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ENGROSSED SENATE
BILL NO. 57 By: Rader of the Senate
and
Echols of the House
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 Revi ew Board to access
central repository for certai n purpose; requiring
physician to disclose c ertain patient history upon
request; 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. 20 20, Section 2-309I),
which relates to prescription limits and rules for
opioid drugs; modifying applicability of section;
defining term; clarifying language; and declaring an
emergency.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. AMENDATORY 63 O.S. 2011, Section 2 -309D, as
last amended by Sectio n 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:
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1. Peace officers certified pursuant to Section 3311 of Title
70 of the Oklahoma Sta tutes who are employed as investigative agents
of the Oklahoma State Bureau of Narcotics and Dangerous Drug s
Control;
2. The United States Drug E nforcement Administration Diversion
Group Supervisor;
3. The executive director or chief investigator, as des ignated
by each board, of the following state boards:
a. Board of Podiatric Medical Examiners,
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 Subst ance Abuse
Services,
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;
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5. Medical practitioners employed by the United States
Department of Veterans Affairs, the United States Military, or other
federal agencies treating patients in th is 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 prescri bed 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 of 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, an d analytical
employees of the Bureau, a nd 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
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from the central repository to the general public which shall b e
limited to types and quantities of controlled substances dispensed
and the county where dispensed.
D. This section shall not prevent the disclo sure, 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 other 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 Healt h may utilize the information in
the central repository for statistical, research, substance abuse
prevention, or educational purposes, provided t hat 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.
G. 1. Registrants shall have acce ss to the central repository
for the purposes of patient treatment and for determination in
prescribing or screening new patients. The patient 's history may be
disclosed to the patient for the purposes of treatment of
information providing information regarding treatment at the
discretion of the physician. Upon the request of a p atient who
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requests the patient’s history for any reason, the physician or
designee shall disclose such history to 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 ch eck, of opiates, synthe tic
opiates, semisynthetic opiates, benzo diazepine 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 patient 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 st andards of care. The r egistrant
or medical provider shall note in the patient file
that the central repository has been checked and may
maintain a copy of the information.
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
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(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 acce ssing 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 regul ation may,
after investigation, be grounds for the licensing boa rd of the
registrant to take disciplinary action against the registrant.
H. The State Board of Podiatric Examiners, the State Board of
Dentistry, the State Board of Medical Licensure and Supe rvision, the
State Board of Examiners in Optometry, the State Bo ard 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 section shall be construed s o as to permit the
Director of the State Bureau of Narcotics and Dangerous Drugs
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Control to assess administrative fines provided for in Section 2 -304
of this title.
I. The Director of the Okl ahoma State Bureau of N arcotics and
Dangerous Drugs Control, or a designee thereof, shall provide a
monthly list to the Directors of the State Board of Podiatric
Examiners, the State Board of Dentistry, the State Board of Medical
Licensure and Supervision, the State Board of Exa miners in
Optometry, the State Board of N ursing, 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 ar eas of jurisdiction. U pon
discovering that a registrant is pres cribing 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 writin g. Such notifications may be
considered complaints for the purp ose 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.
J. Information regarding fatal and nonfatal ov erdoses, 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 Co ntrol or designee, the
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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 lia ble to any person for a
claim of damages for information reporte d 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 cent ral repository information for registrant s
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 contro lled 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 shal l be required to mainta in
a database containing the classificati on of medical practitioners
who prescribed or authorized controlled dangerous substances
pursuant to this subsection.
M. The Oklahoma State Bureau of Narcotics and Dangerous Drugs
is authorized to provide unsolicit ed 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 o f
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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 practi tioner
pursuant to this section:
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 init ial
prescription for an opioid drug in a quantity exceeding a se ven-day
supply for treatment of acute pain. Any opioid prescription for
acute pain shall be for the lowest effective dose of an i mmediate-
release drug.
B. Prior to issuing an initial prescri ption for an opioid dru g
in a course of treatment for acute or c hronic pain, a practitioner
shall:
1. Take and document the results of a thorough medical history,
including the experience of th e patient with nonopioid medication
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and nonpharmacological pai n-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 focus ed
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 prescribed for acute
pain to a duration of no more than seven (7) days as determined by
the directed dosage and frequency o f 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 prescr iption 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 prescriptio n
on the same day as the initial prescription,
c. the practitioner provides written i nstructions on the
subsequent prescriptio n indicating the earliest date
on which the prescription may be filled, otherwise
known as a "do not fill until" date, and
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d. the subsequent prescription is dispensed no more than
five (5) days after the "do not fill until" date
indicated on the prescripti on;
6. In the case of a patient under the age of eighteen (18)
years old, enter into a patient -provider agreement with a parent o r
guardian of the patient; and
7. In the case of a patient wh o is a pregnant woman, enter into
a patient-provider agreement w ith 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 iss ue a
subsequent prescription for the drug to the patient in a qu antity
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 prescrip tion is necessary
and appropriate to the treatment needs of the patient and documents
the rationale for the issuance of the subsequent prescription; and
3. The practitioner determines that issu ance of the subsequent
prescription does not present an undue risk of abuse, addictio n or
diversion and documents that determi nation.
D. Prior to issuing the initial prescription of an opioid drug
in a course of treatment for acute or chronic pain and aga in prior
to issuing the third prescription of the course of tr eatment, a
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practitioner shall discuss with the patient or the pa rent or
guardian of the patient if the patient is under eighteen (18) years
of age and is not an emancipated minor, the risks asso ciated with
the drugs being prescribed, including but not limi ted 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 wi th the use of the drugs being prescribed,
specifically that opioids are highly addictive, even when taken as
prescribed, that ther e is a risk of developing a physical or
psychological dependen ce on the controlled da ngerous 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 medica l record of
the patient that the patient or the parent or guardi an of the
patient, as applicable, has discussed with the practitioner the
risks of developing a physical or psychological dependen ce on the
controlled dangerous substance and alternative treat ments that may
be available. The applicable state licensing boa rd of the
practitioner shall develop and make available to practitioners
guidelines for the discussion required pursuant to this s ubsection.
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E. At the time of the issuance of the third prescr iption for an
opioid drug, the practitioner shall enter into a p atient-provider
agreement with the patient.
F. When an opioid drug is continuously prescribed for three (3)
months or more for ch ronic pain, the practitioner shall:
1. Review, at a minimum o f every three (3) month s, the course
of treatment, any new infor mation about the etiology of the pain,
and the progress of the patient toward treatment objectives and
document the results of tha t review;
2. In the first year of the patient -provider agreement, assess
the patient prior to every renewal to determine whet her 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 p ractitioner shall assess
the patient at a minimum of every six (6) mont hs;
3. Periodically make reasonable efforts, unless clinic ally
contraindicated, to either stop the use of the controlled substance,
decrease the dosage, try other drugs or treatment mo dalities in an
effort to reduce the potential for abuse or the developm ent of an
opioid use disorder as defined by the American Ps ychiatric
Association and document with specificity the effort s undertaken;
4. Review the central repository information in a ccordance with
Section 2-309D of this title; and
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5. Monitor compliance with the patient-provider agreement and
any recommendations that the patient seek a referral.
G. 1. Any prescription f or 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 secti on
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 hos pice provider or palliative care from a
licensed hospice provider or licensed medical doctor or doctor of
osteopathy who is board certified in hospice or palliative m edicine,
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, o r approved for issuance or renewal in
this state by the Insurance Commissioner, and every con tract
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 copa yment,
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coinsurance or deductible for an initial prescription of an opioid
drug prescribed pursuant to this section that is either:
1. Proportional between the cos t 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 th at no additional cost sharing may be charged
for any additional prescriptions f or the remainder of the thirty-day
supply.
J. Any practitioner authorized to prescribe an op ioid 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 practitione r and qualifying opioid
therapy patient. For the purposes of this sec tion, "qualifying
opioid therapy patient " means:
1. A patient requiring opioid trea tment for more than three (3)
months;
2. A patient who is prescribed benzodiaz epines 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 do ses.
SECTION 3. It being immediately necessary for the pr eservation
of the public peace, health or safety, an emergency is hereby
declared to exist, by rea son whereof this act shall take effect and
be in full force from and after its passage and approval.
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Passed the Senate the 10th day of February, 2021.
Presiding Officer of the Senate
Passed the House of Representatives the ____ day of __________,
2021.
Presiding Officer of the House
of Representatives