86R23872 JSC-F
By: Davis of Dallas H.B. No. 1866
Substitute the following for H.B. No. 1866:
By: Price C.S.H.B. No. 1866
A BILL TO BE ENTITLED
AN ACT
relating to the prescribing of opioids for acute pain.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter C, Chapter 481, Health and Safety
Code, is amended by adding Section 481.07635 to read as follows:
Sec. 481.07635. PRESCRIPTIONS OF OPIOIDS FOR ACUTE PAIN.
(a) In this section, "acute pain" means the normal, predicted,
physiological response to a stimulus such as trauma, disease, and
operative procedures. Acute pain is time-limited. The term does not
include:
(1) chronic pain;
(2) pain being treated as part of cancer care;
(3) pain being treated as part of hospice or other
end-of-life care; or
(4) pain being treated as part of palliative care.
(b) For the initial treatment of acute pain, a prescriber
may not issue a prescription for an opioid in an amount that exceeds
a seven-day supply.
(c) Before issuing an initial opioid prescription for acute
pain, a prescriber shall:
(1) take and document the results of a thorough
medical history, including:
(A) the patient's experience with medication
other than opioids and pain management approaches described by
Subsection (d); and
(B) any history of substance abuse;
(2) conduct and document the results of a physical
examination, as appropriate;
(3) develop a treatment plan focused on determining
the cause of the patient's pain; and
(4) comply with the requirements of Section 481.0764.
(d) A prescriber may refer or prescribe any of the following
pain management services to a patient, based on the prescriber's
clinical judgment and the availability of the treatment, when
issuing an opioid prescription for acute pain:
(1) physical therapies;
(2) occupational therapies;
(3) chiropractic treatment;
(4) physical medicine and rehabilitation; or
(5) osteopathic manipulation.
(e) This section does not apply to:
(1) patients:
(A) with pain related to:
(i) progressive functional neurological
deficit;
(ii) fracture;
(iii) tumor;
(iv) infection; or
(v) immediate postsurgical recovery;
(B) with chronic pain that, based on the
prescriber's clinical judgment, is caused by a disease, illness, or
injury that would not improve under the therapies and treatments
described by Subsection (d); or
(C) receiving:
(i) treatment for cancer;
(ii) emergency or trauma care;
(iii) hospice care;
(iv) palliative care;
(v) long-term care; or
(vi) treatment for substance abuse or
opioid dependence; or
(2) a prescriber who is a veterinarian.
(f) This section does not require that all of the treatments
under Subsection (d) be exhausted before the patient may receive a
prescription for an opioid.
(g) A dispenser is not subject to disciplinary action, civil
liability, or criminal, civil, or administrative penalties for
dispensing or refusing to dispense a controlled substance under an
otherwise valid prescription that exceeds the limits provided by
Subsection (b).
SECTION 2. Section 481.003(a), Health and Safety Code, is
amended to read as follows:
(a) The director may adopt rules to administer and enforce
this chapter, other than Sections 481.073, 481.074, 481.075,
481.076, 481.0761, 481.0762, 481.0763, 481.07635, 481.0764,
481.0765, and 481.0766. The board may adopt rules to administer
Sections 481.073, 481.074, 481.075, 481.076, 481.0761, 481.0762,
481.0763, 481.07635, 481.0764, 481.0765, and 481.0766.
SECTION 3. Section 554.051(a-1), Occupations Code, is
amended to read as follows:
(a-1) The board may adopt rules to administer Sections
481.073, 481.074, 481.075, 481.076, 481.0761, 481.0762, 481.0763,
481.07635, 481.0764, 481.0765, and 481.0766, Health and Safety
Code.
SECTION 4. Section 565.003, Occupations Code, is amended to
read as follows:
Sec. 565.003. ADDITIONAL GROUNDS FOR DISCIPLINE REGARDING
APPLICANT FOR OR HOLDER OF NONRESIDENT PHARMACY LICENSE. Unless
compliance would violate the pharmacy or drug statutes or rules in
the state in which the pharmacy is located, the board may discipline
an applicant for or the holder of a nonresident pharmacy license if
the board finds that the applicant or license holder has failed to
comply with:
(1) Section 481.073, 481.074, [or] 481.075, 481.076,
481.0761, 481.0762, 481.0763, 481.07635, 481.0764, 481.0765, or
481.0766, Health and Safety Code;
(2) Texas substitution requirements regarding:
(A) the practitioner's directions concerning
generic substitution;
(B) the patient's right to refuse generic
substitution; or
(C) notification to the patient of the patient's
right to refuse substitution;
(3) any board rule relating to providing drug
information to the patient or the patient's agent in written form or
by telephone; or
(4) any board rule adopted under Section 554.051(a)
and determined by the board to be applicable under Section
554.051(b).
SECTION 5. Section 481.07635, Health and Safety Code, as
added by this Act, applies only to a prescription issued on or after
the effective date of this Act. A prescription issued before the
effective date of this Act is governed by the law in effect on the
date the prescription is issued, and the former law is continued in
effect for that purpose.
SECTION 6. This Act takes effect September 1, 2019.