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ENGROSSED HOUSE
BILL NO. 1082 By: Talley, Echols, and Hefner
of the House
and
Jett of the Senate
[ public health and saf ety - Uniform Controlled
Dangerous Substances Act - creation and posting of
reports on public websites - Anti-Drug Diversion
Act - process for obtaining informed consent from
patients - restrictions when initiating
investigations, disciplinary actions, civil or
criminal penalties -
emergency ]
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. AMENDATORY 63 O.S. 2021, Secti on 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 occup ational 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
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the central repositor y 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 o f the
Oklahoma Statutes;
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 equivale nts;
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.
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SECTION 2. 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 fol lows:
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
acute pain shall be for the lowest effective dose of a n 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 with 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 fo cused
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
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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),
b. the practitioner provides the subsequent prescrip tion
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, t he
practitioner, after consultation with the patient, may issue a
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subsequent prescription for the dru g to the patient in a quantity
not to exceed seven (7) days, provided that:
1. The subsequent prescription would not be deemed an initial
prescription under this section;
2. The practitioner determines the prescription is nece ssary
and appropriate to the treatment needs of the patient and documents
the rationale for the i ssuance of the subsequent prescription; and
3. The practitioner determines that issua nce of the subsequent
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 agai n 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 assoc iated 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 addictive, even when taken as
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prescribed, that there is a risk of developing 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 al cohol with opioids can result in
fatal respiratory de pression.
The practitioner shall include a note in the medical record of
the patient that the patient or the parent or guardian of the
patient, as applicable, has discuss ed with the practitioner the
risks of developing a physical or psychological dependenc e 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 su bsection.
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 continu ously prescribed for three (3)
months or more for chr onic 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
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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 clinica lly
contraindicated, to either stop the use of the controlled substance,
decrease the dosage, tr y other drugs or treatment modalities in an
effort to reduce the potential for abuse or the development o f an
opioid use disorder as defined by the American Psy chiatric
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 patient 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 sectio n
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;
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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
6. For any medications that are being prescribed for use in the
treatment of substance abuse or opioid dependence.
I. Every policy, contract or plan delivered, issued, executed
or renewed in this state, or approved for issuance or 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.
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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:
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 experti se, 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
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opioid therapy. The standard of care requires effective and
individualized treatment for each patient as dee med appropriate by
the prescribing practitioner without an administrative or codified
limit on dose or quantity that is more restrictive than approved by
the Food and Drug Administration (FDA).
SECTION 3. It being immediately necessary for the preservation
of the public peace, health or safety, an emergency is 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.
Passed the House of Representatives the 20th day of March, 2023.
Presiding Officer of the House
of Representatives
Passed the Senate the ____ day of March, 2023.
Presiding Officer of the Senate