Texas 2021 - 87th Regular

Texas House Bill HB2117 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	87R9723 LHC-F
2	2	By: Price H.B. No. 2117
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the prescribing of controlled substances and dangerous
8	8	drugs for acute pain.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Subtitle A, Title 3, Occupations Code, is
11	11	amended by adding Chapter 107A to read as follows:
12	12	CHAPTER 107A. TREATMENT FOR ACUTE PAIN
13	13	Sec. 107A.001. DEFINITIONS. In this chapter:
14	14	(1) "Abuse" or "substance abuse" means the maladaptive
15	15	pattern of substance use manifested by recurrent and significant
16	16	adverse consequences related to the repeated use of controlled
17	17	substances or other drugs.
18	18	(2) "Acute pain" means the normal, predicted,
19	19	physiological response to a stimulus such as trauma, disease, and
20	20	operative procedures. Acute pain is time limited. The term does
21	21	not include:
22	22	(A) chronic pain;
23	23	(B) pain being treated as part of cancer care;
24	24	(C) pain being treated as part of hospice or
25	25	other end-of-life care; or
26	26	(D) pain being treated as part of palliative
27	27	care.
28	28	(3) "Addiction" means a primary, chronic, or
29	29	neurobiological disease characterized by craving and compulsive
30	30	use of drugs. Addiction is often characterized by impaired control
31	31	over drug use, including taking more drugs more often than
32	32	prescribed by a physician. It may also be characterized by
33	33	continued use despite harm to oneself or others. Genetic,
34	34	psychosocial, and environmental factors may influence the
35	35	development and manifestation of addiction. Physical dependence
36	36	and tolerance are normal physiological consequences of extended
37	37	drug therapy for pain and, alone, do not indicate addiction.
38	38	(4) "Chronic pain" means a state in which pain
39	39	persists beyond the usual course of an acute disease or healing of
40	40	an injury. Chronic pain may be associated with a chronic
41	41	pathological process that causes continuous or intermittent pain
42	42	over months or years.
43	43	(5) "Controlled substance" has the meaning assigned by
44	44	Section 481.002, Health and Safety Code.
45	45	(6) "Dangerous drug" has the meaning assigned by
46	46	Section 483.001, Health and Safety Code.
47	47	(7) "Diversion" means the use of drugs by anyone other
48	48	than the person for whom the drug was prescribed.
49	49	(8) "Pain" means an unpleasant sensory and emotional
50	50	experience associated with actual or potential tissue damage.
51	51	(9) "Physical dependence" means a state of adaptation
52	52	that is manifested by drug class-specific signs and symptoms that
53	53	can be produced by abrupt cessation, rapid dose reduction,
54	54	decreasing blood level of the drug, or administration of an
55	55	antagonist.
56	56	(10) "Practitioner" means a person, other than a
57	57	veterinarian, authorized to prescribe a controlled substance.
58	58	(11) "Tolerance" means a physiological state
59	59	resulting from regular use of a drug in which an increased dosage is
60	60	needed to produce a specific effect or in which a reduced effect is
61	61	observed with a constant dose over time. Tolerance does not
62	62	necessarily occur during opioid treatment and does not, alone,
63	63	indicate addiction.
64	64	(12) "Withdrawal" means the physiological and mental
65	65	readjustment that accompanies discontinuation of a drug for which a
66	66	person has established a physical dependency.
67	67	Sec. 107A.002. EVALUATION OF PATIENT WITH ACUTE PAIN. (a)
68	68	A practitioner's treatment of a patient's acute pain is evaluated by
69	69	considering whether the treatment meets the generally accepted
70	70	standard of care.
71	71	(b) A practitioner shall obtain a medical history and a
72	72	physical examination that includes a problem-focused examination
73	73	specific to the chief presenting complaint of the patient. The
74	74	patient's medical record must document the medical history and
75	75	physical examination.
76	76	(c) The Texas Medical Board shall adopt rules governing what
77	77	information a practitioner who is prescribing a controlled
78	78	substance or dangerous drug for acute pain or creating a treatment
79	79	plan for the treatment of acute pain must place in the patient's
80	80	medical record regarding the medical history and physical
81	81	examination of the patient. The rules adopted under this
82	82	subsection may create different standards for practitioners
83	83	treating patients with acute pain in an emergency department.
84	84	(d) Before prescribing a controlled substance or dangerous
85	85	drug for the treatment of acute pain, a practitioner must review
86	86	prescription data and history related to the patient under Section
87	87	481.076, Health and Safety Code.
88	88	(e) If a practitioner determines that reviewing the
89	89	patient's prescription data and history under Subsection (d) is not
90	90	necessary before prescribing a controlled substance or dangerous
91	91	drug to the patient, the practitioner must document in the
92	92	patient's medical record the practitioner's rationale for not
93	93	reviewing the data and history.
94	94	Sec. 107A.003. INFORMED CONSENT. (a) Each regulatory
95	95	agency that issues a license, certification, or registration to a
96	96	practitioner shall create specific written guidelines for a
97	97	discussion between the practitioner and a patient with acute pain,
98	98	or the patient's surrogate or guardian if the patient is unable to
99	99	give consent for the patient's medical treatment, about the risks
100	100	and benefits of the use of a controlled substance or dangerous drug
101	101	to treat the patient's acute pain.
102	102	(b) The written guidelines must require that the
103	103	discussion:
104	104	(1) be verbal;
105	105	(2) except as provided by Subsection (c), be completed
106	106	before the prescription is issued;
107	107	(3) be documented by a signed document maintained in
108	108	the patient's medical record or a contemporaneous notation included
109	109	in the patient's medical record; and
110	110	(4) include an explanation of:
111	111	(A) the risk of addiction associated with the
112	112	drug prescribed, including any risk of developing an addiction or a
113	113	physical or psychological dependence on the drug;
114	114	(B) the risk of taking the drug in a dosage
115	115	greater than the dosage prescribed;
116	116	(C) the danger of taking the drug with
117	117	benzodiazepines, alcohol, or other central nervous system
118	118	depressants;
119	119	(D) the reasons why the prescription is
120	120	necessary;
121	121	(E) the responsibility of the patient to
122	122	safeguard all drugs in a secure location;
123	123	(F) methods for safely disposing of an unused
124	124	portion of a controlled substance or dangerous drug prescription;
125	125	(G) the patient's diagnosis;
126	126	(H) the proposed treatment plan;
127	127	(I) any anticipated therapeutic results,
128	128	including realistic expectations for sustained pain relief and
129	129	improved functioning and possibilities for lack of pain relief;
130	130	(J) therapies available in addition to or instead
131	131	of drug therapy, including non-pharmacological therapeutic
132	132	modalities or psychological techniques;
133	133	(K) potential side effects and techniques for
134	134	managing the side effects;
135	135	(L) possible adverse effects, including the
136	136	potential for tolerance and withdrawal; and
137	137	(M) the potential for impairment of judgment and
138	138	motor skills.
139	139	(c) In the case of prescribing a controlled substance or
140	140	dangerous drug to a patient for acute pain following surgery, the
141	141	written guidelines must:
142	142	(1) allow the practitioner to discuss the information
143	143	described by Subsection (b)(4) with the patient at different phases
144	144	of the healing process, at the time when receiving that information
145	145	would be most effective, regardless of whether some or all of the
146	146	information is discussed with the patient after the prescription is
147	147	issued and the patient has begun taking the controlled substance or
148	148	dangerous drug;
149	149	(2) provide recommendations as to when each piece of
150	150	information described by Subsection (b)(4) should be discussed with
151	151	the surgical patient;
152	152	(3) allow the practitioner to determine when each
153	153	explanation described by Subsection (b)(4) should occur, based on
154	154	the patient's best interest; and
155	155	(4) allow the practitioner to delegate to a licensed
156	156	physician assistant, nurse practitioner, or registered nurse any
157	157	explanation described by Subsection (b)(4).
158	158	(d) A regulatory agency described by Subsection (a) may
159	159	develop written guidelines for written information to be provided
160	160	to the patient about the risks and benefits of a controlled
161	161	substance or dangerous drug used to treat the patient's acute pain.
162	162	The guidelines may not authorize the practitioner to provide the
163	163	written information under this subsection in lieu of discussing the
164	164	information verbally with the patient as described by Subsection
165	165	(b).
166	166	Sec. 107A.004. PERIODIC REVIEW OF TREATMENT OF ACUTE PAIN;
167	167	CONSULTATION AND REFERRAL. (a) If necessary, the practitioner
168	168	shall:
169	169	(1) see the patient being treated for acute pain for
170	170	periodic review at reasonable intervals; or
171	171	(2) subject to Subsection (c), refer the patient to
172	172	another practitioner for further evaluation and treatment.
173	173	(b) The practitioner shall review the patient's compliance
174	174	with the prescribed treatment plan and reevaluate the potential for
175	175	substance abuse or diversion.
176	176	(c) Patients who are at risk for substance abuse or
177	177	addiction and patients with acute pain and histories of substance
178	178	abuse or addiction or with comorbid psychiatric disorders require
179	179	the consideration of a consultation with or referral to an expert in
180	180	the management of those patients.
181	181	SECTION 2. The Texas Medical Board shall adopt and
182	182	implement the rules described by Section 107A.002(c), Occupations
183	183	Code, as added by this Act, not later than March 1, 2022.
184	184	SECTION 3. Each regulatory agency that issues a license,
185	185	certification, or registration to a practitioner as defined by
186	186	Section 107A.001, Occupations Code, as added by this Act, shall
187	187	create and make available to the practitioner the specific written
188	188	discussion guidelines required by Section 107A.003, Occupations
189	189	Code, as added by this Act, not later than March 1, 2022.
190	190	SECTION 4. The change in law made by this Act applies only
191	191	to a prescription issued on or after March 1, 2022. A prescription
192	192	issued before that date is governed by the law in effect immediately
193	193	before March 1, 2022, and the former law is continued in effect for
194	194	that purpose.
195	195	SECTION 5. This Act takes effect September 1, 2021.