, intended for use, or designed for use 145
164+in manufacturing, compounding, converting, producing, 146
165+processing, or preparing controlled substances or imitation 147
166+controlled substances; 148
167+ (c) Isomerization devices used, intended for us e, or 149
168+designed for use in increasing the potency of any species of 150
169+plant which is a controlled substance or an imitation 151
170+controlled substance; 152
171+ (d) Testing equipment used, intended for use, or 153
172+designed for use in identifying, or in analyzing the 154
173+strength, effectiveness or purity of controlled substances 155
174+or imitation controlled substances; 156
175+ (e) Scales and balances used, intended for use, or 157
176+designed for use in weighing or measuring controlled 158
177+substances or imitation controlled substances; 159
178+ (f) Dilutents and adulterants, such as quinine 160
179+hydrochloride, mannitol, mannite, dextrose and lactose, 161
180+used, intended for use, or designed for use in cutting 162
181+controlled substances or imitation controlled substances; 163
182+ (g) Separation gins and si fters used, intended for 164
183+use, or designed for use in removing twigs and seeds from, 165
184+or in otherwise cleaning or refining, marijuana; 166
185+ (h) Blenders, bowls, containers, spoons and mixing 167
186+devices used, intended for use, or designed for use in 168
187+compounding controlled substances or imitation controlled 169
188+substances; 170
189+ (i) Capsules, balloons, envelopes and other containers 171
190+used, intended for use, or designed for use in packaging 172
191+small quantities of controlled substances or imitation 173
192+controlled substances; 174 SB 292 7
193+ (j) Containers and other objects used, intended for 175
194+use, or designed for use in storing or concealing controlled 176
195+substances or imitation controlled substances; 177
196+ (k) Hypodermic syringes, needles and other objects 178
197+used, intended for use, or designed for use in parenterally 179
198+injecting controlled substances or imitation controlled 180
199+substances into the human body; 181
200+ (l) Objects used, intended for use, or designed for 182
201+use in ingesting, inhaling, or otherwise introducing 183
202+marijuana, cocaine, hashish, or hashish oil into the human 184
203+body, such as: 185
204+ a. Metal, wooden, acrylic, glass, stone, plastic, or 186
205+ceramic pipes with or without screens, permanent screens, 187
206+hashish heads, or punctured metal bowls; 188
207+ b. Water pipes; 189
208+ c. Carburetion tubes and devices; 190
209+ d. Smoking and carburetion masks; 191
210+ e. Roach clips meaning objects used to hold burning 192
211+material, such as a marijuana cigarette, that has become too 193
212+small or too short to be held in the hand; 194
213+ f. Miniature cocaine spoons and cocaine vials; 195
214+ g. Chamber pipes; 196
215+ h. Carburetor pipes; 197
216+ i. Electric pipes; 198
217+ j. Air-driven pipes; 199
218+ k. Chillums; 200
219+ l. Bongs; 201
220+ m. Ice pipes or chillers; 202
221+ (m) Substances used, intended for use, or designed for 203
222+use in the manufacture of a controlled substance. 204 SB 292 8
223+In determining whether an object, product, substance or 205
224+material is drug paraphernalia, a court or other authority 206
225+should consider, in addition to all other logically relevant 207
226+factors, the following: 208
227+ a. Statements by an owner or by anyone in control of 209
228+the object concerning its use; 210
229+ b. Prior convictions, if any, of an owner, or of 211
230+anyone in control of the object, under any state or federal 212
231+law relating to any controlled substance or imita tion 213
232+controlled substance; 214
233+ c. The proximity of the object, in time and space, to 215
234+a direct violation of this chapter or chapter 579; 216
235+ d. The proximity of the object to controlled 217
236+substances or imitation controlled substances; 218
237+ e. The existence of any residue of controlled 219
238+substances or imitation controlled substances on the object; 220
239+ f. Direct or circumstantial evidence of the intent of 221
240+an owner, or of anyone in control of the object, to deliver 222
241+it to persons who he or she knows, or should reasonably 223
242+know, intend to use the object to facilitate a violation of 224
243+this chapter or chapter 579; the innocence of an owner, or 225
244+of anyone in control of the object, as to direct violation 226
245+of this chapter or chapter 579 shall not prevent a find ing 227
246+that the object is intended for use, or designed for use as 228
247+drug paraphernalia; 229
248+ g. Instructions, oral or written, provided with the 230
249+object concerning its use; 231
250+ h. Descriptive materials accompanying the object which 232
251+explain or depict its use; 233
252+ i. National or local advertising concerning its use; 234
253+ j. The manner in which the object is displayed for 235
254+sale; 236 SB 292 9
255+ k. Whether the owner, or anyone in control of the 237
256+object, is a legitimate supplier of like or related items to 238
257+the community, such as a licensed distributor or dealer of 239
258+tobacco products; 240
259+ l. Direct or circumstantial evidence of the ratio of 241
260+sales of the object to the total sales of the business 242
261+enterprise; 243
262+ m. The existence and scope of legitimate uses for the 244
263+object in the community; 245
264+ n. Expert testimony concerning its use; 246
265+ o. The quantity, form or packaging of the product, 247
266+substance or material in relation to the quantity, form or 248
267+packaging associated with any legitimate use for the 249
268+product, substance or material; 250
269+ (19) "Federal narcotic laws", the laws of the United 251
270+States relating to controlled substances; 252
271+ (20) "Hospital", a place devoted primarily to the 253
272+maintenance and operation of facilities for the diagnosis, 254
273+treatment or care, for not less than twenty -four hours in 255
274+any week, of three or more nonrelated individuals suffering 256
275+from illness, disease, injury, deformity or other abnormal 257
276+physical conditions; or a place devoted primarily to 258
277+provide, for not less than twenty -four consecutive hours in 259
278+any week, medical or nursing care for three or more 260
279+nonrelated individuals. The term hospital does not include 261
280+convalescent, nursing, shelter or boarding homes as defined 262
281+in chapter 198, but shall include outpatient facilities 263
282+owned and operated by a hospital ; 264
283+ (21) "Illegal industrial hemp": 265
284+ (a) All nonseed parts and varieties of the Cannabis 266
285+sativa L. plant, growing or not, that contain an average 267 SB 292 10
286+delta-9 tetrahydrocannabinol (THC) concentration exceeding 268
287+three-tenths of one percent on a dry weight basis; 269
288+ (b) Illegal industrial hemp shall be destroyed in the 270
289+most effective manner possible, and such destruction shall 271
290+be verified by the Missouri state highway patrol; 272
291+ (22) "Immediate precursor", a substa nce which: 273
292+ (a) The state department of health and senior services 274
293+has found to be and by rule designates as being the 275
294+principal compound commonly used or produced primarily for 276
295+use in the manufacture of a controlled substance; 277
296+ (b) Is an immediate chemical intermediary used or 278
297+likely to be used in the manufacture of a controlled 279
298+substance; and 280
299+ (c) The control of which is necessary to prevent, 281
300+curtail or limit the manufacture of the controlled substance; 282
301+ (23) "Imitation controlle d substance", a substance 283
302+that is not a controlled substance, which by dosage unit 284
303+appearance (including color, shape, size and markings), or 285
304+by representations made, would lead a reasonable person to 286
305+believe that the substance is a controlled substanc e. In 287
306+determining whether the substance is an imitation controlled 288
307+substance the court or authority concerned should consider, 289
308+in addition to all other logically relevant factors, the 290
309+following: 291
310+ (a) Whether the substance was approved by the fede ral 292
311+Food and Drug Administration for over -the-counter 293
312+(nonprescription or nonlegend) sales and was sold in the 294
313+federal Food and Drug Administration -approved package, with 295
314+the federal Food and Drug Administration -approved labeling 296
315+information; 297 SB 292 11
316+ (b) Statements made by an owner or by anyone else in 298
317+control of the substance concerning the nature of the 299
318+substance, or its use or effect; 300
319+ (c) Whether the substance is packaged in a manner 301
320+normally used for illicit controlled substances; 302
321+ (d) Prior convictions, if any, of an owner, or anyone 303
322+in control of the object, under state or federal law related 304
323+to controlled substances or fraud; 305
324+ (e) The proximity of the substances to controlled 306
325+substances; 307
326+ (f) Whether the consideration ten dered in exchange for 308
327+the noncontrolled substance substantially exceeds the 309
328+reasonable value of the substance considering the actual 310
329+chemical composition of the substance and, where applicable, 311
330+the price at which over -the-counter substances of like 312
331+chemical composition sell. An imitation controlled 313
332+substance does not include a placebo or registered 314
333+investigational drug either of which was manufactured, 315
334+distributed, possessed or delivered in the ordinary course 316
335+of professional practice or research; 317
336+ (24) "Industrial hemp": 318
337+ (a) All nonseed parts and varieties of the Cannabis 319
338+sativa L. plant, growing or not, that contain an average 320
339+delta-9 tetrahydrocannabinol (THC) concentration that does 321
340+not exceed three-tenths of one percent on a dry weight basis 322
341+or the maximum concentration allowed under federal law, 323
342+whichever is greater; 324
343+ (b) Any Cannabis sativa L. seed that is part of a 325
344+growing crop, retained by a grower for future planting, or 326
345+used for processing into or use as agricultura l hemp seed; 327
346+ (c) Industrial hemp includes industrial hemp 328
347+commodities and products and topical or ingestible animal 329 SB 292 12
348+and consumer products derived from industrial hemp with a 330
349+delta-9 tetrahydrocannabinol concentration of not more than 331
350+three-tenths of one percent on a dry weight basis; 332
351+ (25) "Initial prescription", a prescription issued to 333
352+a patient who has never previously been issued a 334
353+prescription for the drug or its pharmaceutical equivalent 335
354+or who was previously issued a prescription fo r the drug or 336
355+its pharmaceutical equivalent, but the date on which the 337
356+current prescription is being issued is more than five 338
357+months after the date the patient last used or was 339
358+administered the drug or its equivalent; 340
359+ (26) "Laboratory", a laborat ory approved by the 341
360+department of health and senior services as proper to be 342
361+entrusted with the custody of controlled substances but does 343
362+not include a pharmacist who compounds controlled substances 344
363+to be sold or dispensed on prescriptions; 345
364+ (27) "Manufacture", the production, preparation, 346
365+propagation, compounding or processing of drug paraphernalia 347
366+or of a controlled substance, or an imitation controlled 348
367+substance, either directly or by extraction from substances 349
368+of natural origin, or independ ently by means of chemical 350
369+synthesis, or by a combination of extraction and chemical 351
370+synthesis, and includes any packaging or repackaging of the 352
371+substance or labeling or relabeling of its container. This 353
372+term does not include the preparation or compou nding of a 354
373+controlled substance or an imitation controlled substance or 355
374+the preparation, compounding, packaging or labeling of a 356
375+narcotic or dangerous drug: 357
376+ (a) By a practitioner as an incident to his or her 358
377+administering or dispensing of a contr olled substance or an 359
378+imitation controlled substance in the course of his or her 360
379+professional practice; or 361 SB 292 13
380+ (b) By a practitioner or his or her authorized agent 362
381+under his or her supervision, for the purpose of, or as an 363
382+incident to, research, teac hing or chemical analysis and not 364
383+for sale; 365
384+ (28) "Marijuana", all parts of the plant genus 366
385+Cannabis in any species or form thereof, including, but not 367
386+limited to Cannabis Sativa L., except industrial hemp, 368
387+Cannabis Indica, Cannabis Americana, Cannabis Ruderalis, and 369
388+Cannabis Gigantea, whether growing or not, the seeds 370
389+thereof, the resin extracted from any part of the plant; and 371
390+every compound, manufacture, salt, derivative, mixture, or 372
391+preparation of the plant, its seeds or resin. It does not 373
392+include the mature stalks of the plant, fiber produced from 374
393+the stalks, oil or cake made from the seeds of the plant, 375
394+any other compound, manufacture, salt, derivative, mixture 376
395+or preparation of the mature stalks (except the resin 377
396+extracted therefrom), fiber, oil or cake, or the sterilized 378
397+seed of the plant which is incapable of germination; 379
398+ (29) "Methamphetamine precursor drug", any drug 380
399+containing ephedrine, pseudoephedrine, phenylpropanolamine, 381
400+or any of their salts, optical isomers, or sa lts of optical 382
401+isomers; 383
402+ (30) "Narcotic drug", any of the following, whether 384
403+produced directly or indirectly by extraction from 385
404+substances of vegetable origin, or independently by means of 386
405+chemical synthesis, or by a combination of extraction and 387
406+chemical analysis: 388
407+ (a) Opium, opiate, and any derivative, of opium or 389
408+opiate, including their isomers, esters, ethers, salts, and 390
409+salts of isomers, esters, and ethers, whenever the existence 391
410+of the isomers, esters, ethers, and salts is possible w ithin 392 SB 292 14
411+the specific chemical designation. The term does not 393
412+include the isoquinoline alkaloids of opium; 394
413+ (b) Coca leaves, but not including extracts of coca 395
414+leaves from which cocaine, ecgonine, and derivatives of 396
415+ecgonine or their salts have been removed; 397
416+ (c) Cocaine or any salt, isomer, or salt of isomer 398
417+thereof; 399
418+ (d) Ecgonine, or any derivative, salt, isomer, or salt 400
419+of isomer thereof; 401
420+ (e) Any compound, mixture, or preparation containing 402
421+any quantity of any substance referred to in paragraphs (a) 403
422+to (d) of this subdivision; 404
423+ (31) "Official written order", an order written on a 405
424+form provided for that purpose by the United States 406
425+Commissioner of Narcotics, under any laws of the United 407
426+States making provision therefor, i f such order forms are 408
427+authorized and required by federal law, and if no such order 409
428+form is provided, then on an official form provided for that 410
429+purpose by the department of health and senior services; 411
430+ (32) "Opiate" or "opioid", any substance havi ng an 412
431+addiction-forming or addiction -sustaining liability similar 413
432+to morphine or being capable of conversion into a drug 414
433+having addiction-forming or addiction -sustaining liability. 415
434+The term includes its racemic and levorotatory forms. It 416
435+does not include, unless specifically controlled under 417
436+section 195.017, the dextrorotatory isomer of 3 -methoxy-n- 418
437+methyl-morphinan and its salts (dextromethorphan); 419
438+ (33) "Opium poppy", the plant of the species Papaver 420
439+somniferum L., except its seeds; 421
440+ (34) "Over-the-counter sale", a retail sale licensed 422
441+pursuant to chapter 144 of a drug other than a controlled 423
442+substance; 424 SB 292 15
443+ (35) "Person", an individual, corporation, government 425
444+or governmental subdivision or agency, business trust, 426
445+estate, trust, partnership, joint venture, association, or 427
446+any other legal or commercial entity; 428
447+ (36) "Pharmacist", a licensed pharmacist as defined by 429
448+the laws of this state, and where the context so requires, 430
449+the owner of a store or other place of business where 431
450+controlled substances are compounded or dispensed by a 432
451+licensed pharmacist; but nothing in this chapter shall be 433
452+construed as conferring on a person who is not registered 434
453+nor licensed as a pharmacist any authority, right or 435
454+privilege that is not gran ted to him by the pharmacy laws of 436
455+this state; 437
456+ (37) "Poppy straw", all parts, except the seeds, of 438
457+the opium poppy, after mowing; 439
458+ (38) "Possessed" or "possessing a controlled 440
459+substance", a person, with the knowledge of the presence and 441
460+nature of a substance, has actual or constructive possession 442
461+of the substance. A person has actual possession if he has 443
462+the substance on his or her person or within easy reach and 444
463+convenient control. A person who, although not in actual 445
464+possession, has the power and the intention at a given time 446
465+to exercise dominion or control over the substance either 447
466+directly or through another person or persons is in 448
467+constructive possession of it. Possession may also be sole 449
468+or joint. If one person alone has poss ession of a substance 450
469+possession is sole. If two or more persons share possession 451
470+of a substance, possession is joint; 452
471+ (39) "Practitioner", a physician, dentist, 453
472+optometrist, podiatrist, veterinarian, scientific 454
473+investigator, pharmacy, hospital or other person licensed, 455
474+registered or otherwise permitted by this state to 456 SB 292 16
475+distribute, dispense, conduct research with respect to or 457
476+administer or to use in teaching or chemical analysis, a 458
477+controlled substance in the course of professional practice 459
478+or research in this state, or a pharmacy, hospital or other 460
479+institution licensed, registered, or otherwise permitted to 461
480+distribute, dispense, conduct research with respect to or 462
481+administer a controlled substance in the course of 463
482+professional practice or research; 464
483+ (40) "Production", includes the manufacture, planting, 465
484+cultivation, growing, or harvesting of drug paraphernalia or 466
485+of a controlled substance or an imitation controlled 467
486+substance; 468
487+ (41) "Registry number", the number assigned to e ach 469
488+person registered under the federal controlled substances 470
489+laws; 471
490+ (42) "Sale", includes barter, exchange, or gift, or 472
491+offer therefor, and each such transaction made by any 473
492+person, whether as principal, proprietor, agent, servant or 474
493+employee; 475
494+ (43) "State" when applied to a part of the United 476
495+States, includes any state, district, commonwealth, 477
496+territory, insular possession thereof, and any area subject 478
497+to the legal authority of the United States of America; 479
498+ (44) "Synthetic cannabinoid", includes unless 480
499+specifically excepted or unless listed in another schedule, 481
500+any natural or synthetic material, compound, mixture, or 482
501+preparation that contains any quantity of a substance that 483
502+is a cannabinoid receptor agonist, including but not l imited 484
503+to any substance listed in paragraph (ll) of subdivision (4) 485
504+of subsection 2 of section 195.017 and any analogues; 486
505+homologues; isomers, whether optical, positional, or 487
506+geometric; esters; ethers; salts; and salts of isomers, 488 SB 292 17
507+esters, and ethers, whenever the existence of the isomers, 489
508+esters, ethers, or salts is possible within the specific 490
509+chemical designation, however, it shall not include any 491
510+approved pharmaceutical authorized by the United States Food 492
511+and Drug Administration; 493
512+ (45) "Ultimate user", a person who lawfully possesses 494
513+a controlled substance or an imitation controlled substance 495
514+for his or her own use or for the use of a member of his or 496
515+her household or immediate family, regardless of whether 497
516+they live in the same househo ld, or for administering to an 498
517+animal owned by him or by a member of his or her household. 499
518+For purposes of this section, the phrase "immediate family" 500
519+means a husband, wife, parent, child, sibling, stepparent, 501
520+stepchild, stepbrother, stepsister, grand parent, or 502
521+grandchild; 503
522+ (46) "Wholesaler", a person who supplies drug 504
523+paraphernalia or controlled substances or imitation 505
524+controlled substances that he himself has not produced or 506
525+prepared, on official written orders, but not on 507
526+prescriptions. 508
527+ 195.030. 1. The department of health and senior 1
528+services upon public notice and hearing pursuant to this 2
529+section and chapter 536 may promulgate rules and charge 3
530+reasonable fees relating to the registration and control of 4
531+the manufacture, distribution and dispensing of controlled 5
532+substances within this state. No rule or portion of a rule 6
533+promulgated pursuant to the authority of this chapter shall 7
534+become effective unless it has been promulgated pursuant to 8
535+the provisions of sec tion 536.024. 9
536+ 2. No person shall manufacture, compound, mix, 10
537+cultivate, grow, or by any other process produce or prepare, 11
538+distribute, dispense or prescribe any controlled substance 12 SB 292 18
539+and no person as a wholesaler shall supply the same, without 13
540+having first obtained a registration issued by the 14
541+department of health and senior services in accordance with 15
542+rules and regulations promulgated by it. No registration 16
543+shall be granted for a term exceeding three years. 17
544+ 3. Persons registered by the de partment of health and 18
545+senior services pursuant to this chapter to manufacture, 19
546+distribute, or dispense or conduct research with controlled 20
547+substances are authorized to possess, manufacture, 21
548+distribute or dispense such substances, including any such 22
549+activity in the conduct of research, to the extent 23
550+authorized by their registration and in conformity with 24
551+other provisions of this chapter and chapter 579. 25
552+ 4. The following persons shall not be required to 26
553+register and may lawfully possess control led substances 27
554+pursuant to this chapter and chapter 579: 28
555+ (1) An agent or employee, excluding physicians, 29
556+dentists, optometrists, podiatrists or veterinarians, of any 30
557+registered manufacturer, distributor, or dispenser of any 31
558+controlled substance i f such agent is acting in the usual 32
559+course of his or her business or employment; 33
560+ (2) A common or contract carrier or warehouseman, or 34
561+an employee thereof, whose possession of any controlled 35
562+substance is in the usual course of business or employmen t; 36
563+ (3) An ultimate user or a person in possession of any 37
564+controlled substance pursuant to a lawful order of a 38
565+practitioner or in lawful possession of a Schedule V 39
566+substance. 40
567+ 5. The department of health and senior services may, 41
568+by regulation, waive the requirement for registration of 42
569+certain manufacturers, distributors, or dispensers if it 43
570+finds it consistent with the public health and safety. 44 SB 292 19
571+ 6. A separate registration shall be required at each 45
572+principal place of business or profess ional practice where 46
573+the applicant manufactures, distributes, or dispenses 47
574+controlled substances. A hospital may obtain a separate 48
575+registration for each outpatient facility owned or operated 49
576+by the hospital in which behavioral health or substance 50
577+abuse services are delivered. Such outpatient facility may 51
578+distribute or dispense drugs to the extent allowed under a 52
579+hospital registration. 53
580+ 7. The department of health and senior services is 54
581+authorized to inspect the establishment of a registrant o r 55
582+applicant in accordance with the provisions of this chapter. 56
583+ 195.070. 1. A physician, podiatrist, dentist, a 1
584+registered optometrist certified to administer 2
585+pharmaceutical agents as provided in section 336.220, or an 3
586+assistant physician in accordance with section 334.037 or a 4
587+physician assistant in accordance with section 334.747 in 5
588+good faith and in the course of his or her professional 6
589+practice only, may prescribe, administer, and dispense 7
590+controlled substances or he or she m ay cause the same to be 8
591+administered or dispensed by an individual as authorized by 9
592+statute. 10
593+ 2. An advanced practice registered nurse, as defined 11
594+in section 335.016, but not a certified registered nurse 12
595+anesthetist as defined in subdivision (8) o f section 13
596+335.016, who holds a certificate of controlled substance 14
597+prescriptive authority from the board of nursing under 15
598+section 335.019 and who is delegated the authority to 16
599+prescribe controlled substances under a collaborative 17
600+practice arrangement under section 334.104 may prescribe any 18
601+controlled substances listed in Schedules III, IV, and V of 19
602+section 195.017, and may have restricted authority in 20 SB 292 20
603+Schedule II. Prescriptions for Schedule II medications 21
604+prescribed by an advanced practice registe red nurse who has 22
605+a certificate of controlled substance prescriptive authority 23
606+are restricted to only those medications containing 24
607+hydrocodone and Schedule II controlled substances for 25
608+hospice patients pursuant to the provisions of section 26
609+334.104. However, no such certified advanced practice 27
610+registered nurse shall prescribe controlled substance for 28
611+his or her own self or family. Schedule III narcotic 29
612+controlled substance and Schedule II - hydrocodone 30
613+prescriptions shall be limited to a one hundr ed twenty-hour 31
614+supply without refill. 32
615+ 3. A veterinarian, in good faith and in the course of 33
616+the veterinarian's professional practice only, and not for 34
617+use by a human being, may prescribe, administer, and 35
618+dispense controlled substances and the vet erinarian may 36
619+cause them to be administered by an assistant or orderly 37
620+under his or her direction and supervision. 38
621+ 4. A practitioner shall not accept any portion of a 39
622+controlled substance unused by a patient, for any reason, if 40
623+such practitioner did not originally dispense the drug, 41
624+except: 42
625+ (1) When the controlled substance is delivered to the 43
626+practitioner to administer to the patient for whom the 44
627+medication is prescribed [as authorized by federal law ]. 45
628+Practitioners shall maintain reco rds and secure the 46
629+medication as required by this chapter and regulations 47
630+promulgated pursuant to this chapter; or 48
631+ (2) As provided in section 195.265. 49
632+ 5. An individual practitioner shall not prescribe or 50
633+dispense a controlled substance for s uch practitioner's 51
634+personal use except in a medical emergency. 52 SB 292 21
635+ 334.031. 1. Candidates for licenses as physicians and 1
636+surgeons shall furnish [satisfactory evidence of their good 2
637+moral character, and their preliminary qualifications, to 3
638+wit: a certificate of graduation from an accredited high 4
639+school or its equivalent, and satisfactory evidence of 5
640+completion of preprofessional education consisting of a 6
641+minimum of sixty semester hours of college credits in 7
642+acceptable subjects leadi ng towards the degree of bachelor 8
643+of arts or bachelor of science from an accredited college or 9
644+university. They shall also furnish satisfactory evidence 10
645+of having attended throughout at least four terms of thirty - 11
646+two weeks of actual instructions in ea ch term and of having 12
647+received a diploma from some reputable medical college or 13
648+osteopathic college that enforces requirements of four terms 14
649+of thirty-two weeks for actual instruction in each term, 15
650+including, in addition to class work, such experience in 16
651+operative and hospital work during the last two years of 17
652+instruction as is required by the American Medical 18
653+Association and the American Osteopathic Association before 19
654+the college is approved and accredited as reputable. Any 20
655+medical college approv ed and accredited as reputable by the 21
656+American Medical Association or the Liaison Committee on 22
657+Medical Education and any osteopathic college approved and 23
658+accredited as reputable by the American Osteopathic 24
659+Association is deemed to have complied with th e requirements 25
660+of this subsection]: 26
661+ (1) Evidence of good moral character by submitting to 27
662+a criminal background check as provided in section 43.540; 28
663+ (2) A diploma and academic transcripts from a school 29
664+accredited by the Liaison Committee on Medical Education, 30
665+the Commission on Osteopathic College Accreditation, the 31 SB 292 22
666+Educational Commission for Foreign Medical Graduates 32
667+(ECFMG), or a similar accrediting agency; and 33
668+ (3) A certificate demonstrating that the applicant has 34
669+successfully completed a postgraduate internship or resident 35
670+training in a hospital approved for such training by the 36
671+board. An applicant who holds a valid certificate issued by 37
672+the ECFMG shall submit satisfactory evidence of successful 38
673+completion of two years of suc h training. 39
674+Except as provided in subsection 3 of this section, the 40
675+board shall not require applicants to provide information in 41
676+addition to what the applicant is required to furnish by 42
677+this subsection. 43
678+ 2. In determining the qualifications necessa ry for 44
679+licensure as a qualified physician and surgeon, the board, 45
680+by rule and regulation, may accept the certificate of the 46
681+National Board of Medical Examiners of the United States, 47
682+chartered pursuant to the laws of the District of Columbia, 48
683+of the National Board of Examiners for Osteopathic 49
684+Physicians and Surgeons chartered pursuant to the laws of 50
685+the state of Indiana, or of the Licentiate of the Medical 51
686+Counsel of Canada (LMCC) in lieu of and as equivalent to its 52
687+own professional examination. Every applicant for a license 53
688+on the basis of such certificate, upon making application 54
689+showing necessary qualifications as provided in subsection 1 55
690+of this section, shall be required to pay the same fee 56
691+required of applicants to take the examination bef ore the 57
692+board. 58
693+ 3. The board may require applicants to list all 59
694+licenses to practice as a physician currently or previously 60
695+held in any other state, territory, or country and to 61
696+disclose any past or pending investigations, discipline, or 62 SB 292 23
697+sanctions against each such license. Applicants shall not 63
698+be required to submit verification of such licensure or any 64
699+investigations, discipline, or sanctions, except the board 65
700+may require applicants to provide any authorization 66
701+necessary for the board to ind ependently verify the 67
702+existence or status of an applicant's licensure to practice 68
703+as a physician in any other state, territory, or country. 69
704+ 4. In addition to the criminal background screening 70
705+required by this section, the board may obtain a report on 71
706+the applicant from the National Practitioner Data Bank. 72
707+ 5. Notwithstanding any other provision of law to the 73
708+contrary, if the board does not approve or deny an 74
709+application submitted by a candidate for licensure as a 75
710+physician and surgeon with in forty-five days from the date 76
711+the board receives the application, the application shall be 77
712+deemed approved, and the candidate shall be considered 78
713+licensed as a physician and surgeon in good standing with 79
714+the board as of the date of the deemed approv al. 80
715+ 334.035. 1. For purposes of this section, the 1
716+following terms mean: 2
717+ (1) "ACGME", the Accreditation Council for Graduate 3
718+Medical Education; 4
719+ (2) "Applicant", an applicant for a permanent license 5
720+as a physician and surg eon; 6
721+ (3) "Hospital", the same meaning given to the term in 7
722+section 197.020. 8
723+ 2. Except as otherwise provided in section 334.036, 9
724+every applicant [for a permanent license as a physician and 10
725+surgeon] shall provide the board with satisfactory ev idence 11
726+of having successfully completed such postgraduate training 12
727+in hospitals or medical or osteopathic colleges as the board 13
728+may prescribe by rule. 14 SB 292 24
729+ 3. Any applicant who has completed unaccredited 15
730+postgraduate training in a medical subspecialty for which no 16
731+program accredited by ACGME exists shall be deemed to have 17
732+satisfactorily completed the training requirements of 20 18
733+C.S.R. 2150-2.004(2) or any successor regulation if such 19
734+unaccredited postgraduate training occurred in a teaching 20
735+hospital accredited by ACGME. 21
736+ 4. The board shall waive the training requirements of 22
737+20 C.S.R. 2150-2.004(2) or any successor regulation for any 23
738+applicant who is licensed as a physician in good standing in 24
739+another state and has been in good standing more than three 25
740+years. 26
741+ 338.165. 1. As used in this section, the following 1
742+terms mean: 2
743+ (1) "Board", the Missouri board of pharmacy; 3
744+ (2) "Hospital", a hospital as defined in section 4
745+197.020; 5
746+ (3) "Hospital clinic or facil ity", a clinic or 6
747+facility under the common control, management, or ownership 7
748+of the same hospital or hospital system; 8
749+ (4) "Medical staff committee", the committee or other 9
750+body of a hospital or hospital system responsible for 10
751+formulating policies regarding pharmacy services and 11
752+medication management; 12
753+ (5) "Medication order", an order for a legend drug or 13
754+device that is: 14
755+ (a) Authorized or issued by an authorized prescriber 15
756+acting within the scope of his or her professional practice 16
757+or pursuant to a protocol or standing order approved by the 17
758+medical staff committee; and 18 SB 292 25
759+ (b) To be distributed or administered to the patient 19
760+by a health care practitioner or lawfully authorized 20
761+designee at a hospital or a hospital clinic or facil ity; 21
762+ (6) "Patient", an individual receiving medical 22
763+diagnosis, treatment or care at a hospital or a hospital 23
764+clinic or facility. 24
765+ 2. The department of health and senior services shall 25
766+have sole authority and responsibility for the inspection 26
767+and licensure of hospitals as provided by chapter 197 27
768+including, but not limited to all parts, services, 28
769+functions, support functions and activities which contribute 29
770+directly or indirectly to patient care of any kind 30
771+whatsoever. However, the board ma y inspect a class B 31
772+pharmacy or any portion thereof that is not under the 32
773+inspection authority vested in the department of health and 33
774+senior services by chapter 197 to determine compliance with 34
775+this chapter or the rules of the board. This section shall 35
776+not be construed to bar the board from conducting an 36
777+investigation pursuant to a public or governmental complaint 37
778+to determine compliance by an individual licensee or 38
779+registrant of the board with any applicable provisions of 39
780+this chapter or the rule s of the board. 40
781+ 3. The department of health and senior services shall 41
782+have the sole authority to promulgate rules governing 42
783+pharmacy services in hospitals, but may promulgate rules in 43
784+conjunction with the board governing medication distribution 44
785+and the provision of medication therapy services , as 45
786+described in section 338.010, by a pharmacist at or within a 46
787+hospital. [Rules may include, but are not limited to, 47
788+medication management, preparation, compounding, 48
789+administration, storage, distributi on, packaging and 49
790+labeling. Until such rules are jointly promulgated, 50 SB 292 26
791+hospitals shall comply with all applicable state law and 51
792+department of health and senior services rules governing 52
793+pharmacy services and medication management in hospitals. ] 53
794+The board shall have the sole authority to promulgate rules 54
795+governing inspection and licensure of class B pharmacies. 55
796+The rulemaking authority granted herein to the department of 56
797+health and senior services shall not include the dispensing 57
798+of medication by prescription. 58
799+ 4. All pharmacists providing medication therapy 59
800+services shall obtain a certificate of medication 60
801+therapeutic plan authority as provided by rule of the 61
802+board. Medication therapy services may be provided by a 62
803+pharmacist for patients o f a hospital pursuant to a 63
804+protocol with a physician as required by section 338.010 or 64
805+pursuant to a protocol approved by the medical staff 65
806+committee. However, the medical staff protocol shall 66
807+include a process whereby an exemption to the protocol fo r a 67
808+patient may be granted for clinical efficacy should the 68
809+patient's physician make such request. The medical staff 69
810+protocol shall also include an appeals process to request a 70
811+change in a specific protocol based on medical evidence 71
812+presented by a physician on staff. 72
813+ 5. Medication may be dispensed by a class B hospital 73
814+pharmacy pursuant to a prescription or a medication order. 74
815+ 6. A drug distributor license shall not be required to 75
816+transfer medication from a class B hospital pharmacy to a 76
817+hospital clinic or facility for patient care or treatment. 77
818+ 7. Medication dispensed by a class A pharmacy located 78
819+in a hospital to a hospital patient for use or 79
820+administration outside of the hospital under a medical staff - 80
821+approved protocol for me dication therapy shall be dispensed 81 SB 292 27
822+only by a prescription order for medication therapy from an 82
823+individual physician for a specific patient. 83
824+ 8. Medication dispensed by a hospital to a hospital 84
825+patient for use or administration outside of the hospi tal 85
826+shall be labeled as provided by rules jointly promulgated by 86
827+the department of health and senior services and the board 87
828+including medication distributed for administration by or 88
829+under the supervision of a health care practitioner at a 89
830+hospital clinic or facility. 90
831+ 9. This section shall not be construed to preempt any 91
832+law or rule governing controlled substances. 92
833+ 10. Any rule, as that term is defined in section 93
834+536.010, that is created under the authority delegated in 94
835+this section shall only become effective if it complies with 95
836+and is subject to all of the provisions of chapter 536 and, 96
837+if applicable, section 536.028. This section and chapter 97
838+536 are nonseverable and if any of the powers vested with 98
839+the general assembly under chapte r 536 to review, to delay 99
840+the effective date, or to disapprove and annul a rule are 100
841+subsequently held unconstitutional, then the grant of 101
842+rulemaking authority and any rule proposed or adopted after 102
843+August 28, 2014, shall be invalid and void. 103
844+ 11. The board shall appoint an advisory committee to 104
845+review and make recommendations to the board on the merit of 105
846+all rules and regulations to be jointly promulgated by the 106
847+board and the department of health and senior services 107
848+pursuant to the joint rulema king authority granted by this 108
849+section. The advisory committee shall consist of: 109
850+ (1) Two representatives designated by the Missouri 110
851+Hospital Association, one of whom shall be a pharmacist; 111
852+ (2) One pharmacist designated by the Missouri Societ y 112
853+of Health System Pharmacists; 113 SB 292 28
854+ (3) One pharmacist designated by the Missouri Pharmacy 114
855+Association; 115
856+ (4) One pharmacist designated by the department of 116
857+health and senior services from a hospital with a licensed 117
858+bed count that does not exceed fifty beds or from a critical 118
859+access hospital as defined by the department of social 119
860+services for purposes of MO HealthNet reimbursement; 120
861+ (5) One pharmacist designated by the department of 121
862+health and senior services from a hospital with a license d 122
863+bed count that exceeds two hundred beds; and 123
864+ (6) One pharmacist designated by the board with 124
865+experience in the provision of hospital pharmacy services. 125
866+ 12. Nothing in this section shall be construed to 126
867+limit the authority of a licensed hea lth care provider to 127
868+prescribe, administer, or dispense medications and 128
869+treatments within the scope of their professional practice. 129
870+