SB249 HFLR Page 1 BOLD FACE denotes Committee Amendments. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 HOUSE OF REPRESENTATIVES - FLOOR VERSION STATE OF OKLAHOMA 1st Session of the 59th Legislature (2023) ENGROSSED SENATE BILL NO. 249 By: McCortney of the Senate and Caldwell (Chad) of the House An Act relating to controlled dangerous su bstances; amending 63 O.S. 2021, Section 2-101, as amended by Section 1, Chapter 90, O.S.L. 2021, which relates to definitions used in the Uniform Controlled Dangerous Substances Act; defining term; amending 63 O.S. 2021, Section 2-309, as last amended by Section 1, Chapter 259, O.S.L 2021, which relates to prescriptions; broadening exception from electronic prescription requirement; defining term; 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 1, Chapter 90, O.S.L. 2021, is amended to read as follows: Section 2-101. As used in the Uniform Controlled Dangerous Substances Act: SB249 HFLR Page 2 BOLD FACE denotes Committee Amendments. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1. “Administer” means the direct application of a controlled dangerous substance, whether by injection, inhala tion, 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 an d in the presence of the practi tioner; 2. “Agent” means a peace officer appointed by and who acts on behalf of the Director of the Oklahoma Stat e Bureau of Narcotics and Dangerous Drugs Control or an authorized person who acts on behalf of or at the direction of a person who manufactur es, distributes, dispenses, prescribes, administers or uses for scientific purposes controlled dangerous substance s but does not include a common or contract carrier, public warehouser 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 SB249 HFLR Page 3 BOLD FACE denotes Committee Amendments. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 leaves, except derivatives of coca leaves which do not c ontain 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 placem ent of a drug, substance or immediate precursor un der the Uniform Controlled Dangerous Substances Act; 8. “Controlled dangerous substance ” means a drug, substance or immediate precursor in Schedules I through V of the Uniform Controlled Dangerous Substanc es Act or any drug, substance or immediate precursor listed either temporarily or permanently as a federally controlled substance. Any confli ct between state and federal law with regard to the particular schedule in which a substance is listed shall be re solved in favor of state law; 9. “Counterfeit substance” means a controlled substance which, or the container or labeling of which without au thorization, bears the trademark, trade name or other identifying marks, imprint, number or device or any likeness thereof of a manufacturer, distributor or dispens er other than the person who in fact manufactured, distribute d or dispensed the substance; 10. “Deliver” or “delivery” means the actual, constructive or attempted transfer from one person to another of a c ontrolled dangerous substance or drug paraphernali a, whether or not there is an agency relationship; SB249 HFLR Page 4 BOLD FACE denotes Committee Amendments. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 11. “Dispense” means to deliver a contro lled dangerous substance to an ultimate user or human research subject by or pursuant to the lawful order of a pra ctitioner including the prescribing, administering , packaging, labeling or compounding necessary to prepare the substance for such distributio n. “Dispenser” is a practitioner who delivers a controlled dangerous substance to an ultimate user or human resea rch subject; 12. “Distribute” means to deliver other than by administering or dispensing a controlled dangerou s 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 Pharmacopoeia, official Homeopathic Pharmacopoeia of the United States, or official National Formulary, or any supplement to any of them, b. intended for use in the diagnosis, 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 SB249 HFLR Page 5 BOLD FACE denotes Committee Amendments. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 d. intended for use as a component of any article specified in this paragraph; provided, however, the term “drug” drug does not include devices or their components, parts or accessories; 15. “Drug-dependent person” means a person who is using a controlled dangerous substance and who is in a state of psych ic or physical dependence, or both, arising from administration of that controlled dangerous substance on a continuous basis. Drug dependence is characterized by b ehavioral and other responses which include a strong compulsi on to take the substance on a c ontinuous 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 provide s home care services, 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 pers onal care services provided to clients in their place of resi dence for a fee; 18. “Hospice” means a centrally administered, nonprofit or profit, medically directed, nurse -coordinated program which provides a continuum of home and inpatient care for the te rminally ill patient and the patient’s family. Such term sha ll also include a centrally administered, nonprofit or profit, medically directed, SB249 HFLR Page 6 BOLD FACE denotes Committee Amendments. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 nurse-coordinated program if such program is licensed pursuant to the provisions of the Uniform Controlled Dange rous Substances 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 provide d 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 sub stance is a controlled dangerous substance. In the event the appearance of the dosage unit is not reasonably sufficient to establish that the substance is an “imitation controlled substance ” imitation controlled substance , the court or autho rity concerned should consider, in addition to all other factors, the following factors as related to “representations made” in determining whether the substance is an “imitation controlled substance ” imitation controlled substance : SB249 HFLR Page 7 BOLD FACE denotes Committee Amendments. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 a. statements made by an owner or by any other person in control of the substance concerning the n ature of the substance, or its use or effect, b. statements made to the recipient that the substance may be resold for inord inate 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 frau d, 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 regulatio n designates as being the principal compound commonly used or produced primarily f or use, and which is an immediate chemical intermediary used, or likely to be used, 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 controlled dangerous SB249 HFLR Page 8 BOLD FACE denotes Committee Amendments. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 substances and the use of controlled dangerous substances for scientific and medical purposes and for purposes of instruction; 22. “Manufacture” means the production, preparation, propagation, compounding or processing of a controlled dangerous substance, either directly or indirectly by extraction from substances of natural or synth etic origin, or independently by means of chemical synthesis or by a combination o f extraction and chemical synthesis. “Manufacturer” includes any person who packages, repackages or labels any container of any controlled dangerous substance, except practi tioners 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 ev ery 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 or 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 (except SB249 HFLR Page 9 BOLD FACE denotes Committee Amendments. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 the resin extracted therefrom) including cannabidiol derived from mature stalks, fiber, oi l or cake, 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 pre paration thereof, that has a tetrahydrocannabinol concentration SB249 HFLR Page 10 BOLD FACE denotes Committee Amendments. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 of not more than three-tenths of one percent (0.3%) and that is delivered to the patient in the form of a liquid, g. any federal Food and Drug Administration -approved cannabidiol drug or subst ance, 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 preven tion of a disease condition not in violation of any state or federal law and not f or the purpose of satisfying physiological or psychological dependence or other abuse; 25. “Mid-level practitioner” means an Advanced Practice Registered Nurse as defined an d within parameters specified in Section 567.3a of Title 59 of the Oklahoma Statut es, 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 SB249 HFLR Page 11 BOLD FACE denotes Committee Amendments. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 parameters of such officer ’s duties under Sections 501 through 508 of Title 4 of the Oklahoma Statutes; 26. “Narcotic drug” means any of the fol lowing, whether produced directly or indirectly by extraction from substances of vegetable origin, or independently by means of chemical synthesis, or by a combination of extraction 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 geometric 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 chemicall y identical with any of the substances referred to in subparagraphs a through d of this paragraph, 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 cocaine 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 SB249 HFLR Page 12 BOLD FACE denotes Committee Amendments. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 drug having such addiction-forming or addiction-sustaining liability. The terms do not include, unless specifically designated as controlled under the Uniform Controlled Dangerous Substan ces 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. “Peace officer” means a police officer, sheriff, deput y sheriff, district attorney’s investigator, investigator from the Office of the Attorney General, or an y other person elected or appointed by law to enforce any of the criminal laws of this stat e or of the United States; 30. “Person” means an individual, corporation, governm ent or governmental subdivision or agency, business trust, estate, trust, partnership or association, or any other legal entity; 31. “Poppy straw” means all parts, except th e seeds, of the opium poppy, after mowing; 32. “Practitioner” means: a. (1) a medical doctor or osteopathic physician, (2) a dentist, (3) a podiatrist, (4) an optometrist, (5) a veterinarian, SB249 HFLR Page 13 BOLD FACE denotes Committee Amendments. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 (6) a physician assistant or Advanced Practice Registered Nurse under the supervision of a licensed medical doctor or osteop athic physician, (7) a scientific investigator, or (8) any other person, licensed, registered or otherwi se permitted to prescribe, distribute, dispense, conduct research with respect to, use for scientific purposes or administer a controlled dangerous subs tance in the course o f professional practice or research in this state, or b. a pharmacy, hospital, labo ratory or other institution licensed, registered or otherwise permitted to distribute, dispense, conduct research with respect to, use for scientific pu rposes or administer a controlled dangerous substance in the course of professional practice or research in this state; 33. “Production” includes the manufacture, planting, cultivation, growing or harvesting of a controlled dangerous substance; 34. “State” means the State of Oklahoma or any other state of the United States; 35. “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 adminis tration to SB249 HFLR Page 14 BOLD FACE denotes Committee Amendments. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 an animal owned by the person or by a member of the person ’s household; 36. “Drug paraphernalia” means all equipment, products and materials of any kind which are used, intended for u se, or fashioned specifically for use in planting, propagatin g, cultivating, growi ng, harvesting, manufacturing, compounding, converting, producing, processing, preparing, testing, analyzing, packaging, repackaging, storing, containing, concealing, injecti ng, ingesting, inhaling or otherwise introducing into the hum an body, a controlled dangerous substance in violation of 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 specie s 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 prepar ing controlled dangerous substances, c. isomerization devices used, intended for use, or fashioned specifically for use in increasing the potency of any species of plant whic h is a controlled dangerous substance, SB249 HFLR Page 15 BOLD FACE denotes Committee Amendments. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 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, int ended for use, or fashioned specifically for use in weighing or measuring controlled dangerous substances, f. diluents and adulterants, such as quinine hydrochloride, mannitol, mannite, dextrose and lactose, used, intended for use, or fashioned specifically for use in cutting controlled dangerous substances, g. separation gins and sifte rs used, intended for use, or fashioned specifically for use in removing twigs and seeds from, or in otherwise cleaning or refining, marijuana, h. blenders, bowls, containers , spoons and mixing devices used, intended for use, or fashio ned specifically for use in compounding controlled dangerous 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, SB249 HFLR Page 16 BOLD FACE denotes Committee Amendments. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 j. containers and other ob jects 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 speci fically for use in parenterally injecting controlled dangerous substances into the human body except as authorized by Section 3 of this act 2-1101 of this title, l. objects used, intended for use , or fashioned specifically for use in ingesting, inhaling or otherwise introducing marijuan a, 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, permane nt 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, SB249 HFLR Page 17 BOLD FACE denotes Committee Amendments. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 (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 substance as defined in this section or any other substances not legal for possessio n or use; provided, however, the term “drug paraphernalia” drug paraphernalia shall not include separation gins intended for use in preparing tea or spice, clamps used for constructing electrical equipment, water pipes designed for ornamentation in which n o detectable amount of an illegal substance is found or p ipes designed and used solely for smoking tobacco, traditional pipes of an American Indian tribal religious ceremony, or antique pipes that are thirty (30) years of age or older; 37. a. “Synthetic controlled substance” means a substance: SB249 HFLR Page 18 BOLD FACE denotes Committee Amendments. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 (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, wh ich such person represents or intends to have 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. 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 finding pursuant to subparagraph a of this paragraph that the chemical is a synthetic controlled substance. c. “Synthetic controlled substance” does not include: SB249 HFLR Page 19 BOLD FACE denotes Committee Amendments. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 (1) a controlled dangerous substance, (2) any substance for which there is an approved new drug application, (3) with respect to a particular person an y 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 c onduct with respect to such s ubstance is pursuant to such exemption, or (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 contai ning salvia divinorum has bee n enhanced, concentrated or chemically or physically altere d shall give rise to a rebuttable presumption that the substance is a synthetic controlled substance; 38. “Tetrahydrocannabinols ” means all substances that have been chemically synthesized to emul ate the tetrahydrocannabinols of marijuana; 39. “Isomer” means the optical isomer, except as used in subsections C and F of Section 2-204 of this title and paragraph 4 SB249 HFLR Page 20 BOLD FACE denotes Committee Amendments. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 of subsection A of Section 2 -206 of this title. As used i n subsections C and F of Sect ion 2-204 of this title, “isomer” isomer means the optical, p ositional or geometric isomer. As used in paragraph 4 of subsection A of Section 2-206 of this title, the term “isomer” isomer means the optical or geometric isomer; 40. “Hazardous materials” means materials, whether solid, liquid or gas, which are toxic to human, animal, aquatic or plant life, and the disposal of which materials is controlled by state or federal guidelines; 41. “Anhydrous ammonia” means any substance that exhibi ts cryogenic evaporative behavior and tests positive for ammonia; 42. “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” Acute pain does not include chronic pain, pain being treated as part of cancer care, h ospice or other end-of-life care, or pain being treated as part o f palliative care; 43. “Chronic pain” means pain that persists beyond the usual course of an acute dis ease or healing of an injury. “Chronic pain” Chronic pain may or may not be associated with an acute or chronic pathologic process that causes continuous or intermit tent pain over months or years; 44. “Initial prescription ” means a prescription issued to a patient who: SB249 HFLR Page 21 BOLD FACE denotes Committee Amendments. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 a. has never previously been issued a prescriptio n for the drug or its pharmaceu tical equivalent in the past year, or b. requires a prescription for t he drug or its pharmaceutical equivalent due to a surgical procedure or new acute event and ha s previously had a prescription for the drug or its pharmaceu tical equivalent within the pas t year. 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 monit oring information of the patien t; 45. “Patient-provider agreement” means a written contract or agreement that is executed between a practitioner and a patient, prior to the commencement of treat ment for chronic pain using an opioid drug as a means to: a. explain the possible risk of de velopment of physical or psychological dependence in the patient and p revent the possible development of addiction, b. document the understanding of both the practi tioner and the patient regarding the patient-provider agreement of the patient, c. establish the rights of the patient in association with treatment and the oblig ations of the patient in SB249 HFLR Page 22 BOLD FACE denotes Committee Amendments. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 relation to the responsible use, discontinuation of use, and storage of opioid drugs including any restrictions on the refill of p rescriptions or the acceptance of opioid prescriptions from practitioners, d. identify the specific m edications 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, e. specify the measures the practitioner may employ to monitor the compliance of the patient including, but not limited to, random specimen screens and pill counts, and f. delineate the process for terminating the agreement including the consequences if the p ractitioner 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 lit igation for failure to treat pain if the event occurs because of nonad herence by the patient with any of the provisions of the patient-provider agreement; 46. “Serious illness” means a medical illness or physical injury or condition that substantially aff ects quality of life for SB249 HFLR Page 23 BOLD FACE denotes Committee Amendments. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 more than a short period of time. “Serious illness” Serious illness includes, but is not limited to, Alzheimer ’s disease or related dementias, lung disease, cancer, heart failure, renal failure, live r failure or chronic, unremitti ng or intractable pain such as neuropathic pain; 47. “Surgical procedure” means a procedure that is performed for the purpose of structurally altering the human bo dy by incision or destruction of tissues as part of the pract ice of medicine. This term includes the diagnostic or therapeutic treatment of conditions or disease processes by us e of instruments such as lasers, ultrasound, ionizing, radiation, scalpels, pr obes or needles that cause localized alteration or transporta tion of live human tissue by cutting, burning, vaporizing, freezing, suturing, probing or manipulating by closed redu ction for major dislocations or fractures, or otherwise altering by any mechan ical, thermal, light- based, electromagnetic or chemical means ; and 48. “Harm-reduction services” means programs established to: a. reduce the spread of infectious diseases relat ed to injection drug use, b. reduce drug dependency, overdose deaths and assoc iated complications, and c. increase safe recovery and dispos al of used syringes and sharp waste; and SB249 HFLR Page 24 BOLD FACE denotes Committee Amendments. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 49. “Palliative care” means a specialized medical service for people of any age and at any stage of a serious illness or life - altering medical event that focuses on navigating complex medical decisions while provid ing 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 may be provided in the inpatient, outpatie nt, or home care setting and strives to improve quality of life for both the patient and the family. SECTION 2. AMENDATORY 63 O.S. 2021, Section 2 -309, as last amended by Section 1, Chapter 259, O.S.L 2021, is amended to read as follows: Section 2-309. A. 1. Except for dosages medically required for a period not to exceed forty -eight (48) hours which are administered by or on direction of a practitioner, other than a pharmacist, or medication dispensed directly by a practitioner, other than a pharmacis t, to an ultimate user, no controlled dangerous substance included in Schedule II , which is a prescription drug as determined und er regulation promulgated by the Board of Pharmacy, shall be dispensed without an electronic prescription of a practitioner; provided, that in emergency situations, as prescribed by the Board of Pharmacy by regulation, s uch drug may be dispensed upon oral prescription reduced promptly to writing a nd filed by the SB249 HFLR Page 25 BOLD FACE denotes Committee Amendments. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 pharmacist in a manner to be prescribed by rules and regulations of the Director of the Oklahoma State Bureau of Narcotics and Dangerous Drugs Control. 2. Electronic prescribing shall be utilized f or Schedules II, III, IV and V, subject to the requirements set forth i n 21 CFR, Section 1311 et seq. 3. An electronic prescri ption with electronic signature may serve as an original prescription, subject to the require ments set forth in 21 CFR, Section 1 311 et seq. 4. Prescriptions shall be ret ained in conformity with the requirements of this section and Section 2-307 of this title. No prescription for a Schedule II substance may be refilled. 5. The electronic prescr iption requirement provided for in t his section shall not apply to prescriptio ns for controlled dangerous substances issued by any of the following: a. a person licensed to practice veterinary medicine, b. a practitioner who experiences temporary technolog ical or electrical failure or other extenuating circumstance that prevents the prescription from being transmitted electronically; provided, however, that the practitioner documents the reason for this exception in the medical record of the patient, c. a practitioner, other than a pharmacist , who dispenses directly to an ultimate us er, SB249 HFLR Page 26 BOLD FACE denotes Committee Amendments. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 d. a practitioner who ord ers a controlled dangerous substance to be administered through an on-site pharmacy in: (1) a hospital as defined in Section 1 -701 of this title, (2) a nursing facility as defined in Se ction 1-1902 of this title, (3) a hospice inpatient facility as defined in Section 1-860.2 of this title, (4) an outpatient dialysis f acility, (5) a continuum of care facility as defined in Section 1-890.2 of this title, or (6) a penal institution listed i n Section 509 of Title 57 of the Oklahoma Statutes, e. a practitioner who orders a controlled dangerous substance to be administered t hrough a hospice program as defined in including but not limited to a hospice program that provides hospice services in the private residence of a patient or in a long-term care facility where the patient resides. As used in this subparagraph, “hospice program” has the same meaning as provided by Section 1-860.2 of this title, f. a practitioner who writes a prescription to be dispensed by a pharmacy located on federal property, SB249 HFLR Page 27 BOLD FACE denotes Committee Amendments. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 provided the practitioner documents the reason f or this exception in the medic al record of the patient, or g. a practitioner that has received a waiv er or extension from his or her licensing board. 6. Electronic prescriptions shall not be utilized under the following circumstances: a. compound prescriptions containing two or more commercially available products or two or more active pharmaceutical ingredients, b. compounded infusion prescriptions containing two or more commercially available products or two or mo re active pharmaceutical ingredients, c. prescriptions issued under app roved research protocols, or d. if the practitioner determines that an electronic prescription cannot be issued in a timely manner and the condition of the patient is at risk. 7. A pharmacist who receives a written, oral or f acsimile prescription shall no t be required to verify that the prescription falls under one of the ex ceptions provided for in paragraph 6 of this subsection. Pharmacists may cont inue to dispense medications from otherwise valid written, oral or facsimile prescriptions that are consistent with the provisions of this section. SB249 HFLR Page 28 BOLD FACE denotes Committee Amendments. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 8. Practitioners shall indica te in the health record of a patient that an exception to the electronic presc ription requirement was utilized. 9. All prescriptions issued pursuant to pa ragraphs 5 and 6 of this subsection shall be issued on an official prescription form provided by the Oklahoma State Bureau of Narcotics and Dangerous Drugs Control. 10. a. Effective January 1, 2020, practitioners s hall register with the Oklahoma State Bur eau of Narcotics and Dangerous Drugs Control in order to be issued official prescription forms. Such registration shall include, but not be limited to, the primary address and the address of each place of business to be imprinted on official prescription forms. Any change to a registered practitioner’s registered address shall be promptly reported to the practitioner’s licensing board and the Bureau by the practitioner in a manner approved by the Bureau. b. A practitioner’s registration shall be without f ee and subject to approval by the Bureau. Such registration shall be valid for a period of two (2) ye ars and may be denied, suspended or revoked by the Bureau upon a finding by the Bureau or licensing board that th e registered practitioner has had any lic ense to SB249 HFLR Page 29 BOLD FACE denotes Committee Amendments. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 practice a medical pro fession revoked or suspended by any state or federal agency. c. Where the Bureau has revoked the registration of a registered practitioner, the Bureau may revoke or cancel any official prescription forms in the possession of the registered practitioner. A ny revocation or any suspension shall require the registered practitione r to return all unused official prescription forms to the Bureau within fiftee n (15) calendar days after the date of the written notification. d. A practitioner that has had any licens e to practice terminated, revoked or suspended by a state or federal agency may, upon restoration of such license or certificate, register to be issue d official prescription forms. 11. a. Except as provided in subparagraph f of this paragraph, the Bureau shall issue official prescription forms free of charge only to registered practitioners in this state. Such forms shall not be transferable. The numb er of official prescription forms issued to a registered practitioner at an y time shall be at the discret ion of the Bureau. SB249 HFLR Page 30 BOLD FACE denotes Committee Amendments. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 b. Official prescription forms issued to a registered practitioner shall be imprinted only with the primary address and other addres ses listed on the registration of the practitioner. Such prescriptions sha ll be sent only to the primary address of the registered practitioner. c. Official prescription forms i ssued to a registered practitioner shall be used only by the practitioner to whom they are issued. d. The Bureau may revoke or cancel official prescripti on forms in possession of regi stered practitioners when the license of such practitioner is suspended, terminated or revoked. e. Official prescription forms of registered practitioners who are deceased or who no lon ger prescribe shall be returned to the Bu reau at a designated address. If the registered practitioner is deceased, it is the responsibility of the registered practitioner’s estate or lawful designee to return such forms. f. The Bureau may issue official p rescription forms to employees or agents of the Bureau and other govern ment agencies for the purpose of preventing, identifying, investigating and prosecuting unacceptable or illegal SB249 HFLR Page 31 BOLD FACE denotes Committee Amendments. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 practices by providers and other person s and assisting in the recovery of overpayments under any program operated by the state or paid for with state funds. Such prescription forms shall be issued for this purpose only to individuals who are authorized to conduct investigations on behalf of th e Bureau or other government agenc ies as part of their official duties. Individuals and agencies receivi ng such prescription forms for this purpose shall provide appropriate assurances to the Bureau that adequate safeguards and security measures are in pl ace to prevent the use of such prescription forms for anything other than o fficial government purposes. 12. a. Adequate safeguards and security measures shall be undertaken by registered practitioners holding official prescription forms to assure against t he loss, destruction, theft or un authorized use of the forms. Registered practitioners shall maintain a sufficient but not excessive supply of such forms in reserve. b. Registered practitioners shall immediately notify the Bureau, in a manner designated b y the Bureau, upon their knowledge of the loss, destruction, theft or unauthorized use of any official p rescription forms SB249 HFLR Page 32 BOLD FACE denotes Committee Amendments. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 issued to them, as well as the failure to receive official prescription forms within a reasonable time after ordering them from the Bu reau. c. Registered practitioners shall immediately notify the Bureau upon their knowledge of any divers ion or suspected diversion of drugs pursuant to the loss, theft or unauthorized use of prescriptions. B. 1. Except for dosages medically required for a period not to exceed seventy-two (72) hours which are administered by or on direction of a practitione r, other than a pharmacist, or medication dispensed directly by a practiti oner, other than a pharmacist, to an ultimate user, no controlled dangerous su bstance included in Schedule III or IV, which is a prescription drug as de termined under regulation promulgated by the Board of Pharmacy, shall be dispensed without an electronic prescription. 2. Any prescription for a controlled dangerous substance in Schedule III, IV or V may not be fi lled or refilled more than six (6) months after the date thereof or be refilled more than five times after the date of the prescription, unless r enewed by the practitioner. C. Whenever it appears to the Director of the Okl ahoma State Bureau of Narcotics a nd Dangerous Drugs Control that a drug no t considered to be a prescript ion drug under existing state law or regulation of the Board of Pharmacy s hould be so considered because SB249 HFLR Page 33 BOLD FACE denotes Committee Amendments. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 of its abuse potential, the Director shall so a dvise the Board of Pharmacy and furnish to the Board all available data re levant thereto. D. 1. “Prescription”, as used in this section, means a written, oral or electronic ord er by a practitioner to a pharmacist for a controlled dangerous substance for a particular patient, which specifies the date of its issue, and the full name and address of the patient and, if the controlled dangerous substance is prescribed for an animal, the species of the animal, the name and quantity of the controlled dangerous s ubstance prescribed, the directio ns for use, the name and address of the o wner of the animal and, if written, the signature of the practitioner. 2. “Registered practitioner ”, as used in this section, means a licensed practitioner duly registered with the Oklahoma State Bureau of Narcotics and Dangerous Drugs Control to be issue d official prescription forms. E. No person shall solicit, dispense, receive or deliver any controlled dangerous substance through the mail, unless the ultimate user is personally k nown to the practitioner and circ umstances clearly indicate such method of delivery is in the best inter est of the health and welfare of the ultimate user. SECTION 3. It being immediately necessary for the pr eservation of the public peace, health or safety, an emergency i s hereby SB249 HFLR Page 34 BOLD FACE denotes Committee Amendments. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 declared to exist, by reason whe reof this act shall take effec t and be in full force from and after its passage and approval. COMMITTEE REPORT BY: COMMITTEE ON HEALTH SERVICES AND LONG -TERM CARE, dated 04/04/2023 - DO PASS.