2019 -- H 5537 SUBSTITUTE A

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LC001484/SUB A/3

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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 Mattiello, Caldwell, Serpa, Alzate, and Bennett

     Date Introduced: February 27, 2019

     Referred To: House Health, Education & Welfare

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

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only, 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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     (2) When issuing an initial prescription for an opiate to an adult patient, a practitioner

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shall not exceed the maximum daily dose requirements established by the department of health.

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     (3) Except as provided in subsection (a)(4) of this section, a practitioner shall not issue an

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opiate prescription to a minor for more than twenty (20) doses at any time. Prior to issuing an

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opiate prescription to a minor, a practitioner shall discuss with the parent or guardian of the minor

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the risks associated with opiate use and the reasons why the prescription is necessary. The

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practitioner shall document their discussion with the parent or guardian in the medical record.

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     (4) Notwithstanding the limitations referenced in subsection (a)(3) of this section, if, in

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the professional medical judgment of a practitioner, a greater dosage or supply of an opiate is

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required to treat the minor patient's acute medical condition or is necessary for the treatment of

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chronic pain management, sickle cell related pain, intractable pain treatment as defined in chapter

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37.4 of title 5, pain associated with a cancer diagnosis or for palliative care, then the practitioner

 

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may issue a prescription for the quantity needed to treat such acute medical condition, chronic

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pain, sickle cell related pain, intractable pain, pain associated with a cancer diagnosis, or pain

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experienced while the patient is in palliative care, provided that this dosage shall not exceed the

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maximum daily dosage permitted for the treatment of this pain as set forth in the department of

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health regulations. The condition triggering the prescription of an opiate shall be documented in

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the minor patient's medical record, and the practitioner shall indicate that a non-opiate alternative

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was not appropriate to address the medical condition.

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     (5) Notwithstanding subsections (a)(2) and (a)(3) of this section, this section shall not

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apply to medications designed for the treatment of substance abuse or opioid dependence.

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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 ยง 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, or other

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exception in accordance with department of health regulations.

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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. 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 restrict the initial prescription to an adult to the maximum daily dosage

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established by the department of health. The act would also restrict all prescriptions to a minor

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patient for an opiate to twenty (20) doses, with exceptions for certain conditions and medicines

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designed for substance abuse or opioid dependence treatment.

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     This act would take effect upon passage.

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