87R9723 LHC-F
By: Price H.B. No. 2117
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. TREATMENT FOR ACUTE PAIN
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 acute 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. The
patient's medical record must document the medical history and
physical examination.
(c) The Texas Medical Board shall adopt rules governing what
information a practitioner who is prescribing a controlled
substance or dangerous drug for acute pain or creating a treatment
plan for the treatment of acute pain must place in the patient's
medical record regarding the medical history and physical
examination of the patient. The rules adopted under this
subsection may create different standards for practitioners
treating patients with acute pain in an emergency department.
(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 reviewing the
patient's prescription data and history under Subsection (d) is 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
reviewing the data and history.
Sec. 107A.003. INFORMED CONSENT. (a) Each regulatory
agency that issues a license, certification, or registration to a
practitioner shall create specific written guidelines for a
discussion between the practitioner and a patient with acute pain,
or the patient's surrogate or guardian if the patient is unable to
give consent for the patient's medical treatment, about the risks
and benefits of the use of a controlled substance or dangerous drug
to treat the patient's acute pain.
(b) The written guidelines must require that the
discussion:
(1) be verbal;
(2) except as provided by Subsection (c), be completed
before the prescription is issued;
(3) be documented by a signed document maintained in
the patient's medical record or a contemporaneous notation included
in the patient's medical record; and
(4) include an explanation of:
(A) 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;
(B) the risk of taking the drug in a dosage
greater than the dosage prescribed;
(C) the danger of taking the drug with
benzodiazepines, alcohol, or other central nervous system
depressants;
(D) the reasons why the prescription is
necessary;
(E) the responsibility of the patient to
safeguard all drugs in a secure location;
(F) methods for safely disposing of an unused
portion of a controlled substance or dangerous drug prescription;
(G) the patient's diagnosis;
(H) the proposed treatment plan;
(I) any anticipated therapeutic results,
including realistic expectations for sustained pain relief and
improved functioning and possibilities for lack of pain relief;
(J) therapies available in addition to or instead
of drug therapy, including non-pharmacological therapeutic
modalities or psychological techniques;
(K) potential side effects and techniques for
managing the side effects;
(L) possible adverse effects, including the
potential for tolerance and withdrawal; and
(M) the potential for impairment of judgment and
motor skills.
(c) In the case of prescribing a controlled substance or
dangerous drug to a patient for acute pain following surgery, the
written guidelines must:
(1) allow the practitioner to discuss the information
described by Subsection (b)(4) with the patient at different phases
of the healing process, at the time when receiving that information
would be most effective, regardless of whether some or all of the
information is discussed with the patient after the prescription is
issued and the patient has begun taking the controlled substance or
dangerous drug;
(2) provide recommendations as to when each piece of
information described by Subsection (b)(4) should be discussed with
the surgical patient;
(3) allow the practitioner to determine when each
explanation described by Subsection (b)(4) should occur, based on
the patient's best interest; and
(4) allow the practitioner to delegate to a licensed
physician assistant, nurse practitioner, or registered nurse any
explanation described by Subsection (b)(4).
(d) A regulatory agency described by Subsection (a) may
develop written guidelines for written information to be provided
to the patient about the risks and benefits of a controlled
substance or dangerous drug used to treat the patient's acute pain.
The guidelines may not authorize the practitioner to provide the
written information under this subsection in lieu of discussing the
information verbally with the patient as described by Subsection
(b).
Sec. 107A.004. PERIODIC REVIEW OF TREATMENT OF ACUTE PAIN;
CONSULTATION AND REFERRAL. (a) If necessary, the practitioner
shall:
(1) see the patient being treated for acute pain for
periodic review at reasonable intervals; or
(2) subject to Subsection (c), refer the patient to
another practitioner for further evaluation and treatment.
(b) The practitioner shall review the patient's compliance
with the prescribed treatment plan and reevaluate the potential for
substance abuse or diversion.
(c) 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.
SECTION 2. The Texas Medical Board shall adopt and
implement the rules described by Section 107A.002(c), Occupations
Code, as added by this Act, not later than March 1, 2022.
SECTION 3. Each regulatory agency that issues a license,
certification, or registration to a practitioner as defined by
Section 107A.001, Occupations Code, as added by this Act, shall
create and make available to the practitioner the specific written
discussion guidelines required by Section 107A.003, Occupations
Code, as added by this Act, not later than March 1, 2022.
SECTION 4. The change in law made by this Act applies only
to a prescription issued on or after March 1, 2022. A prescription
issued before that date is governed by the law in effect immediately
before March 1, 2022, and the former law is continued in effect for
that purpose.
SECTION 5. This Act takes effect September 1, 2021.