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SENATE FLOOR VERSION
April 11, 2022
AS AMENDED
ENGROSSED HOUSE
BILL NO. 3073 By: Talley, Randleman, Bush,
Miller, Echols, Pittman,
Stinson, and Goodwin of the
House
and
Rader and Dugger of the
Senate
An Act relating to controlled dangerous substances;
amending 63 O.S. 2021, Section 2 -309I, which relates
to prescription of opioid drugs ; adding an exception;
and declaring an emergency.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. AMENDATORY 63 O.S. 2021, 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 quantit y exceeding a seven-day
supply for treatment of acute pain . Any opioid prescrip tion for
acute pain shall be for the lowest effective dose of an immediate -
release drug.
B. Prior to issuing an initial prescription for an opioid drug
in a course of treatmen t for acute or chronic pain, a practitioner
shall:
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1. Take and document the res ults of a thorough medical history,
including the experience of the patient with nonopio id 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 plan with particular attention focused
on determining the cause of pain of the patient;
4. Access relevant prescription monitoring information fr om the
central repository pursuant to Section 2-309D of this title;
5. Limit the supply of any opioid drug prescribed for acute
pain to a duration of no more than seve n (7) days as determined by
the directed dosage and frequency of dosage; provided, howev er, upon
issuing an initial prescription for acute pain pu rsuant to this
section, the practitioner may issue one (1) subsequent prescription
for an opioid drug in a qua ntity not to exceed seven (7) days if:
a. the subsequent prescription is due to a major surgical
procedure or "confined to h ome" status as defined in
42 U.S.C., Section 1395n(a),
b. the practitioner provides the subsequent prescription
on the same day as t he initial prescription,
c. the practitioner provides written instructions on the
subsequent prescription indicating the ear liest date
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on which the prescription may be filled, otherwise
known as a "do not fill until" date, and
d. the subsequent prescriptio n 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, 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) d ays after issuing the initial
prescription pursuant to subsection A of this section, the
practitioner, after c onsultation 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 treatm ent needs of the patient and documents
the rationale for the i ssuance of the subsequent prescription; and
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.
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D. Prior to issuing the initial pres cription 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 th e patient or the parent or
guardian of the patient if the patien t 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 overd ose associated with opioid
drugs and the dangers of taking opioid drugs with alcohol,
benzodiazepines and other central nervous system depressants;
2. The reasons why the pre scription 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 when 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 tha n 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
patient, as applicable, has discuss ed with the practitioner the
risks of developing a physical or psychological dependence on the
controlled dangerous substance and alternative treatments that may
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be available. The applic able state licensing board of the
practitioner shall develop and make available to practitioners
guidelines for the discussion required pursuant to this subsection.
E. At the time of the issuance of the third prescription for an
opioid drug, the practiti oner shall enter into a patient-provider
agreement with the patient.
F. When an opioid drug is continuously prescribed for three (3)
months or more for chronic pain, the practitio ner shall:
1. Review, at a minimum of every three (3) months, the course
of treatment, any new information about the etiolo gy of the pain,
and the progress of the patie nt toward treatment objectives and
document the results of that review;
2. In the first year of the patient-provider agreement, assess
the patient prior to eve ry renewal to determine whether the patient
is experiencing problems asso ciated with an opioid u se disorder as
defined by the American Psychiatric Association and document the
results of that assessment. Following one (1) year of compliance
with the patient-provider agreement, the practitioner shall asses s
the patient at a min imum of every six (6) m onths;
3. Periodically make reasonable efforts, unless clinically
contraindicated, to either stop the use of the controlled substance,
decrease the dosage, tr y other drugs or treatment modalities in an
effort to reduce the potentia l for abuse or the devel opment of an
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opioid use disorder as defined by the American Psychiatric
Association and document with specificity the efforts undertaken;
4. Review the centr al 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 s ection
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 practit ioner.
H. This section shall not apply to a prescriptio n for a patient
who:
1. Who has sickle cell disease;
2. Who is in treatment for cancer or receiving aftercare cancer
treatment, receiving;
3. Who is receiving hospice care from a licensed hospice , or;
4. Who is receiving palliative care in conjunction with a
serious illness, or;
5. Who is a resident of a long-term care facility, or to; or
6. For any medications that are being prescribed for use in the
treatment of substance abuse or opioid dependence.
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I. Every policy, contract or plan delive red, 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 Gr oup Insurance Division of the Office of
Management and Enterprise Services, on or after November 1, 2018,
that provides coverage for prescription drugs subject to a
copayment, coinsurance or deductible shall charge a copayment,
coinsurance or deductible fo r an initial prescription of an opioid
drug prescribed pursuant to this section that is either:
1. Proportional between the cost 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 e ngage 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;
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2. A patient who is pr escribed benzodiazepines 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 cons trued to
require a practitioner to limit or forcibly taper a patient on
opioid therapy. The standard of care requires effective and
individualized treatment for each patient as deemed appropriate by
the prescribing practitio ner without an administrative o r codified
limit on dose or quantity that is more restrictive than approved by
the Food and Drug Administration (FDA).
SECTION 2. It being immediately necessary for the preservation
of the public peace, health or safety, an emergency is he reby
declared to exist, by reason whereof this act shall take effect and
be in full force from and after its passage an d approval.
COMMITTEE REPORT BY: COMMITTEE ON HEALTH AND HUMAN SERVICES
April 11, 2022 - DO PASS AS AMENDED