By: Price H.B. No. 2811
A BILL TO BE ENTITLED
AN ACT
relating to the prescribing of controlled substances and dangerous
drugs for acute pain.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle A, Title 3, Occupations Code, is
amended by adding Chapter 107A to read as follows:
CHAPTER 107A. ACUTE PAIN TREATMENT
Sec. 107A.001. DEFINITIONS. In this chapter:
(1) "Abuse" or "substance abuse" means the maladaptive
pattern of substance use manifested by recurrent and significant
adverse consequences related to the repeated use of controlled
substances or other drugs.
(2) "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:
(A) chronic pain;
(B) pain being treated as part of cancer care;
(C) pain being treated as part of hospice or
other end-of-life care; or
(D) pain being treated as part of palliative
care.
(3) "Addiction" means a primary, chronic, or
neurobiological disease characterized by craving and compulsive
use of drugs. Addiction is often characterized by impaired control
over drug use, including taking more drugs more often than
prescribed by a physician. It may also be characterized by
continued use despite harm to oneself or others. Genetic,
psychosocial, and environmental factors may influence the
development and manifestation of addiction. Physical dependence
and tolerance are normal physiological consequences of extended
drug therapy for pain and, alone, do not indicate addiction.
(4) "Chronic pain" means a state in which pain
persists beyond the usual course of an acute disease or healing of
an injury. Chronic pain may be associated with a chronic
pathological process that causes continuous or intermittent pain
over months or years.
(5) "Controlled substance" has the meaning assigned by
Section 481.002, Health and Safety Code.
(6) "Dangerous drug" has the meaning assigned by
Section 483.001, Health and Safety Code.
(7) "Diversion" means the use of drugs by anyone other
than the person for whom the drug was prescribed.
(8) "Pain" means an unpleasant sensory and emotional
experience associated with actual or potential tissue damage.
(9) "Physical dependence" means a state of adaptation
that is manifested by drug class-specific signs and symptoms that
can be produced by abrupt cessation, rapid dose reduction,
decreasing blood level of the drug, or administration of an
antagonist.
(10) "Practitioner" means a person, other than a
veterinarian, authorized to prescribe a controlled substance.
(11) "Tolerance" means a physiological state
resulting from regular use of a drug in which an increased dosage is
needed to produce a specific effect or in which a reduced effect is
observed with a constant dose over time. Tolerance does not
necessarily occur during opioid treatment and does not, alone,
indicate addiction.
(12) "Withdrawal" means the physiological and mental
readjustment that accompanies discontinuation of a drug for which a
person has established a physical dependency.
Sec. 107A.002. EVALUATION OF PATIENT WITH ACUTE PAIN. (a)
A practitioner's treatment of a patient's pain is evaluated by
considering whether the treatment meets the generally accepted
standard of care.
(b) A practitioner shall obtain a medical history and a
physical examination that includes a problem-focused examination
specific to the chief presenting complaint of the patient.
(c) The patient's medical record must document the medical
history and physical examination. The medical record must document:
(1) the nature and intensity of the pain;
(2) any current and past treatments for the pain;
(3) any underlying or coexisting diseases and
conditions;
(4) the effect of the pain on physical and
psychological function;
(5) the patient's history and the potential for
substance abuse or diversion; and
(6) the presence of one or more recognized medical
indications for the use of a controlled substance or dangerous
drug.
(d) Before prescribing a controlled substance or dangerous
drug for the treatment of acute pain, a practitioner must review
prescription data and history related to the patient under Section
481.076, Health and Safety Code.
(e) If a practitioner determines that the steps under
Subsection (d) are not necessary before prescribing a controlled
substance or dangerous drug to the patient, the practitioner must
document in the patient's medical record the practitioner's
rationale for not completing the steps.
Sec. 107A.003. TREATMENT PLAN FOR ACUTE PAIN. The
practitioner shall ensure that a written treatment plan is
documented in the patient's medical record. The medical record must
include:
(1) the manner in which the medication relates to the
chief presenting complaint of acute pain;
(2) the dosage and frequency of any drugs prescribed;
(3) any further testing and diagnostic evaluations to
be ordered, if medically indicated;
(4) any other treatments that are planned or
considered;
(5) any periodic reviews planned; and
(6) the objectives that will be used to determine
treatment success, such as pain relief and improved physical and
psychosocial function.
Sec. 107A.004. INFORMED CONSENT. (a) The practitioner
shall discuss the risks and benefits of the use of a controlled
substance or dangerous drug for the treatment of acute pain with the
patient, any persons designated by the patient, or the patient's
surrogate or guardian if the patient may not give consent for the
patient's medical treatment.
(b) The discussion must include:
(1) the risk of addiction associated with the drug
prescribed, including any risk of developing an addiction or a
physical or psychological dependence on the drug;
(2) the risk of taking the drug in a dosage greater
than the dosage prescribed;
(3) the danger of taking the drug with
benzodiazepines, alcohol, or other central nervous system
depressants;
(4) the reasons why the prescription is necessary;
(5) any alternative drugs or nonpharmacological
treatment modalities available for the acute pain;
(6) the responsibility of the patient to safeguard all
drugs in a secure location; and
(7) methods for safely disposing of an unused portion
of a controlled substance or dangerous drug prescription.
(c) The discussion of risks and benefits must also include
an explanation of:
(1) the patient's diagnosis;
(2) the proposed treatment plan;
(3) any anticipated therapeutic results, including
realistic expectations for sustained pain relief and improved
functioning and possibilities for lack of pain relief;
(4) therapies available in addition to or instead of
drug therapy, including nonpharmacological therapeutic modalities
or psychological techniques;
(5) potential side effects and techniques for managing
the side effects;
(6) possible adverse effects, including the potential
for tolerance and withdrawal; and
(7) the potential for impairment of judgment and motor
skills.
(d) The discussion under this section must be documented by
a signed document maintained in the records or a contemporaneous
notation included in the patient's medical record.
(e) Each regulatory agency that issues a license,
certification, or registration to a practitioner shall create
specific written guidelines for discussing with a patient the risks
and benefits of the use of a controlled substance or dangerous drug.
Sec. 107A.005. PERIODIC REVIEW OF TREATMENT OF ACUTE PAIN.
(a)
If needed the practitioner shall see the patient for periodic
review at reasonable intervals. The practitioner shall review the
patient's compliance with the prescribed treatment plan and shall
reevaluate potential for substance abuse or diversion. The
practitioner shall consider:
(1) reviewing prescription data and history related to
the patient under Section 481.076, Health and Safety Code; and
(2) obtaining at a minimum a toxicology drug screen to
determine the presence of drugs in the patient's body.
(b) If a practitioner determines that the steps under
Subsection (a) are not necessary, the practitioner shall document
in the patient's medical record the practitioner's rationale for
not completing the steps.
(c) The periodic review must:
(1) assess progress toward reaching treatment
objectives, taking into consideration the history of drug usage, as
well as any new information about the etiology of the pain;
(2) be documented in the medical record; and
(3) note contemporaneously in the medical record any
adjustment in the treatment plan based on the individual medical
needs of the patient.
(d) A practitioner must base any continuation or
modification of the use of a controlled substance or dangerous drug
for pain management on an evaluation of progress toward treatment
objectives, including:
(1) progress or the lack of progress in relieving pain
documented in the patient's medical record;
(2) satisfactory response to treatment that may be
indicated by the patient's:
(A) decreased pain;
(B) increased level of function; or
(C) improved quality of life; and
(3) objective evidence of improved or diminished
function provided by:
(A) the practitioner; or
(B) family members or other caregivers.
(e) If the patient's progress is unsatisfactory, the
practitioner shall reassess the current treatment plan and consider
the use of other nonpharmacological therapeutic modalities.
Sec. 107A.006. CONSULTATION AND REFERRAL. The practitioner
shall refer a patient with acute pain for further evaluation and
treatment as necessary. Patients who are at risk for substance
abuse or addiction and patients with acute pain and histories of
substance abuse or addiction or with comorbid psychiatric disorders
require the consideration of a consultation with or referral to an
expert in the management of those patients.
Sec. 107A.007. MEDICAL RECORD. A patient's medical record
must document the practitioner's rationale for the treatment plan
and the prescription of drugs for the chief complaint of acute pain
and show that the practitioner has complied with this chapter. The
medical record must document:
(1) the medical history and the physical examination;
(2) diagnostic, therapeutic, and laboratory results;
(3) evaluations and consultations;
(4) treatment objectives;
(5) discussions of risks and benefits;
(6) informed consent for the patient;
(7) treatments;
(8) the date, type, dosage, and quantity of drugs
prescribed;
(9) instructions to and agreements with the patient;
and
(10) periodic reviews.
SECTION 2. The change in law made 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 3. This Act takes effect September 1, 2019.