| 503 | + | and that is delivered to the patient in the form of a |
|---|
| 504 | + | liquid, |
|---|
| 505 | + | g. any federal Food-and-Drug-Administration-approved drug |
|---|
| 506 | + | or substance, or |
|---|
| 507 | + | h. industrial hemp, from the plant Cannabis sativa L. and |
|---|
| 508 | + | any part of such plant, whether growing or not, with a |
|---|
| 509 | + | delta-9 tetrahydrocannabinol concentration of not more |
|---|
| 510 | + | than three-tenths of one percent (0.3%) on a dry- |
|---|
| 511 | + | weight basis which shall only be grown pursuant to the |
|---|
| 512 | + | Oklahoma Industrial Hemp Program and may be shipped |
|---|
| 513 | + | intrastate and interstate; |
|---|
| 514 | + | 24. "Medical purpose" means an intention to utilize a |
|---|
| 515 | + | controlled dangerous substance for physical or mental treatment, for |
|---|
| 516 | + | diagnosis, or for the prevention of a disease condition not in |
|---|
| 517 | + | violation of any state or federal law and not for the purpose of |
|---|
| 518 | + | satisfying physiological or psychological dependence or other abuse; |
|---|
| 519 | + | 25. "Mid-level practitioner" means an Advanced Practice |
|---|
| 520 | + | Registered Nurse as defined and within parameters specified in |
|---|
| 521 | + | Section 567.3a of Title 59 of the Oklahoma Statutes, or a certified |
|---|
| 522 | + | animal euthanasia technician as defined in Section 698.2 of Title 59 |
|---|
| 523 | + | of the Oklahoma Statutes, or an animal control officer registered by |
|---|
| 524 | + | the Oklahoma State Bureau of Narcotics and Dangerous Drugs Control |
|---|
| 525 | + | under subsection B of Section 2-301 of this title within the |
|---|
| 526 | + | |
|---|
| 527 | + | HB1082 HFLR Page 11 |
|---|
| 528 | + | BOLD FACE denotes Committee Amendments. 1 |
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| 552 | + | |
|---|
| 553 | + | parameters of such officer's duties under Sections 501 throug h 508 |
|---|
| 554 | + | of Title 4 of the Oklahoma Statutes; |
|---|
| 555 | + | 26. "Narcotic drug" means any of the following, whether |
|---|
| 556 | + | produced directly or indirectly by extraction from substances of |
|---|
| 557 | + | vegetable origin, or independently b y means of chemical synthesis, |
|---|
| 558 | + | or by a combination of e xtraction and chemical synthesis: |
|---|
| 559 | + | a. opium, coca leaves and opiates, |
|---|
| 560 | + | b. a compound, manufacture, salt, derivative or |
|---|
| 561 | + | preparation of opium, coca leaves or opiates, |
|---|
| 562 | + | c. cocaine, its salts, optical and geo metric isomers, and |
|---|
| 563 | + | salts of isomers, |
|---|
| 564 | + | d. ecgonine, its derivatives, their salts, isomers and |
|---|
| 565 | + | salts of isomers, and |
|---|
| 566 | + | e. a substance, and any compound, manufacture, salt, |
|---|
| 567 | + | derivative or preparation thereof, which is chemically |
|---|
| 568 | + | identical with any of the substan ces referred to in |
|---|
| 569 | + | subparagraphs a through d of this pa ragraph, except |
|---|
| 570 | + | that the words "narcotic drug" as used in Section 2- |
|---|
| 571 | + | 101 et seq. of this title shall not include |
|---|
| 572 | + | decocainized coca leaves or extracts of coca leaves, |
|---|
| 573 | + | which extracts do not contain cocain e or ecgonine; |
|---|
| 574 | + | 27. "Opiate" or "opioid" means any Schedule II, III, IV or V |
|---|
| 575 | + | substance having an addiction-forming or addiction-sustaining |
|---|
| 576 | + | liability similar to morphine or being capable of conversion into a |
|---|
| 577 | + | |
|---|
| 578 | + | HB1082 HFLR Page 12 |
|---|
| 579 | + | BOLD FACE denotes Committee Amendments. 1 |
|---|
| 580 | + | 2 |
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| 603 | + | |
|---|
| 604 | + | drug having such addiction-forming or addiction -sustaining |
|---|
| 605 | + | liability. The terms do not include, unless specifically designated |
|---|
| 606 | + | as controlled under the Uniform Controlled Dangerous Substances Act, |
|---|
| 607 | + | the dextrorotatory isomer of 3-methoxy-n-methyl-morphinan and its |
|---|
| 608 | + | salts (dextromethorphan). The terms do include the racemic and |
|---|
| 609 | + | levorotatory forms; |
|---|
| 610 | + | 28. "Opium poppy" means the plant of the species Papaver |
|---|
| 611 | + | somniferum L., except the seeds thereof; |
|---|
| 612 | + | 29. "Palliative care" means a specialized medical service for |
|---|
| 613 | + | people of any age, and at any stage of a serious illness or life - |
|---|
| 614 | + | altering event. Palliative care focuses on mitigating symptoms such |
|---|
| 615 | + | as pain and suffering while navigating comple x medical decisions |
|---|
| 616 | + | with special attention paid to ensuring patient autonomy and access |
|---|
| 617 | + | to information. Utilizing a holistic and interdisciplinary team |
|---|
| 618 | + | approach, palliative care addresses physical, intellectual, |
|---|
| 619 | + | emotional, social, and spiritual needs. Pa lliative care can be |
|---|
| 620 | + | provided in the inpatient, outpatient, or home care setting and |
|---|
| 621 | + | strives to improve quality of life for both the patient and the |
|---|
| 622 | + | family. Palliative care does not always include a requirement for |
|---|
| 623 | + | hospice care or attention to spiritual needs. Palliative care may |
|---|
| 624 | + | be appropriate at any stage of a serious illness, not just at the |
|---|
| 625 | + | end of one's life; |
|---|
| 626 | + | 30. "Peace officer" means a police officer, sheriff, deputy |
|---|
| 627 | + | sheriff, district attorney's investigator, investigator from the |
|---|
| 628 | + | |
|---|
| 629 | + | HB1082 HFLR Page 13 |
|---|
| 630 | + | BOLD FACE denotes Committee Amendments. 1 |
|---|
| 631 | + | 2 |
|---|
| 632 | + | 3 |
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| 633 | + | 4 |
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| 653 | + | 24 |
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| 654 | + | |
|---|
| 655 | + | Office of the Attorney General, or any other person elected or |
|---|
| 656 | + | appointed by law to enforce any of the criminal laws of this state |
|---|
| 657 | + | or of the United States; |
|---|
| 658 | + | 30. 31. "Person" means an individual, corporation, government |
|---|
| 659 | + | or governmental subdivision or agency, business trust, estate, |
|---|
| 660 | + | trust, partnership or association, or any other legal entity; |
|---|
| 661 | + | 31. 32. "Poppy straw" means all parts, except the seeds, of the |
|---|
| 662 | + | opium poppy, after mowing; |
|---|
| 663 | + | 32. 33. "Practitioner" means: |
|---|
| 664 | + | a. (1) a medical doctor or osteopathic physician, |
|---|
| 665 | + | (2) a dentist, |
|---|
| 666 | + | (3) a podiatrist, |
|---|
| 667 | + | (4) an optometrist, |
|---|
| 668 | + | (5) a veterinarian, |
|---|
| 669 | + | (6) a physician assistant or Advanced Practice |
|---|
| 670 | + | Registered Nurse under the supervision of a |
|---|
| 671 | + | licensed medical doctor or osteopathic physician, |
|---|
| 672 | + | (7) a scientific investigator, or |
|---|
| 673 | + | (8) any other person, |
|---|
| 674 | + | licensed, registered or ot herwise permitted to |
|---|
| 675 | + | prescribe, distribute, dispense, conduct research with |
|---|
| 676 | + | respect to, use for scientific purposes or administer |
|---|
| 677 | + | a controlled dangerous substance in the course of |
|---|
| 678 | + | professional practice or research in this state, or |
|---|
| 679 | + | |
|---|
| 680 | + | HB1082 HFLR Page 14 |
|---|
| 681 | + | BOLD FACE denotes Committee Amendments. 1 |
|---|
| 682 | + | 2 |
|---|
| 683 | + | 3 |
|---|
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|---|
| 705 | + | |
|---|
| 706 | + | b. a pharmacy, hospital , laboratory or other institution |
|---|
| 707 | + | licensed, registered or otherwise permitted to |
|---|
| 708 | + | distribute, dispense, conduct research with respect |
|---|
| 709 | + | to, use for scientific purposes or administer a |
|---|
| 710 | + | controlled dangerous substance in the course of |
|---|
| 711 | + | professional practice or re search in this state; |
|---|
| 712 | + | 33. 34. "Production" includes the manufacture, planting, |
|---|
| 713 | + | cultivation, growing or harvesting of a controlled dangerous |
|---|
| 714 | + | substance; |
|---|
| 715 | + | 34. 35. "State" means the State of Oklahoma or any other state |
|---|
| 716 | + | of the United States; |
|---|
| 717 | + | 35. 36. "Ultimate user" means a person who lawfully possesses a |
|---|
| 718 | + | controlled dangerous substance for the person's own use or for the |
|---|
| 719 | + | use of a member of the person's household or for administration to |
|---|
| 720 | + | an animal owned by the person or by a member of the person's |
|---|
| 721 | + | household; |
|---|
| 722 | + | 36. 37. "Drug paraphernalia" means all equipment, products and |
|---|
| 723 | + | materials of any kind which are used, intended for use, or fashioned |
|---|
| 724 | + | specifically for use in planting, propagating, cultivating, growing, |
|---|
| 725 | + | harvesting, manufacturing, comp ounding, converting, producing, |
|---|
| 726 | + | processing, preparing, testing, analyzing, packaging, repackaging, |
|---|
| 727 | + | storing, containing, concealing, injecting, ingesting, inhaling or |
|---|
| 728 | + | otherwise introducing into the human body, a controlled dangerous |
|---|
| 729 | + | |
|---|
| 730 | + | HB1082 HFLR Page 15 |
|---|
| 731 | + | BOLD FACE denotes Committee Amendments. 1 |
|---|
| 732 | + | 2 |
|---|
| 733 | + | 3 |
|---|
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| 754 | + | 24 |
|---|
| 755 | + | |
|---|
| 756 | + | substance in violation o f the Uniform Controlled Dangerous |
|---|
| 757 | + | Substances Act including, but not limited to: |
|---|
| 758 | + | a. kits used, intended for use, or fashioned specifically |
|---|
| 759 | + | for use in planting, propagating, cultivating, growing |
|---|
| 760 | + | or harvesting of any species of plant which is a |
|---|
| 761 | + | controlled dangerous substance or from which a |
|---|
| 762 | + | controlled dangerous substance can be derived, |
|---|
| 763 | + | b. kits used, intended for use, or fashioned specifically |
|---|
| 764 | + | for use in manufacturing, compounding, converting, |
|---|
| 765 | + | producing, processing or preparing controlled |
|---|
| 766 | + | dangerous substances , |
|---|
| 767 | + | c. isomerization devices used, in tended for use, or |
|---|
| 768 | + | fashioned specifically for use in increasing the |
|---|
| 769 | + | potency of any species of plant which is a controlled |
|---|
| 770 | + | dangerous substance, |
|---|
| 771 | + | d. testing equipment used, intended for use, or fashioned |
|---|
| 772 | + | specifically for use in identifying, or in analyzing |
|---|
| 773 | + | the strength, effectiveness or purity of controlled |
|---|
| 774 | + | dangerous substances, |
|---|
| 775 | + | e. scales and balances used, intended for use, or |
|---|
| 776 | + | fashioned specifically for use in weighing or |
|---|
| 777 | + | measuring controlled dangerous substances, |
|---|
| 778 | + | f. diluents and adulterants, such as quini ne |
|---|
| 779 | + | hydrochloride, mannitol, mannite, dextrose and |
|---|
| 780 | + | |
|---|
| 781 | + | HB1082 HFLR Page 16 |
|---|
| 782 | + | BOLD FACE denotes Committee Amendments. 1 |
|---|
| 783 | + | 2 |
|---|
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|---|
| 806 | + | |
|---|
| 807 | + | lactose, used, intended for use, or fashioned |
|---|
| 808 | + | specifically for use in cutting controlled dangerous |
|---|
| 809 | + | substances, |
|---|
| 810 | + | g. separation gins and sifters used, intended for use, or |
|---|
| 811 | + | fashioned specifically for use in re moving twigs and |
|---|
| 812 | + | seeds from, or in otherwise cleaning or refining, |
|---|
| 813 | + | marijuana, |
|---|
| 814 | + | h. blenders, bowls, containers, spoons and mixing devices |
|---|
| 815 | + | used, intended for use, or fashioned specifically for |
|---|
| 816 | + | use in compounding controlled dange rous substances, |
|---|
| 817 | + | i. capsules, balloons, envelopes and other containers |
|---|
| 818 | + | used, intended for use, or fashioned specifically for |
|---|
| 819 | + | use in packaging small quantities of controlled |
|---|
| 820 | + | dangerous substances, |
|---|
| 821 | + | j. containers and other objects used, intended for use, |
|---|
| 822 | + | or fashioned specifically for use in parenterally |
|---|
| 823 | + | injecting controlled dangerous substances into the |
|---|
| 824 | + | human body, |
|---|
| 825 | + | k. hypodermic syringes, needles and other objects used, |
|---|
| 826 | + | intended for use, or fashioned specifically for use in |
|---|
| 827 | + | parenterally injecting controlled dan gerous substances |
|---|
| 828 | + | into the human body, |
|---|
| 829 | + | l. objects used, intended for use, or fashioned |
|---|
| 830 | + | specifically for use in ingesting, inhaling or |
|---|
| 831 | + | |
|---|
| 832 | + | HB1082 HFLR Page 17 |
|---|
| 833 | + | BOLD FACE denotes Committee Amendments. 1 |
|---|
| 834 | + | 2 |
|---|
| 835 | + | 3 |
|---|
| 836 | + | 4 |
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|---|
| 855 | + | 23 |
|---|
| 856 | + | 24 |
|---|
| 857 | + | |
|---|
| 858 | + | otherwise introducing marijuana, cocaine, hashish or |
|---|
| 859 | + | hashish oil into the human body, such as: |
|---|
| 860 | + | (1) metal, wooden, acrylic, glass, stone, plastic or |
|---|
| 861 | + | ceramic pipes with or without screens, permanent |
|---|
| 862 | + | screens, hashish heads or punctured metal bowls, |
|---|
| 863 | + | (2) water pipes, |
|---|
| 864 | + | (3) carburetion tubes and devices, |
|---|
| 865 | + | (4) smoking and carburetion masks, |
|---|
| 866 | + | (5) roach clips, meaning objects used to hold burning |
|---|
| 867 | + | material, such as a marijuana cigarette, that has |
|---|
| 868 | + | become too small or too short to be held in the |
|---|
| 869 | + | hand, |
|---|
| 870 | + | (6) miniature cocaine spoons and cocaine vials, |
|---|
| 871 | + | (7) chamber pipes, |
|---|
| 872 | + | (8) carburetor pipes, |
|---|
| 873 | + | (9) electric pipes, |
|---|
| 874 | + | (10) air-driven pipes, |
|---|
| 875 | + | (11) chillums, |
|---|
| 876 | + | (12) bongs, or |
|---|
| 877 | + | (13) ice pipes or chillers, |
|---|
| 878 | + | m. all hidden or novelty pipes, and |
|---|
| 879 | + | n. any pipe that has a tobacco bowl or chamber of less |
|---|
| 880 | + | than one-half (1/2) inch in diameter in which there is |
|---|
| 881 | + | any detectable residue of any controlled dangerous |
|---|
| 882 | + | |
|---|
| 883 | + | HB1082 HFLR Page 18 |
|---|
| 884 | + | BOLD FACE denotes Committee Amendments. 1 |
|---|
| 885 | + | 2 |
|---|
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|---|
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|---|
| 907 | + | 24 |
|---|
| 908 | + | |
|---|
| 909 | + | substance as defined in this section or any oth er |
|---|
| 910 | + | substances not legal for possession or use; |
|---|
| 911 | + | provided, however, the term "drug paraphernalia" shall not include |
|---|
| 912 | + | separation gins intended for use in preparing tea or spice, clamps |
|---|
| 913 | + | used for constructing electrical equipme nt, water pipes designed for |
|---|
| 914 | + | ornamentation in which no detectable amount of an illegal substance |
|---|
| 915 | + | is found or pipes designed and used solely for smoking tobacco, |
|---|
| 916 | + | traditional pipes of an American Indian tribal religious ceremony, |
|---|
| 917 | + | or antique pipes that are th irty (30) years of age or older; |
|---|
| 918 | + | 37. 38. a. "Synthetic controlled substance" means a |
|---|
| 919 | + | substance: |
|---|
| 920 | + | (1) the chemical structure of which is substantially |
|---|
| 921 | + | similar to the chemical structure of a controlled |
|---|
| 922 | + | dangerous substance in Schedule I or II, |
|---|
| 923 | + | (2) which has a stimulant, depressant, or |
|---|
| 924 | + | hallucinogenic effect on the central nervous |
|---|
| 925 | + | system that is substantially similar to or |
|---|
| 926 | + | greater than the stimulant, depressant or |
|---|
| 927 | + | hallucinogenic effect on the central nervous |
|---|
| 928 | + | system of a controlled dangerous substance in |
|---|
| 929 | + | Schedule I or II, or |
|---|
| 930 | + | (3) with respect to a particular person, which such |
|---|
| 931 | + | person represents or intends to have a stimulant, |
|---|
| 932 | + | depressant, or hallucinogenic effect on the |
|---|
| 933 | + | |
|---|
| 934 | + | HB1082 HFLR Page 19 |
|---|
| 935 | + | BOLD FACE denotes Committee Amendments. 1 |
|---|
| 936 | + | 2 |
|---|
| 937 | + | 3 |
|---|
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| 959 | + | |
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| 960 | + | central nervous system that is substantially |
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| 961 | + | similar to or greater than the stimulant, |
|---|
| 962 | + | depressant, or hallucinogenic effect on the |
|---|
| 963 | + | central nervous system of a controlled dangerous |
|---|
| 964 | + | substance in Schedule I or II. |
|---|
| 965 | + | b. The designation of gamma butyrolactone or any other |
|---|
| 966 | + | chemical as a precursor, pursuant to Section 2-322 of |
|---|
| 967 | + | this title, does not preclude a fin ding pursuant to |
|---|
| 968 | + | subparagraph a of this paragraph that the chemical is |
|---|
| 969 | + | a synthetic controlled substance. |
|---|
| 970 | + | c. "Synthetic controlled substance" does not include: |
|---|
| 971 | + | (1) a controlled dangerous substance, |
|---|
| 972 | + | (2) any substance for which there is an approved new |
|---|
| 973 | + | drug application, |
|---|
| 974 | + | (3) with respect to a particular person any |
|---|
| 975 | + | substance, if an exemption is in effect for |
|---|
| 976 | + | investigational use, for that person under the |
|---|
| 977 | + | provisions of Section 505 of the Federal Food, |
|---|
| 978 | + | Drug and Cosmetic Act, Title 21 of the United |
|---|
| 979 | + | States Code, Section 355, to the extent conduct |
|---|
| 980 | + | with respect to such substance is pursuant to |
|---|
| 981 | + | such exemption, or |
|---|
| 982 | + | |
|---|
| 983 | + | HB1082 HFLR Page 20 |
|---|
| 984 | + | BOLD FACE denotes Committee Amendments. 1 |
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| 1008 | + | |
|---|
| 1009 | + | (4) any substance to the extent not intended for |
|---|
| 1010 | + | human consumption before such an exemption takes |
|---|
| 1011 | + | effect with respect to that substance. |
|---|
| 1012 | + | d. Prima facie evidence that a substance containing |
|---|
| 1013 | + | salvia divinorum has been enhanced, concentrated or |
|---|
| 1014 | + | chemically or physically altered shall give rise to a |
|---|
| 1015 | + | rebuttable presumption that the substance is a |
|---|
| 1016 | + | synthetic controlled substance; |
|---|
| 1017 | + | 38. 39. "Tetrahydrocannabinols" means all substances that have |
|---|
| 1018 | + | been chemically synthesized to emulate the tetrahydrocannabinols of |
|---|
| 1019 | + | marijuana, specifically including any tetrahydrocannabinols derived |
|---|
| 1020 | + | from industrial hemp; |
|---|
| 1021 | + | 39. 40. "Isomer" means the optical isomer, except as used in |
|---|
| 1022 | + | subsections C and F of Section 2-204 of this title and paragraph 4 |
|---|
| 1023 | + | of subsection A of Section 2-206 of this title. As used in |
|---|
| 1024 | + | subsections C and F of Section 2-204 of this title, "isomer" means |
|---|
| 1025 | + | the optical, positional or geometric isomer. As used in paragraph 4 |
|---|
| 1026 | + | of subsection A of Section 2-206 of this title, the term "isomer" |
|---|
| 1027 | + | means the optical or geometric isomer; |
|---|
| 1028 | + | 40. 41. "Hazardous materials" means materials, whether solid, |
|---|
| 1029 | + | liquid or gas, which are toxic to human, animal, aquatic or plant |
|---|
| 1030 | + | life, and the disposal of which materials is controlled by state or |
|---|
| 1031 | + | federal guidelines; |
|---|
| 1032 | + | |
|---|
| 1033 | + | HB1082 HFLR Page 21 |
|---|
| 1034 | + | BOLD FACE denotes Committee Amendments. 1 |
|---|
| 1035 | + | 2 |
|---|
| 1036 | + | 3 |
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| 1058 | + | |
|---|
| 1059 | + | 41. 42. "Anhydrous ammonia" means any substance that exhibits |
|---|
| 1060 | + | cryogenic evaporative behavior and tests positive for ammonia; |
|---|
| 1061 | + | 42. 43. "Acute pain" means pain, whether resulting from |
|---|
| 1062 | + | disease, accidental or intentional trauma or other cause, that the |
|---|
| 1063 | + | practitioner reasonably expects to last only a short period of time. |
|---|
| 1064 | + | "Acute pain" does not include chronic pain, pain being treated as |
|---|
| 1065 | + | part of cancer care, hospice or other end-of-life care, or pain |
|---|
| 1066 | + | being treated as part of palliative care; |
|---|
| 1067 | + | 43. 44. "Chronic pain" means pain that persists beyond the |
|---|
| 1068 | + | usual course of an acute disease or healing of an injury. "Chronic |
|---|
| 1069 | + | pain" may or may not be associated with an acute or chronic |
|---|
| 1070 | + | pathologic process that causes continuous or intermittent pain over |
|---|
| 1071 | + | months or years; |
|---|
| 1072 | + | 44. 45. "Initial prescription" means a prescription issued to a |
|---|
| 1073 | + | patient who: |
|---|
| 1074 | + | a. has never previously been issued a prescription for |
|---|
| 1075 | + | the drug or its pharmaceutical equivalent in the past |
|---|
| 1076 | + | year, or |
|---|
| 1077 | + | b. requires a prescription for the drug or its |
|---|
| 1078 | + | pharmaceutical equivalent due to a surgical procedure |
|---|
| 1079 | + | or new acute event and has previously had a |
|---|
| 1080 | + | prescription for the drug or its pharmaceutical |
|---|
| 1081 | + | equivalent within the past year. |
|---|
| 1082 | + | |
|---|
| 1083 | + | HB1082 HFLR Page 22 |
|---|
| 1084 | + | BOLD FACE denotes Committee Amendments. 1 |
|---|
| 1085 | + | 2 |
|---|
| 1086 | + | 3 |
|---|
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| 1107 | + | 24 |
|---|
| 1108 | + | |
|---|
| 1109 | + | When determining whether a patient was previously issued a |
|---|
| 1110 | + | prescription for a drug or its pharmaceutical equivalent, the |
|---|
| 1111 | + | practitioner shall consult with the patient and review the medical |
|---|
| 1112 | + | record and prescription monitoring information of the patient; |
|---|
| 1113 | + | 45. 46. "Patient-provider agreement" means a written contract |
|---|
| 1114 | + | or agreement that is executed between a practitioner and a patien t, |
|---|
| 1115 | + | prior to the commencement of treatment for chronic pain using an |
|---|
| 1116 | + | opioid drug as a means to: |
|---|
| 1117 | + | a. explain the possible risk of development of physical |
|---|
| 1118 | + | or psychological dependence in the patient and prevent |
|---|
| 1119 | + | the possible development of addiction, |
|---|
| 1120 | + | b. document the understanding of both the practitioner |
|---|
| 1121 | + | and the patient regarding the patient-provider |
|---|
| 1122 | + | agreement of the patient, |
|---|
| 1123 | + | c. establish the rights of the patient in association |
|---|
| 1124 | + | with treatment and the obligations of the patient in |
|---|
| 1125 | + | relation to the responsible use, discontinuation of |
|---|
| 1126 | + | use, and storage of opioid drugs, including any |
|---|
| 1127 | + | restrictions on the refill of prescriptions or the |
|---|
| 1128 | + | acceptance of opioid prescriptions from practitioners, |
|---|
| 1129 | + | d. identify the specific medications and other modes of |
|---|
| 1130 | + | treatment, including physical therapy or exercise, |
|---|
| 1131 | + | relaxation or psychological counseling, that are |
|---|
| 1132 | + | included as a part of the patient-provider agreement, |
|---|
| 1133 | + | |
|---|
| 1134 | + | HB1082 HFLR Page 23 |
|---|
| 1135 | + | BOLD FACE denotes Committee Amendments. 1 |
|---|
| 1136 | + | 2 |
|---|
| 1137 | + | 3 |
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|---|
| 1158 | + | 24 |
|---|
| 1159 | + | |
|---|
| 1160 | + | e. specify the measures the practitioner may employ to |
|---|
| 1161 | + | monitor the compliance of the patient including, but |
|---|
| 1162 | + | not limited to, rand om specimen screens and pill |
|---|
| 1163 | + | counts, and |
|---|
| 1164 | + | f. delineate the process for terminating the agreement, |
|---|
| 1165 | + | including the consequences if the practitioner has |
|---|
| 1166 | + | reason to believe that the patient is not complying |
|---|
| 1167 | + | with the terms of the agreement. Compliance with the |
|---|
| 1168 | + | "consent items" shall constitute a valid, informed |
|---|
| 1169 | + | consent for opioid therapy. The practitioner shall be |
|---|
| 1170 | + | held harmless from civil litigation for failure to |
|---|
| 1171 | + | treat pain if the event occurs because of nonadherence |
|---|
| 1172 | + | by the patient with any of the provisions of t he |
|---|
| 1173 | + | patient-provider agreement; |
|---|
| 1174 | + | 46. 47. "Serious illness" means a medical illness or physical |
|---|
| 1175 | + | injury or condition that substantially affects quality of life for |
|---|
| 1176 | + | more than a short period of time. "Serious illness" includes, but |
|---|
| 1177 | + | is not limited to, Alzheimer 's disease or related dementias, lung |
|---|
| 1178 | + | disease, cancer, heart failure, renal failure, liver failure or |
|---|
| 1179 | + | chronic, unremitting or intractable pain such as neuropathic pain; |
|---|
| 1180 | + | and |
|---|
| 1181 | + | 47. 48. "Surgical procedure" means a procedure that is |
|---|
| 1182 | + | performed for the purpose of struct urally altering the human body by |
|---|
| 1183 | + | incision or destruction of tissues as part of the practice of |
|---|
| 1184 | + | |
|---|
| 1185 | + | HB1082 HFLR Page 24 |
|---|
| 1186 | + | BOLD FACE denotes Committee Amendments. 1 |
|---|
| 1187 | + | 2 |
|---|
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|---|
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|---|
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|---|
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|---|
| 1208 | + | 23 |
|---|
| 1209 | + | 24 |
|---|
| 1210 | + | |
|---|
| 1211 | + | medicine. This term includes the diagnostic or therapeutic |
|---|
| 1212 | + | treatment of conditions or disease processes by use of instruments |
|---|
| 1213 | + | such as lasers, ultrasound, ioniz ing, radiation, scalpels, probes or |
|---|
| 1214 | + | needles that cause localized alteration or transportation of live |
|---|
| 1215 | + | human tissue by cutting, burning, vaporizing, freezing, suturing, |
|---|
| 1216 | + | probing or manipulating by closed reduction for major dislocations |
|---|
| 1217 | + | or fractures, or othe rwise altering by any mechanical, thermal, |
|---|
| 1218 | + | light-based, electromagnetic or chemical means. |
|---|
| 1219 | + | SECTION 2. AMENDATORY 63 O.S. 2021, Secti on 2-112, is |
|---|
| 1220 | + | amended to read as fo llows: |
|---|
| 1221 | + | Section 2-112. The Oklahoma State Bureau of Narcotics and |
|---|
| 1222 | + | Dangerous Drugs Control shall report to the standing committees of |
|---|
| 1223 | + | the Legislature having jurisdiction over health and human services |
|---|
| 1224 | + | matters and over occup ational and professional regulatio n matters, |
|---|
| 1225 | + | no later than create and make available reports regarding an annual |
|---|
| 1226 | + | change, plus or minus, of relevant de -identified data collected from |
|---|
| 1227 | + | the central repository by January 31, 2020, with progress on |
|---|
| 1228 | + | implementing the provisions of this act of each year. The report |
|---|
| 1229 | + | shall may contain, at a minimum but is not limited to , the following |
|---|
| 1230 | + | information: |
|---|
| 1231 | + | 1. Registration of prescribers and dispensers in the c entral |
|---|
| 1232 | + | repository pursuant to Section 2-309A et seq. of Title 63 o f the |
|---|
| 1233 | + | Oklahoma Statutes; |
|---|
| 1234 | + | |
|---|
| 1235 | + | HB1082 HFLR Page 25 |
|---|
| 1236 | + | BOLD FACE denotes Committee Amendments. 1 |
|---|
| 1237 | + | 2 |
|---|
| 1238 | + | 3 |
|---|
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|---|
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|---|
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|---|
| 1258 | + | 23 |
|---|
| 1259 | + | 24 |
|---|
| 1260 | + | |
|---|
| 1261 | + | 2. Data regarding the checking and using of the centr al |
|---|
| 1262 | + | repository by data requesters; |
|---|
| 1263 | + | 3. Data from profession al boards regarding the implementation |
|---|
| 1264 | + | of continuing education requirements for prescribers of opioid |
|---|
| 1265 | + | drugs; |
|---|
| 1266 | + | 4. Effects on the prescriber workforce; |
|---|
| 1267 | + | 5. Changes in the numbers of patients taking mo re than one |
|---|
| 1268 | + | hundred (100) morphine milligram equivalents o f opioid drugs per |
|---|
| 1269 | + | day; |
|---|
| 1270 | + | 6. Data regarding the total quantity of opioid drugs prescribed |
|---|
| 1271 | + | in morphine milligram equivale nts; |
|---|
| 1272 | + | 7. Progress on electronic pr escribing of opioid drugs; and |
|---|
| 1273 | + | 8. Improvements to the central repo sitory through the request |
|---|
| 1274 | + | for proposals process including feedback from prescribers, |
|---|
| 1275 | + | dispensers and applicable state licensing boards on those |
|---|
| 1276 | + | improvements; and |
|---|
| 1277 | + | 9. Number of prescriptions notated as acute and chronic. |
|---|
| 1278 | + | SECTION 3. AMENDATORY 63 O.S. 2021, Section 2 -309I, as |
|---|
| 1279 | + | amended by Section 1, Chapter 257, O.S .L. 2022 (63 O.S. Supp. 2022, |
|---|
| 1280 | + | Section 2-309I), is amended to read as fol lows: |
|---|
| 1281 | + | Section 2-309I. A. A practitioner shall not issue an initial |
|---|
| 1282 | + | prescription for an opioid drug in a quantity exceeding a seven-day |
|---|
| 1283 | + | supply for treatment of acute pain . Any opioid prescription for |
|---|
| 1284 | + | |
|---|
| 1285 | + | HB1082 HFLR Page 26 |
|---|
| 1286 | + | BOLD FACE denotes Committee Amendments. 1 |
|---|
| 1287 | + | 2 |
|---|
| 1288 | + | 3 |
|---|
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|---|
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|---|
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|---|
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|---|
| 1309 | + | 24 |
|---|
| 1310 | + | |
|---|
| 1311 | + | acute pain shall be for the lowest effective dose of a n immediate- |
|---|
| 1312 | + | release drug. |
|---|
| 1313 | + | B. Prior to issuing an initial prescription fo r an opioid drug |
|---|
| 1314 | + | in a course of treatment for acute or chronic pain, a practitioner |
|---|
| 1315 | + | shall: |
|---|
| 1316 | + | 1. Take and document the resul ts of a thorough medical history, |
|---|
| 1317 | + | including the experience of the patient with nonopioid medication |
|---|
| 1318 | + | and nonpharmacological pain-management approaches and substanc e |
|---|
| 1319 | + | abuse history; |
|---|
| 1320 | + | 2. Conduct, as appropriate, and document the results of a |
|---|
| 1321 | + | physical examination; |
|---|
| 1322 | + | 3. Develop a treatment plan with particular attention fo cused |
|---|
| 1323 | + | on determining the cause of pain of the patient; |
|---|
| 1324 | + | 4. Access relevant prescription monitoring in formation from the |
|---|
| 1325 | + | central repository pursuant to Section 2-309D of this title; |
|---|
| 1326 | + | 5. Limit the supply of any opioid drug prescribed for acute |
|---|
| 1327 | + | pain to a duration of no more than seven (7) days as determined by |
|---|
| 1328 | + | the directed dosage and frequency of dosage; pro vided, however, upon |
|---|
| 1329 | + | issuing an initial prescription for acute pain pu rsuant to this |
|---|
| 1330 | + | section, the practitioner may issue one (1) subsequent prescription |
|---|
| 1331 | + | for an opioid drug in a quantity not to exceed seven (7) days if: |
|---|
| 1332 | + | a. the subsequent prescription is due to a major surgical |
|---|
| 1333 | + | procedure or "confined to home" status as defined in |
|---|
| 1334 | + | 42 U.S.C., Section 1395n(a), |
|---|
| 1335 | + | |
|---|
| 1336 | + | HB1082 HFLR Page 27 |
|---|
| 1337 | + | BOLD FACE denotes Committee Amendments. 1 |
|---|
| 1338 | + | 2 |
|---|
| 1339 | + | 3 |
|---|
| 1340 | + | 4 |
|---|
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|---|
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|---|
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|---|
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|---|
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|---|
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|---|
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|---|
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|---|
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|---|
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|---|
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|---|
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|---|
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|---|
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|---|
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|---|
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|---|
| 1359 | + | 23 |
|---|
| 1360 | + | 24 |
|---|
| 1361 | + | |
|---|
| 1362 | + | b. the practitioner provides the subsequent prescrip tion |
|---|
| 1363 | + | on the same day as the initial prescription, |
|---|
| 1364 | + | c. the practitioner pro vides written instructions o n the |
|---|
| 1365 | + | subsequent prescription indicating the ea rliest date |
|---|
| 1366 | + | on which the prescription may be filled, otherwise |
|---|
| 1367 | + | known as a "do not fill until" date, and |
|---|
| 1368 | + | d. the subsequent prescription is dispensed no more than |
|---|
| 1369 | + | five (5) days after the "do not fill until" date |
|---|
| 1370 | + | indicated on the prescription; |
|---|
| 1371 | + | 6. In the case of a patient under the age of eighteen (18) |
|---|
| 1372 | + | years, enter into a patient-provider agreement with a parent or |
|---|
| 1373 | + | guardian of the patient; and |
|---|
| 1374 | + | 7. In the case of a patient who is a pregn ant woman, enter into |
|---|
| 1375 | + | a patient-provider agreement with the patient. |
|---|
| 1376 | + | C. No less than seven (7) d ays after issuing the initial |
|---|
| 1377 | + | prescription pursuant to subsection A of this section, t he |
|---|
| 1378 | + | practitioner, after consultation with the patient, may issue a |
|---|
| 1379 | + | subsequent prescription for the dru g to the patient in a quantity |
|---|
| 1380 | + | not to exceed seven (7) days, provided that: |
|---|
| 1381 | + | 1. The subsequent prescripti on would not be deemed an initial |
|---|
| 1382 | + | prescription under this section; |
|---|
| 1383 | + | 2. The practitioner determines the prescription is nece ssary |
|---|
| 1384 | + | and appropriate to the treatment needs of the patient and documents |
|---|
| 1385 | + | the rationale for the i ssuance of the subsequent prescripti on; and |
|---|
| 1386 | + | |
|---|
| 1387 | + | HB1082 HFLR Page 28 |
|---|
| 1388 | + | BOLD FACE denotes Committee Amendments. 1 |
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| 1412 | + | |
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| 1413 | + | 3. The practitioner determines that issua nce of the subsequent |
|---|
| 1414 | + | prescription does not present an undue risk of abus e, addiction or |
|---|
| 1415 | + | diversion and documents that determination. |
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| 1416 | + | D. Prior to issuing the initial pres cription of an opioid drug |
|---|
| 1417 | + | in a course of treatment for acute or chronic pain and agai n prior |
|---|
| 1418 | + | to issuing the third prescription of the course of treatment, a |
|---|
| 1419 | + | practitioner shall discuss wi th the patient or the parent or |
|---|
| 1420 | + | guardian of the patient if the patien t is under eighteen (18) years |
|---|
| 1421 | + | of age and is not an emancipated minor, the risks assoc iated with |
|---|
| 1422 | + | the drugs being prescribed, including but not limited to: |
|---|
| 1423 | + | 1. The risks of addiction and o verdose associated with opioid |
|---|
| 1424 | + | drugs and the dangers of taking opioid drugs with alcohol, |
|---|
| 1425 | + | benzodiazepines and other central nervous system depressants; |
|---|
| 1426 | + | 2. The reasons why the prescription is necessary; |
|---|
| 1427 | + | 3. Alternative treatment s that may be available; and |
|---|
| 1428 | + | 4. Risks associated with the use of the drugs being prescribed, |
|---|
| 1429 | + | specifically that opioids are highly ad dictive, even when taken as |
|---|
| 1430 | + | prescribed, that there is a risk of developing a physical or |
|---|
| 1431 | + | psychological dependence on the co ntrolled dangerous substance , and |
|---|
| 1432 | + | that the risks of taking more opioids tha n prescribed or mixing |
|---|
| 1433 | + | sedatives, benzodiazepines or alcoh ol with opioids can result in |
|---|
| 1434 | + | fatal respiratory de pression. |
|---|
| 1435 | + | The practitioner shall include a note in the medical record of |
|---|
| 1436 | + | the patient that the patient or the parent or guardian of the |
|---|
| 1437 | + | |
|---|
| 1438 | + | HB1082 HFLR Page 29 |
|---|
| 1439 | + | BOLD FACE denotes Committee Amendments. 1 |
|---|
| 1440 | + | 2 |
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| 1441 | + | 3 |
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| 1463 | + | |
|---|
| 1464 | + | patient, as applicable, has discuss ed with the practitioner the |
|---|
| 1465 | + | risks of developing a physical or psychological dependenc e on the |
|---|
| 1466 | + | controlled dangerous substance and alternative treatments that m ay |
|---|
| 1467 | + | be available. The applicable state licensing board of the |
|---|
| 1468 | + | practitioner shall develop and make available to practitioners |
|---|
| 1469 | + | guidelines for the discussion required pursuant to this su bsection. |
|---|
| 1470 | + | E. At the time of the issuance of the third prescription for a n |
|---|
| 1471 | + | opioid drug, the practiti oner shall enter into a patient-provider |
|---|
| 1472 | + | agreement with the patient. |
|---|
| 1473 | + | F. When an opioid drug is continuo usly prescribed for three (3) |
|---|
| 1474 | + | months or more for chr onic pain, the practitioner shall: |
|---|
| 1475 | + | 1. Review, at a minimum of every thre e (3) months, the course |
|---|
| 1476 | + | of treatment, any new information about the etiolo gy of the pain, |
|---|
| 1477 | + | and the progress of the patient toward treatment objectives and |
|---|
| 1478 | + | document the results of that review; |
|---|
| 1479 | + | 2. In the first year of the patient-provider agreement, assess |
|---|
| 1480 | + | the patient prior to eve ry renewal to determine whether the patient |
|---|
| 1481 | + | is experiencing problems asso ciated with an opioid use disord er as |
|---|
| 1482 | + | defined by the American Psychiatric Association and document the |
|---|
| 1483 | + | results of that assessment. Following one (1) year of c ompliance |
|---|
| 1484 | + | with the patient-provider agreement, the practitioner shall asses s |
|---|
| 1485 | + | the patient at a min imum of every six (6) months; |
|---|
| 1486 | + | 3. Periodically make reasonable efforts, unless clinica lly |
|---|
| 1487 | + | contraindicated, to either stop the use of the controlled substance, |
|---|
| 1488 | + | |
|---|
| 1489 | + | HB1082 HFLR Page 30 |
|---|
| 1490 | + | BOLD FACE denotes Committee Amendments. 1 |
|---|
| 1491 | + | 2 |
|---|
| 1492 | + | 3 |
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|---|
| 1514 | + | |
|---|
| 1515 | + | decrease the dosage, tr y other drugs or treatment modalities in an |
|---|
| 1516 | + | effort to reduce the potential for abuse or the development o f an |
|---|
| 1517 | + | opioid use disorder as defined by the American Psy chiatric |
|---|
| 1518 | + | Association and document with specificity the efforts undertaken ; |
|---|
| 1519 | + | 4. Review the central repository information in accordance with |
|---|
| 1520 | + | Section 2-309D of this title; and |
|---|
| 1521 | + | 5. Monitor compliance wi th the patient-provider agreement and |
|---|
| 1522 | + | any recommendations that the patient seek a referral. |
|---|
| 1523 | + | G. 1. Any prescription for acute pai n pursuant to this s ection |
|---|
| 1524 | + | shall have the words "acute pain" notated on the face of the |
|---|
| 1525 | + | prescription by the practitioner. |
|---|
| 1526 | + | 2. Any prescription for chronic pain pursuant to this sectio n |
|---|
| 1527 | + | shall have the words "chronic pain" notated on the face of the |
|---|
| 1528 | + | prescription by the practitioner. |
|---|
| 1529 | + | H. This section shall not apply to a prescriptio n for a |
|---|
| 1530 | + | patient: |
|---|
| 1531 | + | 1. Who has sickle cell disease; |
|---|
| 1532 | + | 2. Who is in treatment for cancer or receiving aftercare cancer |
|---|
| 1533 | + | treatment; |
|---|
| 1534 | + | 3. Who is receiving hospice care from a licensed hospi ce; |
|---|
| 1535 | + | 4. Who is receiving palliative care in conjunction with a |
|---|
| 1536 | + | serious illness; |
|---|
| 1537 | + | 5. Who is a resident of a long-term care facility; or |
|---|
| 1538 | + | |
|---|
| 1539 | + | HB1082 HFLR Page 31 |
|---|
| 1540 | + | BOLD FACE denotes Committee Amendments. 1 |
|---|
| 1541 | + | 2 |
|---|
| 1542 | + | 3 |
|---|
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|---|
| 1564 | + | |
|---|
| 1565 | + | 6. For any medications that are being prescribed for use in the |
|---|
| 1566 | + | treatment of substance abuse or opioid dependence. |
|---|
| 1567 | + | I. Every policy, contract or plan delivered, issued, executed |
|---|
| 1568 | + | or renewed in this state, or approved for issuance or renew al in |
|---|
| 1569 | + | this state by the Insurance Commissioner, and every contract |
|---|
| 1570 | + | purchased by the Employees Group Insurance Division of the Office of |
|---|
| 1571 | + | Management and Enterprise Services, on or after November 1, 2018, |
|---|
| 1572 | + | that provides coverage for prescription drugs subject to a |
|---|
| 1573 | + | copayment, coinsurance or deductible shall charge a copayment, |
|---|
| 1574 | + | coinsurance or deductible for an initial prescription of an opioid |
|---|
| 1575 | + | drug prescribed pursuant to this section that is either: |
|---|
| 1576 | + | 1. Proportional between the cost sharing for a thirty-day |
|---|
| 1577 | + | supply and the amount of drugs the patient was prescribed; or |
|---|
| 1578 | + | 2. Equivalent to the cost sharing for a full thirty-day supply |
|---|
| 1579 | + | of the drug, provided that no additional cost sharing may be charged |
|---|
| 1580 | + | for any additional prescriptions for the remainder of the thirty-day |
|---|
| 1581 | + | supply. |
|---|
| 1582 | + | J. Any practitioner authorized to prescribe an opioid drug |
|---|
| 1583 | + | shall adopt and maintain a written policy or policies that include |
|---|
| 1584 | + | execution of a written agreement to engage in an informed consent |
|---|
| 1585 | + | process between the prescribing practitioner and qua lifying opioid |
|---|
| 1586 | + | therapy patient. For the purposes of this section, "qualifying |
|---|
| 1587 | + | opioid therapy patient" means: |
|---|
| 1588 | + | |
|---|
| 1589 | + | HB1082 HFLR Page 32 |
|---|
| 1590 | + | BOLD FACE denotes Committee Amendments. 1 |
|---|
| 1591 | + | 2 |
|---|
| 1592 | + | 3 |
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|---|
| 1614 | + | |
|---|
| 1615 | + | 1. A Informed consent is required for a patient requiring |
|---|
| 1616 | + | prescribed opioid treatment for more than three (3) months; |
|---|
| 1617 | + | 2. A patient fourteen (14) days or who is prescribed |
|---|
| 1618 | + | benzodiazepines and opioids together for more than one twenty-four- |
|---|
| 1619 | + | hour period; or |
|---|
| 1620 | + | 3. A patient who is prescribed a dose of opioi ds that exceeds |
|---|
| 1621 | + | one hundred (100) morphine equivalent doses. Informed consent |
|---|
| 1622 | + | required by this subsection is not equivalent to a patient-provider |
|---|
| 1623 | + | agreement as defined in Section 2-101 of this title. |
|---|
| 1624 | + | K. When a practitioner thoroughly assesses and documents his or |
|---|
| 1625 | + | her findings as required by this section and prescribe s in good |
|---|
| 1626 | + | faith using his or her clinical expertise, neither the average |
|---|
| 1627 | + | prescribed doses or quantities alone of an individual patient or |
|---|
| 1628 | + | practice of a practitioner shall be used as the basis to ini tiate an |
|---|
| 1629 | + | investigation or disciplinary action, or to pursue civil liability |
|---|
| 1630 | + | or criminal penalties. |
|---|
| 1631 | + | L. Nothing in the Anti-Drug Diversion Act shall be construed to |
|---|
| 1632 | + | require a practitioner to limit or forcibly taper a patient on |
|---|