2019 -- H 5434

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LC001373

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2019

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A N   A C T

RELATING TO FOOD AND DRUGS -- UNIFORM CONTROLLED SUBSTANCES ACT

     

     Introduced By: Representatives Amore, Serodio, Ruggiero, and Kazarian

     Date Introduced: February 14, 2019

     Referred To: House Health, Education & Welfare

     (by request)

It is enacted by the General Assembly as follows:

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     SECTION 1. Section 21-28-3.20 of the General Laws in Chapter 21-28 entitled "Uniform

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Controlled Substances Act" is hereby amended to read as follows:

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     21-28-3.20. Authority of practitioner to prescribe, administer, and dispense.

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     (a) A practitioner, in good faith and in the course of his or her professional practice only,

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may prescribe, administer, and dispense controlled substances, or he or she may cause the

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controlled substances to be administered by a nurse or intern under his or her direction and

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supervision.

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     (b) The prescription-monitoring program shall be reviewed prior to starting any opioid. A

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prescribing practitioner, or designee as authorized by § 21-28-3.32(a)(3), shall review the

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prescription-monitoring program prior to refilling or initiating opioid therapy with an intrathecal

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pump. For patients the prescribing practitioner is maintaining on continuous opioid therapy for

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pain for three (3) months or longer, the prescribing practitioner shall review information from the

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prescription-monitoring program at least every three (3) months. Documentation of that review

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shall be noted in the patient's medical record.

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     (c) The director of health shall develop regulations for prescribing practitioners on

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appropriate limits of opioid use in acute pain management. Initial prescriptions of opioids for

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acute pain management of outpatient adults shall not exceed thirty (30) morphine milligram

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equivalents (MMEs) total daily dose per day for a maximum total of twenty (20) doses, and, for

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pediatric patients, the appropriate opioid dosage maximum per the department of health.

 

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     (d) For the purposes of this section, acute pain management shall not include chronic pain

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management, pain associated with a cancer diagnosis, palliative or nursing home care, chronic

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intractable pain, or other exception in accordance with department of health regulations:

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     (1) "Chronic intractable pain" means pain that is: excruciating; constant; incurable, and of

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such severity that it dominates virtually every conscious moment; produces mental and physical

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debilitation; and may produce a desire to commit suicide for the sole purpose of stopping the

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pain.

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     (e) Subsection (c) shall not apply to medications designed for the treatment of substance

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abuse or opioid dependence.

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     (f) On or before September 1, 2018, the director of health shall develop, and make

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available to health-care practitioners, information on best practices for co-prescribing opioid

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antagonists to patients. The best practices information shall identify situations in which co-

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prescribing an opioid antagonist may be appropriate, including, but not limited to:

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     (1) In conjunction with a prescription for an opioid medication, under circumstances in

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which the health-care practitioner determines the patient is at an elevated risk for an opioid drug

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overdose;

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     (2) In conjunction with medications prescribed pursuant to a course of medication

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therapy management for the treatment of a substance use disorder involving opioids; or

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     (3) Under any other circumstances in which a health-care practitioner identifies a patient

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as being at an elevated risk for an opioid drug overdose.

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     (g) The best practices information developed pursuant to subsection (f) of this section

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shall include guidelines for determining when a patient is at an elevated risk for an opioid drug

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overdose, including, but not limited to, situations in which the patient:

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     (1) Meets the criteria provided in the opioid overdose toolkit published by the federal

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substance abuse and mental health service administration;

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     (2) Is receiving high-dose, extended-release, or long-acting opioid medications;

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     (3) Has a documented history of an alcohol or substance use disorder, or a mental health

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disorder;

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     (4) Has a respiratory ailment or other co-morbidity that may be exacerbated by the use of

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opioid medications;

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     (5) Has a known history of intravenous drug use or misuse of prescription opioids;

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     (6) Has received emergency medical care or been hospitalized for an opioid overdose; or

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     (7) Uses opioids with antidepressants, benzodiazepines, alcohol, or other drugs.

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     (h) On or before September 1, 2018, the director of health and the secretary of the

 

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executive office of health and human services shall develop strategies that include:

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     (1) Allowing practitioners in non-pharmacy settings to prescribe and dispense opioid

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antagonists; and

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     (2) Ensuring that opioid antagonists that are distributed in a non-pharmacy setting are

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eligible for reimbursement from any health insurance carrier, as defined under chapters 18, 19,

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20, and 41 of title 27, and the Rhode Island medical assistance program, as defined under chapter

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7.2 of title 42.

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     SECTION 2. Chapter 21-28 of the General Laws entitled "Uniform Controlled

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Substances Act" is hereby amended by adding thereto the following section:

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     21-28-3.20.1. Authority of practitioner to prescribe, administer, and dispense --

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Cancer, palliative care and chronic intractable pain.

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     (a) A practitioner, in good faith and in the course of his or her professional practice

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managing pain associated with a cancer diagnosis, palliative or nursing home care, chronic

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intractable pain, or other condition allowed by department of health regulations pursuant to the

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exception in § 21-28-3.20(d), may prescribe, administer, and dispense controlled substances, or

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he or she may cause the controlled substances to be administered by a nurse or intern under his or

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her direction and supervision without regard to the 2016 CDC Guideline for Prescribing Opioids

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for Chronic Pain.

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     (b) For the purposes of this section "chronic intractable pain" means pain that is:

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excruciating; constant; incurable, and of such severity that it dominates virtually every conscious

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moment; produces mental and physical debilitation; and may produce a desire to commit suicide

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for the sole purpose of stopping the pain. A diagnosis of chronic intractable pain made by a

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physician licensed in any of the United States or the District of Columbia, and supported by

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written documentation of the diagnosis by the treating physician, shall constitute proof that the

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patient suffers from chronic and intractable pain.

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     (c) Practitioners, in the course of their professional practice, shall not refuse treatment to

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chronic intractable pain patients for the sole reason that these patients require intensive treatment.

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     (d) Pharmacists, upon receiving the proper documentation that a person suffers from

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chronic intractable pain, shall not refuse to fill a prescription related to the diagnosis.

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Documentation related to the filling of a prescription under this subsection shall only be required

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by the pharmacist upon the initial filling of the prescription.

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     (e) The director of health shall promulgate rules and regulations necessary to ensure that

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pain management associated with a cancer diagnosis, palliative or nursing home care, chronic

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intractable pain, or other condition allowed by department of health regulations pursuant to the

 

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exception created in § 21-28-3.20(d), as may be necessary to effectuate the provisions of this

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section.

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     (d) Rules and regulations promulgated herein shall take into consideration the

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individualized needs of patients covered by this section and make provisions for practitioners

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acting in good faith, and in the course of their profession, and managing pain associated with their

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patients' illness, to use their best judgment notwithstanding any state or federal laws, rule or

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regulation to the contrary.

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     SECTION 3. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO FOOD AND DRUGS -- UNIFORM CONTROLLED SUBSTANCES ACT

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     This act would exclude chronic intractable pain from the definition of "acute pain

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management", for purposes of prescribing, administering and dispensing controlled substances by

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a practitioner. The act would prescribe new guidelines for the treatment of "chronic intractable

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pain" based upon 2016 CDC Guideline for Prescribing Opioids for Chronic Pain.

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     This act would take effect upon passage.

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