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HOUSE OF REPRESENTATIVES - FLOOR VERSION
STATE OF OKLAHOMA
1st Session of the 58th Legislature (2021)
COMMITTEE SUBSTITUTE
FOR ENGROSSED
SENATE BILL NO. 57 By: Rader of the Senate
and
Echols and McEntire of the
House
COMMITTEE SUBSTITUTE
An Act relating to controlled dangerous substances;
amending 63 O.S. 2011, Section 2 -309D, as last
amended by Section 59, Chapter 161, O.S.L. 2020 (63
O.S. Supp. 2020, Section 2 -309D), which relates to
the central repository; authorizing members of the
Opioid Overdose Fatality Review Board to access
central repository for certain purpose; requiring
physician to disclose certain patient history upon
request; modifying circumstances that require
unsolicited notification to certain licensing board;
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;
providing reference to certain definition; modifying
applicability of section; providing construing
provision; stating standard of care for patients; and
declaring an emergency.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
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SECTION 1. AMENDATORY 63 O.S. 2011, Section 2 -309D, as
last amended by Section 59, Chapter 161, O.S.L. 2020 (63 O.S. Supp.
2020, Section 2-309D), is amended to read as follows:
Section 2-309D. A. The information collected at the central
repository pursuant to the Anti -Drug Diversion Act shall be
confidential and shall not be open to the public. Access to the
information shall be limited to:
1. Peace officers certified pursuant to Section 3311 of Title
70 of the Oklahoma Statutes who are employed as investigative agents
of the Oklahoma State Bureau of Narcotics and Dangerous Drugs
Control;
2. The United States Drug Enforcement Administration Diversion
Group Supervisor;
3. The executive director or chief investigator, as designated
by each board, of the following state boards:
a. Board of Podiatric Medical Exami ners,
b. Board of Dentistry,
c. State Board of Pharmacy,
d. State Board of Medical Licensure and Supervision,
e. State Board of Osteopathic Examiners,
f. State Board of Veterinary Medical Examiners,
g. Oklahoma Health Care Authority,
h. Department of Mental Health and Substance Abuse
Services,
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i. Board of Examiners in Optometry,
j. Board of Nursing,
k. Office of the Chief Medical Examiner, and
l. State Board of Health;
4. A multicounty grand jury properly convened pursuant to the
Multicounty Grand Jury Act ;
5. Medical practitioners employed by the United States
Department of Veterans Affairs, the United States Military, or other
federal agencies treating patients in this state; and
6. At the discretion of the Director of the Oklahoma State
Bureau of Narcotics and Dangerous Drugs Control, medical
practitioners and their staff, including those employed by the
federal government in this state ; and
7. The members of the Opioid Overdose Fatality Review Board for
the purpose of carrying out the duties prescribe d by Section 2-1001
of this title.
B. This section shall not prevent access, at the discretion of
the Director of the Oklahoma State Bureau of Narcotics and Dangerous
Drugs Control, to investigative information by peace officers and
investigative agents o f federal, state, tribal, county or municipal
law enforcement agencies, district attorneys and the Attorney
General in furtherance of criminal, civil or administrative
investigations or prosecutions within their respective
jurisdictions, designated legal, communications, and analytical
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employees of the Bureau, and to registrants in furtherance of
efforts to guard against the diversion of controlled dangerous
substances.
C. This section shall not prevent the disclosure, at the
discretion of the Director of the Oklahoma State Bureau of Narcotics
and Dangerous Drugs Control, of statistical information gathered
from the central repository to the general public which shall be
limited to types and quantities of controlled substances dispensed
and the county where dispensed.
D. This section shall not prevent the disclosure, at the
discretion of the Director of the Oklahoma State Bureau of Narcotics
and Dangerous Drugs Control, of prescription -monitoring-program
information to prescription -monitoring programs of ot her states
provided a reciprocal data -sharing agreement is in place.
E. The Department of Mental Health and Substance Abuse Services
and the State Department of Health may utilize the information in
the central repository for statistical, research, substa nce abuse
prevention, or educational purposes, provided that consumer
confidentiality is not compromised.
F. Any unauthorized disclosure of any information collected at
the central repository provided by the Anti -Drug Diversion Act shall
be a misdemeanor. Violation of the provisions of this section shall
be deemed willful neglect of duty and shall be grounds for removal
from office.
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G. 1. Registrants shall have access to the central repository
for the purposes of patient treatment and for to aid in the
determination in prescribing or screening new patients. The
patient's history may be disclosed to the patient for the purposes
of treatment of information at the discretion of the physician. The
physician or designee shall provide, upon request by the pa tient,
the history of the patient or the query history of the patient.
2. a. Prior to prescribing or authorizing for refill, if one
hundred eighty (180) days have elapsed prior to the
previous access and check, of opiates, synthetic
opiates, semisynthetic opiates, benzodiazepine or
carisoprodol to a patient of record, registrants or
members of their medical or administrative staff shall
be required to access the information in the central
repository to assess medical necessity and the
possibility that the p atient may be unlawfully
obtaining prescription drugs in violation of the
Uniform Controlled Dangerous Substances Act. The duty
to access and check shall not alter or otherwise amend
appropriate medical standards of care. The registrant
or medical provider shall note in the patient file
that the central repository has been checked and may
maintain a copy of the information.
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b. The requirements set forth in subparagraph a of this
paragraph shall not apply:
(1) to medical practitioners who prescribe the
controlled substances set forth in subparagraph a
of this paragraph for hospice or end -of-life
care, or
(2) for a prescription of a controlled substance set
forth in subparagraph a of this paragraph that is
issued by a practitioner for a patient residing
in a nursing facility as defined by Section 1 -
1902 of this title, provided that the
prescription is issued to a resident of such
facility.
3. Registrants shall not be liable to any person for any claim
of damages as a result of accessing or failing to access the
information in the central repository and no lawsuit may be
predicated thereon.
4. The failure of a registrant to access and check the central
repository as required under state or federal law or regulation may,
after investigation, be grounds for the licensing board of the
registrant to take disciplinary action against the registrant.
H. The State Board of Podiatric Medical Examiners, the State
Board of Dentistry, the State Board of Medical Licensure and
Supervision, the State Board of Examiners in O ptometry, the State
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Board of Nursing, the State Board of Osteopathic Examiners and the
State Board of Veterinary Medical Examiners shall have the sole
responsibility for enforcement of the provisions of subsection G of
this section. Nothing in this sectio n shall be construed so as to
permit the Director of the State Bureau of Narcotics and Dangerous
Drugs Control to assess administrative fines provided for in Section
2-304 of this title.
I. The Director of the Oklahoma State Bureau of Narcotics and
Dangerous Drugs Control, or a designee thereof, shall provide a
monthly list to the Directors of the State Board of Podiatric
Medical Examiners, the State Board of Dentistry, the State Board of
Medical Licensure and Supervision, the State Board of Examiners in
Optometry, the State Board of Nursing, the State Board of
Osteopathic Examiners and the State Board of Veterinary Medical
Examiners of the top twenty prescribers of controlled dangerous
substances within their respective areas of jurisdiction. Upon
discovering that a registrant is prescribing outside the limitations
of his or her licensure or outside of drug registration rules or
applicable state laws, the respective licensing board shall be
notified by the Bureau in writing. Such notifications may be
considered complaints for the purpose of investigations or other
actions by the respective licensing board. Licensing boards shall
have exclusive jurisdiction to take action against a licensee for a
violation of subsection G of this section.
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J. Information regarding fatal and nonfatal overdoses, other
than statistical information as required by Section 2 -106 of this
title, shall be completely confidential. Access to this information
shall be strictly limited to the Director of the Oklahoma State
Bureau of Narcotics and Dangerous Drugs Control or designee, the
Chief Medical Examiner, state agencies and boards provided in
subsection A of this section, and the registrant that enters the
information. Registrants shall not be liable to any person for a
claim of damages for information reported pursuant to the provisions
of Section 2-105 of this title.
K. The Director of the Oklahoma State Bureau of Narcotics and
Dangerous Drugs Control shall provide adequate means and procedures
allowing access to central reposit ory information for registrants
lacking direct computer access.
L. Upon completion of an investigation in which it is
determined that a death was caused by an overdose, either
intentionally or unintentionally, of a controlled dangerous
substance, the medical examiner shall be required to report the
decedent's name and date of birth to the Oklahoma State Bureau of
Narcotics and Dangerous Drugs Control. The Oklahoma State Bureau of
Narcotics and Dangerous Drugs Control shall be required to maintain
a database containing the classification of medical practitioners
who prescribed or authorized controlled dangerous substances
pursuant to this subsection.
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M. The Oklahoma State Bureau of Narcotics and Dangerous Drugs
Control is authorized to provide unsolicited notification to the
licensing board of a pharmacist or practitioner if a patient has
received one or more prescriptions for controlled substances in
quantities or with a frequency inconsistent with generally
recognized standards of safe practice or if a practitioner or
prescriber has exhibited prescriptive behavior consistent with
generally recognized standards indicating potentially problematic
prescribing patterns . An unsolicited notification to the licensing
board of the practitioner pursuant to this se ction:
1. Is confidential;
2. May not disclose information that is confidential pursuant
to this section; and
3. May be in a summary form sufficient to provide notice of the
basis for the unsolicited notification.
SECTION 2. 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 op ioid 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 history,
including the experience of the patient with nonopioid medication
and nonpharmacological pain -management approaches an d 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 mon itoring information from 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 seven (7) days as determined by
the directed dosage and frequency of d osage; 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 prescript ion 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 inst ructions 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 u ntil" 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, ent er 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 prescripti on 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 o r
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 central 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 when taken as
prescribed, that there is a risk of developing a physical or
psychological dependence on the controlled dange rous 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 physical 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 discussion 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 for 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 objectives 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 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 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,
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decrease the dosage, try other drugs or treatment modalities in an
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 pr actitioner.
H. This section shall not apply to a prescription for a patient
who is currently in active treatment for cancer or receiving
aftercare cancer treatment , receiving hospice care from a licensed
hospice, or palliative care in conjunction with a s erious illness,
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
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purchased by the Employees Group 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 for an initial prescription of an opioid
drug prescribed pursuant to this section that is either:
1. Proportional betw een 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 pres criptions 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 prescribe d 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.
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K. Nothing in the Anti -Drug Diversion Act shall be construed t o
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 practitioner without an administrative or codif ied
limit on dose or quantity that is more restrictive than approved by
the Food and Drug Administration (FDA).
SECTION 3. 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.
COMMITTEE REPORT BY: COMMITTEE ON ALCOHOL, TOBACCO AND CONTROLLED
SUBSTANCES, dated 04/08/2021 - DO PASS, As Amended and Coauthored .