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STATE OF OKLAHOMA
1st Session of the 59th Legislature (2023)
COMMITTEE SUBSTITUTE
FOR
HOUSE BILL NO. 1082 By: Talley
COMMITTEE SUBSTITUTE
An Act relating to public health and saf ety; amending
63 O.S. 2021, Sections 2-101, as amended by Section
4, Chapter 265, O.S.L. 2022 and 2-112 (63 O.S. Supp.
2022, Section 2-101), which relate to the Uniform
Controlled Dangerous Substances Act; adding
definition; providing for the creation and posting of
reports on public websites; req uiring certain
information be included in report; amending 63 O.S.
2021, Section 2-309I, as amended by Section 1,
Chapter 257, O.S.L. 2022 (63 O.S. Supp. 2022, Section
2-309I), which relates to the Anti-Drug Diversion
Act; clarifying process for obtaining informed
consent from certain patients; providing restrictions
when initiating investigations, disciplinary actions,
civil or criminal penalties; and declaring an
emergency.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. AMENDATORY 63 O.S. 2021, Section 2 -101, as
amended by Section 4, Chapter 265, O.S.L. 2022 (63 O.S. Supp. 2022,
Section 2-101), is amended to read as follows:
Section 2-101. As used in the Uniform Controlled Dangerous
Substances Act:
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1. "Administer" means the direct application of a controlled
dangerous substance, whether by injection, inhalation, ingestion or
any other means, to the body of a patient, animal or research
subject by:
a. a practitioner (or, in the presence of the
practitioner, by the authorized agent of the
practitioner), or
b. the patient or research subject at the direction and
in the presence of the practitioner;
2. "Agent" means a peace officer appointed by and who acts on
behalf of the Director of the Oklahoma State Bureau of Narcotics and
Dangerous Drugs Control or an authorized p erson who acts on behalf
of or at the direction of a person who manufactures, distrib utes,
dispenses, prescribes, administers or uses for scientific purposes
controlled dangerous substances but does not include a common or
contract carrier, public warehous er or employee thereof, or a person
required to register under the Uniform Controlled Dangerous
Substances Act;
3. "Board" means the Advisory Board to the Director of the
Oklahoma State Bureau of Narcotics and Dangerous Drugs Control;
4. "Bureau" means the Oklahoma State Bureau of Narcotics and
Dangerous Drugs Control;
5. "Coca leaves" includes cocaine and any compound,
manufacture, salt, derivative, mixture or preparation of coca
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leaves, except derivatives of coca leaves which do not contain
cocaine or ecgonine;
6. "Commissioner" or "Director" means the Director of the
Oklahoma State Bureau of Narcotics and Dangerous Drugs Control;
7. "Control" means to add, remove or change the placement of a
drug, substance or immediate precursor under the Uniform Co ntrolled
Dangerous Substances Act;
8. "Controlled dangerous substance " means a drug, substance or
immediate precursor in Schedules I through V of the Uniform
Controlled Dangerous Substances Act or any drug, substance or
immediate precursor listed either t emporarily or permanently as a
federally controlled substance. Any conflict between state and
federal law with regard to the particular schedule in which a
substance is listed shall be resolved in favor of state law;
9. "Counterfeit substance" means a controlled substance which,
or the container or labeling of which without authorization , bears
the trademark, trade name or other identifying marks, imprint,
number or device or any likeness thereof of a manufacturer,
distributor or dispenser other than the person who in fact
manufactured, distributed or dispensed the substance;
10. "Deliver" or "delivery" means the actual, constructive or
attempted transfer from one person to another of a controlled
dangerous substance or drug paraphernalia, whether or not there is
an agency relationship;
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11. "Dispense" means to deliver a controlled danger ous
substance to an ultimate user or human research subject by or
pursuant to the lawful order of a practitioner, including the
prescribing, administering, packaging, labe ling or compounding
necessary to prepare the substance for such distribution .
"Dispenser" is a practitioner who delivers a controlled dangerous
substance to an ultimate user or human research subject;
12. "Distribute" means to deliver other than by admin istering
or dispensing a controlled dangerous substance;
13. "Distributor" means a commercial entity engaged in the
distribution or reverse distribution of narcotics and dangerous
drugs and who complies with all regulations promulgated by the
federal Drug Enforcement Administration and the Oklahoma State
Bureau of Narcotics and Dangerous Drugs Control;
14. "Drug" means articles:
a. recognized in the official United States Pharmacopeia,
official Homeopathic Pharmacopoeia of the United
States, or official N ational Formulary, or any
supplement to any of them,
b. intended for use in the diagn osis, cure, mitigation,
treatment or prevention of disease in man or other
animals,
c. other than food, intended to affect the structure or
any function of the body of man or other animals, and
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d. intended for use as a component of any article
specified in this paragraph;
provided, however, the term "drug" does not include devices or their
components, parts or accessories;
15. "Drug-dependent person" means a person who i s using a
controlled dangerous substance and who is in a state of psychic or
physical dependence, or both, arising from administration of that
controlled dangerous substance on a continuous basis. Drug
dependence is characterized by behavioral and other r esponses which
include a strong compulsion to take the substance on a continuous
basis in order to experience its psychic effects, or to avoid the
discomfort of its absence;
16. "Home care agency" means any sole proprietorship,
partnership, association, corporation, or other organization which
administers, offers, or provides home care serv ices, for a fee or
pursuant to a contract for such services, to clients in their place
of residence;
17. "Home care services" means skilled or personal care
services provided to clients in their place of residence for a fee;
18. "Hospice" means a centrally administered, nonprofit or for-
profit, medically directed, nurse-coordinated program which provides
a continuum of home and inpatient care for the terminally ill
patient and the patient's family. Such term shall also include a
centrally administered, n onprofit or for-profit, medically directed,
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nurse-coordinated program if such program is licensed pursuant to
the provisions of the Uniform Controlled Dangerous Subst ances Act.
A hospice program offers palliative and supportive care to meet the
special needs arising out of the physical, emotional and spiritual
stresses which are experienced during the final stages of illness
and during dying and bereavement. This care is available twenty-
four (24) hours a day, seven (7) days a week, and is provided on the
basis of need, regardless of ability to pay. "Class A" Hospice
refers to Medicare-certified hospices. "Class B" refers to all
other providers of hospice services;
19. "Imitation controlled substance" means a substance that is
not a controlled dangerous substance, which by dosage unit
appearance, color, shape, size, markings or by representations made,
would lead a reasonable person to believe that the substance is a
controlled dangerous substance. In the event the appearance of the
dosage unit is not r easonably sufficient to establish that the
substance is an "imitation controlled substance", the court or
authority concerned should consider, in addition to all oth er
factors, the following factors as related to "representations made"
in determining wheth er the substance is an "imitation controlled
substance":
a. statements made by an owner or by any other person in
control of the substance concerning the nature of the
substance, or its use or effect,
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b. statements made to the recipient that the substance
may be resold for inordinate profit,
c. whether the substance is packaged in a manner normally
used for illicit controlled substances,
d. evasive tactics or actions utilized by the owner or
person in control of the substance to avoid detection
by law enforcement authorities,
e. prior convictions, if any, of an owner, or any other
person in control of the object, under state or
federal law related to controlled substances or fraud,
and
f. the proximity of the substances to controlled
dangerous substances;
20. "Immediate precursor" means a substance which the Director
has found to be and by regulation designates as being the principal
compound commonly used or produced primarily for use, and which is
an immediate chemical intermediary used, or likely to be us ed, in
the manufacture of a controlled dangerous substance, the control of
which is necessary to prevent, curtail or limit such manufacture;
21. "Laboratory" means a laboratory approved by the Director as
proper to be entrusted with the custody of control led dangerous
substances and the use of controlled dangerous substances for
scientific and medical purposes and for purposes of instruction;
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22. "Manufacture" means the production, preparation,
propagation, compounding or processing of a controlled danger ous
substance, either directly or indirectly by extraction from
substances of natural or synthetic origin, or independently by means
of chemical synthesis or by a combination of extraction and chemical
synthesis. "Manufacturer" includes any person who pac kages,
repackages or labels any container of any controlled dangerous
substance, except practitioners who dispense or compound
prescription orders for delivery to the ultimate consumer;
23. "Marijuana" means all parts of the plant Cannabis sativa
L., whether growing or not; the seeds thereof; the resin extracted
from any part of such plant; and every compound, manufacture, salt,
derivative, mixture or preparation of such plant, its seeds or
resin, but shall not include:
a. the mature stalks of such plant o r fiber produced from
such stalks,
b. oil or cake made from the seeds of such plant,
including cannabidiol derived from the seeds of the
marijuana plant,
c. any other compound, manufacture, salt, derivative,
mixture or preparation of such mature stalks (ex cept
the resin extracted therefrom), including cannabidiol
derived from mature stalks, fiber, oil or cake,
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d. the sterilized seed of such plant which is incapable
of germination,
e. for any person participating in a clinical trial to
administer cannabidiol for the treatment of severe
forms of epilepsy pursuant to Section 2-802 of this
title, a drug or substance approved by the federal
Food and Drug Administration for use by those
participants,
f. for any person or the parents, legal guardians or
caretakers of the person who have received a written
certification from a physician licensed in this state
that the person has been diagnosed by a physician as
having Lennox-Gastaut syndrome, Dravet syndrome, also
known as severe myoclonic epilepsy of infancy, or any
other severe form of epilepsy that is not adequately
treated by traditional medical therapies, spasticity
due to multiple sclerosis or due to paraplegia,
intractable nausea and vomiting, appetite stimulation
with chronic wasting diseases, the substance
cannabidiol, a nonpsychoactive cannabinoid, found in
the plant Cannabis sativa L. or any other preparation
thereof, that has a tetrahydrocannabinol concentration
of not more than three-tenths of one percent (0.3%)
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and that is delivered to the patient in the form of a
liquid,
g. any federal Food-and-Drug-Administration-approved drug
or substance, or
h. industrial hemp, from the plant Cannabis sativa L. and
any part of such plant, whether growing or not, with a
delta-9 tetrahydrocannabinol concentration of not more
than three-tenths of one percent (0.3%) on a dry-
weight basis which shall only be grown pursuant to the
Oklahoma Industrial Hemp Program and may be shipped
intrastate and interstate;
24. "Medical purpose" means an intention to utilize a
controlled dangerous substance for physical or mental treatment, for
diagnosis, or for the prevention of a disease condition not in
violation of any state or federal law and not for the purpose of
satisfying physiological or psychological dependence or other abuse;
25. "Mid-level practitioner" means an Advanced Practice
Registered Nurse as defined and within parameters specified in
Section 567.3a of Title 59 of the Oklahoma Statutes, or a certified
animal euthanasia technician as defined in Section 698.2 of Title 59
of the Oklahoma Statutes, or an animal control officer registered by
the Oklahoma State Bureau of Narcotics and Dangerous Drugs Control
under subsection B of Section 2-301 of this title within the
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parameters of such officer's duties under Sections 501 throug h 508
of Title 4 of the Oklahoma Statutes;
26. "Narcotic drug" means any of the following, whether
produced directly or indirectly by extraction from substances of
vegetable origin, or independently b y means of chemical synthesis,
or by a combination of e xtraction and chemical synthesis:
a. opium, coca leaves and opiates,
b. a compound, manufacture, salt, derivative or
preparation of opium, coca leaves or opiates,
c. cocaine, its salts, optical and geo metric isomers, and
salts of isomers,
d. ecgonine, its derivatives, their salts, isomers and
salts of isomers, and
e. a substance, and any compound, manufacture, salt,
derivative or preparation thereof, which is chemically
identical with any of the substan ces referred to in
subparagraphs a through d of this pa ragraph, except
that the words "narcotic drug" as used in Section 2-
101 et seq. of this title shall not include
decocainized coca leaves or extracts of coca leaves,
which extracts do not contain cocain e or ecgonine;
27. "Opiate" or "opioid" means any Schedule II, III, IV or V
substance having an addiction-forming or addiction-sustaining
liability similar to morphine or being capable of conversion into a
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drug having such addiction-forming or addiction -sustaining
liability. The terms do not include, unless specifically designated
as controlled under the Uniform Controlled Dangerous Substances Act,
the dextrorotatory isomer of 3-methoxy-n-methyl-morphinan and its
salts (dextromethorphan). The terms do include the racemic and
levorotatory forms;
28. "Opium poppy" means the plant of the species Papaver
somniferum L., except the seeds thereof;
29. "Palliative care" means a specialized medical service for
people of any age, and at any stage of a serious illness or life -
altering event. Palliative care focuses on mitigating symptoms such
as pain and suffering while navigating complex medical decisions
with special attention paid to ensuring patient autonomy and access
to information. Utilizing a holistic and interdisciplinary team
approach, palliative care addresses physical, intellectual,
emotional, social, and spiritual needs. Palliative care can be
provided in the inpatient, outpatient, or home care setting and
strives to improve quality of life for both the patient and the
family. Palliative care does not always include a requirement for
hospice care or attention to spiritual needs. Palliative care may
be appropriate at any stage of a serious illness, not just at the
end of one's life;
30. "Peace officer" means a police officer, sheriff, deputy
sheriff, district attorney's investigator, investigator from the
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Office of the Attorney General, or any other person elected or
appointed by law to enforce any of the criminal laws of this state
or of the United States;
30. 31. "Person" means an individual, corporation, government
or governmental subdivision or agency, business trust, estate,
trust, partnership or association, or any other legal entity;
31. 32. "Poppy straw" means all parts, except the seeds, of the
opium poppy, after mowing;
32. 33. "Practitioner" means:
a. (1) a medical doctor or osteopathic physician,
(2) a dentist,
(3) a podiatrist,
(4) an optometrist,
(5) a veterinarian,
(6) a physician assistant or Advanced Practice
Registered Nurse under the supervision of a
licensed medical doctor or osteopathic physician,
(7) a scientific investigator, or
(8) any other person,
licensed, registered or ot herwise permitted to
prescribe, distribute, dispense, conduct research with
respect to, use for scientific purposes or administer
a controlled dangerous substance in the course of
professional practice or research in this state, or
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b. a pharmacy, hospital , laboratory or other institution
licensed, registered or otherwise permitted to
distribute, dispense, conduct research with respect
to, use for scientific purposes or administer a
controlled dangerous substance in the course of
professional practice or re search in this state;
33. 34. "Production" includes the manufacture, planting,
cultivation, growing or harvesting of a controlled dangerous
substance;
34. 35. "State" means the State of Oklahoma or any other state
of the United States;
35. 36. "Ultimate user" means a person who lawfully possesses a
controlled dangerous substance for the person's own use or for the
use of a member of the person's household or for administration to
an animal owned by the person or by a member of the person's
household;
36. 37. "Drug paraphernalia" means all equipment, products and
materials of any kind which are used, intended for use, or fashioned
specifically for use in planting, propagating, cultivating, growing,
harvesting, manufacturing, comp ounding, converting, producing,
processing, preparing, testing, analyzing, packaging, repackaging,
storing, containing, concealing, injecting, ingesting, inhaling or
otherwise introducing into the human body, a controlled dangerous
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substance in violation o f the Uniform Controlled Dangerous
Substances Act including, but not limited to:
a. kits used, intended for use, or fashioned specifically
for use in planting, propagating, cultivating, growing
or harvesting of any species of plant which is a
controlled dangerous substance or from which a
controlled dangerous substance can be derived,
b. kits used, intended for use, or fashioned specifically
for use in manufacturing, compounding, converting,
producing, processing or preparing controlled
dangerous substances ,
c. isomerization devices used, in tended for use, or
fashioned specifically for use in increasing the
potency of any species of plant which is a controlled
dangerous substance,
d. testing equipment used, intended for use, or fashioned
specifically for use in identifying, or in analyzing
the strength, effectiveness or purity of controlled
dangerous substances,
e. scales and balances used, intended for use, or
fashioned specifically for use in weighing or
measuring controlled dangerous substances,
f. diluents and adulterants, such as quini ne
hydrochloride, mannitol, mannite, dextrose and
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lactose, used, intended for use, or fashioned
specifically for use in cutting controlled dangerous
substances,
g. separation gins and sifters used, intended for use, or
fashioned specifically for use in re moving twigs and
seeds from, or in otherwise cleaning or refining,
marijuana,
h. blenders, bowls, containers, spoons and mixing devices
used, intended for use, or fashioned specifically for
use in compounding controlled dange rous substances,
i. capsules, balloons, envelopes and other containers
used, intended for use, or fashioned specifically for
use in packaging small quantities of controlled
dangerous substances,
j. containers and other objects used, intended for use,
or fashioned specifically for use in parenterally
injecting controlled dangerous substances into the
human body,
k. hypodermic syringes, needles and other objects used,
intended for use, or fashioned specifically for use in
parenterally injecting controlled dan gerous substances
into the human body,
l. objects used, intended for use, or fashioned
specifically for use in ingesting, inhaling or
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otherwise introducing marijuana, cocaine, hashish or
hashish oil into the human body, such as:
(1) metal, wooden, acrylic, glass, stone, plastic or
ceramic pipes with or without screens, permanent
screens, hashish heads or punctured metal bowls,
(2) water pipes,
(3) carburetion tubes and devices,
(4) smoking and carburetion masks,
(5) roach clips, meaning objects used to hold burning
material, such as a marijuana cigarette, that has
become too small or too short to be held in the
hand,
(6) miniature cocaine spoons and cocaine vials,
(7) chamber pipes,
(8) carburetor pipes,
(9) electric pipes,
(10) air-driven pipes,
(11) chillums,
(12) bongs, or
(13) ice pipes or chillers,
m. all hidden or novelty pipes, and
n. any pipe that has a tobacco bowl or chamber of less
than one-half (1/2) inch in diameter in which there is
any detectable residue of any controlled dangerous
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substance as defined in this section or any oth er
substances not legal for possession or use;
provided, however, the term "drug paraphernalia" shall not include
separation gins intended for use in preparing tea or spice, clamps
used for constructing electrical equipme nt, water pipes designed for
ornamentation in which no detectable amount of an illegal substance
is found or pipes designed and used solely for smoking tobacco,
traditional pipes of an American Indian tribal religious ceremony,
or antique pipes that are th irty (30) years of age or older;
37. 38. a. "Synthetic controlled substance" means a
substance:
(1) the chemical structure of which is substantially
similar to the chemical structure of a controlled
dangerous substance in Schedule I or II,
(2) which has a stimulant, depressant, or
hallucinogenic effect on the central nervous
system that is substantially similar to or
greater than the stimulant, depressant or
hallucinogenic effect on the central nervous
system of a controlled dangerous substance in
Schedule I or II, or
(3) with respect to a particular person, which such
person represents or intends to have a stimulant,
depressant, or hallucinogenic effect on the
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central nervous system that is substantially
similar to or greater than the stimulant,
depressant, or hallucinogenic effect on the
central nervous system of a controlled dangerous
substance in Schedule I or II.
b. The designation of gamma butyrolactone or any other
chemical as a precursor, pursuant to Section 2-322 of
this title, does not preclude a findin g pursuant to
subparagraph a of this paragraph that the chemical is
a synthetic controlled substance.
c. "Synthetic controlled substance" does not include:
(1) a controlled dangerous substance,
(2) any substance for which there is an approved new
drug application,
(3) with respect to a particular person any
substance, if an exemption is in effect for
investigational use, for that person under the
provisions of Section 505 of the Federal Food,
Drug and Cosmetic Act, Title 21 of the United
States Code, Section 355, to the extent conduct
with respect to such substance is pursuant to
such exemption, or
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(4) any substance to the extent not intended for
human consumption before such an exemption takes
effect with respect to that substance.
d. Prima facie evidence that a substance containing
salvia divinorum has been enhanced, concentrated or
chemically or physically altered shall give rise to a
rebuttable presumption that the substance is a
synthetic controlled substance;
38. 39. "Tetrahydrocannabinols" means all substances that have
been chemically synthesized to emulate the tetrahydrocannabinols of
marijuana, specifically including any tetrahydrocannabinols derived
from industrial hemp;
39. 40. "Isomer" means the optical isomer, except as used in
subsections C and F of Section 2-204 of this title and paragraph 4
of subsection A of Section 2-206 of this title. As used in
subsections C and F of Section 2-204 of this title, "isomer" means
the optical, positional or geometric isomer. As used in paragraph 4
of subsection A of Section 2-206 of this title, the term "isomer"
means the optical or geometric isomer;
40. 41. "Hazardous materials" means materials, whether solid,
liquid or gas, which are toxic to human, animal, aquatic or plant
life, and the disposal of which materia ls is controlled by state or
federal guidelines;
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41. 42. "Anhydrous ammonia" means any substance that exhibits
cryogenic evaporative behavior and tests positive for ammonia;
42. 43. "Acute pain" means pain, whether resulting from
disease, accidental or intentional trauma or other cause, that the
practitioner reasonably expects to last only a short period of time.
"Acute pain" does not include chronic pain, pain being treated as
part of cancer care, hospice or other end-of-life care, or pain
being treated as part of palliative care;
43. 44. "Chronic pain" means pain that persists beyond the
usual course of an acute disease or healing of an injury. "Chronic
pain" may or may not be associated with an acute or chronic
pathologic process that causes continuous or intermittent pain over
months or years;
44. 45. "Initial prescription" means a prescription issued to a
patient who:
a. has never previously been issued a prescription for
the drug or its pharmaceutical equivalent in the past
year, or
b. requires a prescription for the drug or its
pharmaceutical equivalent due to a surgical procedure
or new acute event and has previously had a
prescription for the drug or its pharmaceutical
equivalent within the past year.
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When determining whether a patient was previously issued a
prescription for a drug or its pharmaceutical equivalent, the
practitioner shall consult with the patient and review the medical
record and prescription monitoring information of the patient;
45. 46. "Patient-provider agreement" means a written contract
or agreement that is executed between a practitioner and a patien t,
prior to the commencement of treatment for chronic pain using an
opioid drug as a means to:
a. explain the possible risk of development of physical
or psychological dependence in the patient and prevent
the possible development of addiction,
b. document the understanding of both the practitioner
and the patient regarding the patient-provider
agreement of the patient,
c. establish the rights of the patient in association
with treatment and the obligations of the patient in
relation to the responsible use, discontinuation of
use, and storage of opioid drugs, including any
restrictions on the refill of prescriptions or the
acceptance of opioid prescriptions from practitioners,
d. identify the specific medications and other modes of
treatment, including physical therapy or exercise,
relaxation or psychological counseling, that are
included as a part of the patient-provider agreement,
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e. specify the measures the practitioner may employ to
monitor the compliance of the patient including, but
not limited to, rand om specimen screens and pill
counts, and
f. delineate the process for terminating the agreement,
including the consequences if the practitioner has
reason to believe that the patient is not complying
with the terms of the agreement. Compliance with the
"consent items" shall constitute a valid, informed
consent for opioid therapy. The practitioner shall be
held harmless from civil litigation for failure to
treat pain if the event occurs because of nonadherence
by the patient with any of the provisions of t he
patient-provider agreement;
46. 47. "Serious illness" means a medical illness or physical
injury or condition that substantially affects quality of life for
more than a short period of time. "Serious illness" includes, but
is not limited to, Alzheimer 's disease or related dementias, lung
disease, cancer, heart failure, renal failure, liver failure or
chronic, unremitting or intractable pain such as neuropathic pain;
and
47. 48. "Surgical procedure" means a procedure that is
performed for the purpose of struct urally altering the human body by
incision or destruction of tissues as part of the practice of
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medicine. This term includes the diagnostic or therapeutic
treatment of conditions or disease processes by use of instruments
such as lasers, ultrasound, ioniz ing, radiation, scalpels, probes or
needles that cause localized alteration or transportation of live
human tissue by cutting, burning, vaporizing, freezing, suturing,
probing or manipulating by closed reduction for major dislocations
or fractures, or othe rwise altering by any mechanical, thermal,
light-based, electromagnetic or chemical means.
SECTION 2. AMENDATORY 63 O.S. 2021, Section 2 -112, is
amended to read as fo llows:
Section 2-112. The Oklahoma State Bureau of Narcotics and
Dangerous Drugs Control shall report to the standing committees of
the Legislature having jurisdiction over health and human services
matters and over occupat ional and professional regulatio n matters,
no later than create and make available reports regarding an annual
change, plus or minus, of relevant de -identified data collected from
the central repository by January 31, 2020, with progress on
implementing the provisions of this act of each year. The report
shall may contain, at a minimum but is not limited to , the following
information:
1. Registration of prescribers and dispensers in the c entral
repository pursuant to Section 2-309A et seq. of Title 63 of the
Oklahoma Statutes;
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2. Data regarding the checking and using of the centr al
repository by data requesters;
3. Data from profession al boards regarding the implementation
of continuing education requirements for prescribers of opioid
drugs;
4. Effects on the prescriber workforce;
5. Changes in the numbers of patients taking mo re than one
hundred (100) morphine milligram equivalents o f opioid drugs per
day;
6. Data regarding the total quantity of opioid drugs prescribed
in morphine milligram equivalents;
7. Progress on electronic pr escribing of opioid drugs; and
8. Improvements to the central repo sitory through the request
for proposals process including feedback from prescribers,
dispensers and applicable state licensing boards on those
improvements; and
9. Number of prescriptions notated as acute and chronic.
SECTION 3. AMENDATORY 63 O.S. 2021, Section 2 -309I, as
amended by Section 1, Chapter 257, O.S .L. 2022 (63 O.S. Supp. 2022,
Section 2-309I), is amended to read as follows:
Section 2-309I. A. A practitioner shall not issue an initial
prescription for an opioid drug in a quantity exceeding a seven-day
supply for treatment of acute pain . Any opioid prescription for
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acute pain shall be for the lowest effective dose of an immediate -
release drug.
B. Prior to issuing an initial prescription fo r an opioid drug
in a course of treatment for acute or chronic pain, a practitioner
shall:
1. Take and document the resul ts of a thorough medical history,
including the experience of the patient wi th nonopioid medication
and nonpharmacological pain-management approaches and substanc e
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 in formation 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 dosage; pro vided, however, 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 quantity not to exceed seven (7) days if:
a. the subsequent prescription is due to a major surgical
procedure or "confined to home" status as defined in
42 U.S.C., Section 1395n(a),
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b. the practitioner provides the subsequent prescription
on the same day as the initial prescription,
c. the practitioner pro vides written instructions o n the
subsequent prescription indicating the ea rliest date
on which the prescription may be filled, otherwise
known as a "do not fill until" date, and
d. the subsequent prescription is dispensed no more than
five (5) days after the "do not fill until" date
indicated on the prescription;
6. In the case of a patient under the age of eighteen (18)
years, 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 pregn ant 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 consultation with the patient, may issue a
subsequent prescription for the dru g to the patient in a quantity
not to exceed seven (7) days, provided that:
1. The subsequent prescripti on would not be deemed an initial
prescription under this section ;
2. The practitioner determines the prescription is nece ssary
and appropriate to the treatment needs of the patient and documents
the rationale for the i ssuance of the subsequent prescripti on; and
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3. The practitioner determines that issuance of the subs equent
prescription does not present an undue risk of abus e, addiction or
diversion and documents that determination.
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 wi th the 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 o verdose 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 treatment s that may be available; and
4. Risks associated with the use of the drugs being prescribed,
specifically that opioids are highly ad dictive, even when taken as
prescribed, that there is a risk of d eveloping a physical or
psychological dependence on the co ntrolled dangerous substance , and
that the risks of taking more opioids tha n prescribed or mixing
sedatives, benzodiazepines or alcoh ol 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 discuss ed with the practitioner the
risks of developing a physical or psychological dependence on the
controlled dangerous substance and alternative treatments that m ay
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 a n
opioid drug, the practiti oner shall enter into a patient-provider
agreement with the patient.
F. When an opioid drug is continuo usly prescribed for three (3)
months or more for chronic pain, the practitioner shall:
1. Review, at a minimum of every thre e (3) months, the course
of treatment, any new information about the etiolo gy 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 eve ry renewal to determine whether the patient
is experiencing problems asso ciated with an opioid use disord er as
defined by the American Psychiatric Association and document the
results of that assessment. Following one (1) year of c ompliance
with the patient-provider agreement, the practitioner shall asses s
the patient at a min imum 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, tr y other drugs or treatment modalities in an
effort to reduce the potential for abuse or the development o f 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 wi th the patient-provider agreement and
any recommendations that the patie nt seek a referral.
G. 1. Any prescription for acute pai n 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 practitioner.
H. This section shall not apply to a prescriptio n for a
patient:
1. Who has sickle cell disease;
2. Who is in treatment for cancer or receiving aftercare cancer
treatment;
3. Who is receiving hospice care from a licensed hospi ce;
4. Who is receiving palliative care in conjunction with a
serious illness;
5. Who is a resident of a long-term care facility; or
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6. For any medications that are being prescribed for use in t he
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 renew al in
this state by the Insurance Commissioner, and every contract
purchased by the Employees Group Insurance Division of the Office of
Management and Enterprise Services, on or after November 1, 2018,
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 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 engage in an informed consent
process between the prescribing practitioner and qua lifying opioid
therapy patient. For the purposes of this section, "qualifying
opioid therapy patient" means:
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1. A Informed consent is required for a patient requiring
prescribed opioid treatment for more than three (3) months;
2. A patient fourteen (14) days or who is prescribed
benzodiazepines and opioids together for more than one twenty-four-
hour period; or
3. A patient who is prescribed a dose of opioi ds that exceeds
one hundred (100) morphine equivalent doses. Informed consent
required by this subsection is not equivalent to a patient-provider
agreement as defined in Section 2 -101 of this title.
K. When a practitioner thoroughly assesses and documents his or
her findings as required by this section and prescribe s in good
faith using his or her clinical expertise, neither the average
prescribed doses or quantities alone of an individual patient or
practice of a practitioner shall be used as the basis to ini tiate an
investigation or disciplinary action, or to pursue civil liability
or criminal penalties.
L. Nothing in the Anti-Drug Diversion Act shall be construed 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 dee med appropriate by
the prescribing practit ioner without an administrative or codified
limit on dose or quantity that is more restrictive than approved by
the Food and Drug Administration (FDA).
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SECTION 4. It being immediately necessary for the preservation
of the public peace, hea lth or safety, an emergency is hereb y
declared to exist, by reason where of this act shall take effect and
be in full force from and after its passage a nd approval.
59-1-7860 JL 03/01/23