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STATE OF OKLAHOMA
1st Session of the 58th Legislature (2021)
HOUSE BILL 1013 By: Talley
AS INTRODUCED
An Act relating to public health; amending Section 5,
Chapter 175, O.S.L. 2018, as last amended by Section
19, Chapter 428, O.S.L. 2019 ( 63 O.S. Supp. 2020,
Section 2-309I), which relates to prescription limits
and rules for opioid drugs; clarifying construction
of the Anti-Drug Diversion Act; defining the standard
of care; protecting practitioners who prescribe in
good faith; and declaring an emergency.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. AMENDATORY Section 5, Chapter 175, O.S.L.
2018, as last amended by Section 19, Chapter 428, O.S.L. 2019 (63
O.S. Supp. 2020, Section 2 -309I), is amended to read as follows:
Section 2-309I. A. A practitioner shall not issue an initial
prescription for an opioid drug in a quantity exceeding a seven -day
supply for treatment of acute pain. Any opioid prescription for
acute pain shall be for the lowest effective dose of an immediate -
release drug.
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B. Prior to issuing an initial prescription for an opioid drug
in a course of treatment for acute or chronic pain, a practitioner
shall:
1. Take and document the results of a thorough medical histor y,
including the experience of the patient with nonopioid medication
and nonpharmacological pain -management approaches and substance
abuse history;
2. Conduct, as appropriate, and document the results of a
physical examination;
3. Develop a treatment pla n with particular attention focused
on determining the cause of pain of the patient;
4. Access relevant prescription monitoring information from the
central repository pursuant to Section 2 -309D of this title;
5. Limit the supply of any opioid drug presc ribed for acute
pain to a duration of no more than seven (7) days as determined by
the directed dosage and frequency of dosage; provided, however, upon
issuing an initial prescription for acute pain pursuant to this
section, the practitioner may issue one (1) subsequent prescription
for an opioid drug in a quantity not to exceed seven (7) days if:
a. the subsequent prescription is due to a major surgical
procedure or "confined to home" status as defined in
42 U.S.C., Section 1395n(a),
b. the practitioner provides the subsequent prescription
on the same day as the initial prescription,
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c. the practitioner provides written instructions on the
subsequent prescription indicating the earliest date
on which the prescription may be filled, otherwise
known as a "do not fill until" date, and
d. the subsequent prescription is dispensed no more than
five (5) days after the "do not fill until" date
indicated on the prescription;
6. In the case of a patient under the age of eighteen (18)
years old, enter into a patient -provider agreement with a parent or
guardian of the patient; and
7. In the case of a patient who is a pregnant woman, enter into
a patient-provider agreement with the patient.
C. No less than seven (7) days after issuing the initial
prescription pursuant to subsection A of this section, the
practitioner, after consultation with the patient, may issue a
subsequent prescription for the drug to the patient in a quantity
not to exceed seven (7) days, provided that:
1. The subsequent prescription would not be deemed an initial
prescription under this section;
2. The practitioner determines the prescription is necessary
and appropriate to the treatment needs of the patient and documents
the rationale for the issuance of the subsequent prescription; and
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3. The practitioner determines that issuance of the subsequent
prescription does not present an undue risk of abuse, addiction or
diversion and documents that determination.
D. Prior to issuing the initial prescription of an opioid drug
in a course of treatment for acute or chronic pain and again prior
to issuing the third prescription of the course of treatment, a
practitioner shall discuss with the patient or the parent or
guardian of the patient if the patient is under eighteen (18) years
of age and is not an emancipated minor, the risks associated with
the drugs being prescribed, including but not limited to:
1. The risks of addiction and overdose associated with opioid
drugs and the dangers of taking opioid drugs with alcohol,
benzodiazepines and other centr al nervous system depressants;
2. The reasons why the prescription is necessary;
3. Alternative treatments that may be available; and
4. Risks associated with the use of the drugs being prescribed,
specifically that opioids are highly addictive, even wh en taken as
prescribed, that there is a risk of developing a physical or
psychological dependence on the controlled dangerous substance, and
that the risks of taking more opioids than prescribed or mixing
sedatives, benzodiazepines or alcohol with opioids can result in
fatal respiratory depression.
The practitioner shall include a note in the medical record of
the patient that the patient or the parent or guardian of the
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patient, as applicable, has discussed with the practitioner the
risks of developing a p hysical or psychological dependence on the
controlled dangerous substance and alternative treatments that may
be available. The applicable state licensing board of the
practitioner shall develop and make available to practitioners
guidelines for the discu ssion required pursuant to this subsection.
E. At the time of the issuance of the third prescription for an
opioid drug, the practitioner shall enter into a patient -provider
agreement with the patient.
F. When an opioid drug is continuously prescribed fo r three (3)
months or more for chronic pain, the practitioner shall:
1. Review, at a minimum of every three (3) months, the course
of treatment, any new information about the etiology of the pain,
and the progress of the patient toward treatment objective s and
document the results of that review;
2. In the first year of the patient -provider agreement, assess
the patient prior to every renewal to determine whether the patient
is experiencing problems associated with an opioid use disorder and
document the results of that assessment. Following one (1) year of
compliance with the patient -provider agreement, the practitioner
shall assess the patient at a minimum of every six (6) months;
3. Periodically make reasonable efforts, unless clinically
contraindicated, to either stop the use of the controlled substance,
decrease the dosage, try other drugs or treatment modalities in an
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effort to reduce the potential for abuse or the development of an
opioid use disorder as defined by the American Psychiatric
Association and document with specificity the efforts undertaken;
4. Review the central repository information in accordance with
Section 2-309D of this title; and
5. Monitor compliance with the patient -provider agreement and
any recommendations that the patient seek a referral.
G. 1. Any prescription for acute pain pursuant to this section
shall have the words "acute pain" notated on the face of the
prescription by the practitioner.
2. Any prescription for chronic pain pursuant to this section
shall have the words "chronic pain" notated on the face of the
prescription by the practitioner.
H. This section shall not apply to a prescription for a patient
who is currently in active treatment for cancer, receiving hospice
care from a licensed hospice or palliative care, or is a resident of
a long-term care facility, or to any medications that are being
prescribed for use in the treatment of substance abuse or opioid
dependence.
I. Every policy, contract or plan delivered, issued, executed
or renewed in this state, or approved for issuance or renewal in
this state by the Insurance Commissioner, and every contract
purchased by the Employees Group Insurance Division of the Office of
Management and Enterprise Services, on or after November 1, 2018,
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that provides covera ge for prescription drugs subject to a
copayment, coinsurance or deductible shall charge a copayment,
coinsurance or deductible for an initial prescription of an opioid
drug prescribed pursuant to this section that is either:
1. Proportional between the c ost sharing for a thirty -day
supply and the amount of drugs the patient was prescribed; or
2. Equivalent to the cost sharing for a full thirty -day supply
of the drug, provided that no additional cost sharing may be charged
for any additional prescriptions for the remainder of the thirty -day
supply.
J. Any practitioner authorized to prescribe an opioid drug
shall adopt and maintain a written policy or policies that include
execution of a written agreement to engage in an informed consent
process between the prescribing practitioner and qualifying opioid
therapy patient. For the purposes of this section, "qualifying
opioid therapy patient " means:
1. A patient requiring opioid treatment for more than three (3)
months;
2. A patient who is prescribed benzodi azepines and opioids
together for more than one twenty -four-hour period; or
3. A patient who is prescribed a dose of opioids that exceeds
one hundred (100) morphine equivalent doses.
K. Nothing in the Anti-Drug Diversion Act shall be construed to
require a practitioner to limit or forcibly taper a stable long -term
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opioid therapy patient. The standard of care requires effective and
individualized treatment for each patient without limits or
thresholds on dose or quantity.
L. When a practitioner thoroughl y assesses and documents his or
her findings as required by this section and prescribes in good
faith using his or her clinical expertise, neither an individual
patient's nor practitioner's practice's average prescribed doses or
quantities alone shall be u sed as the basis to initiate an
investigation or disciplinary action, or to pursue civil liability
or criminal penalties .
SECTION 2. It being immediately necessary for the preservation
of the public peace, health or safety, an emergency is hereby
declared to exist, by reason whereof this act shall take effect and
be in full force from and after its passage and approval.
58-1-6540 AB 12/11/20