Chapter 105
2019 -- H 5537 SUBSTITUTE A
Enacted 07/08/2019

A N   A C T

Introduced By: Representatives Mattiello, Caldwell, Serpa, Alzate, and Bennett
Date Introduced: February 27, 2019

It is enacted by the General Assembly as follows:
     SECTION 1. Section 21-28-3.20 of the General Laws in Chapter 21-28 entitled "Uniform
Controlled Substances Act" is hereby amended to read as follows:
     21-28-3.20. Authority of practitioner to prescribe, administer, and dispense.
     (a)(1) A practitioner, in good faith and in the course of his or her professional practice
only, may prescribe, administer, and dispense controlled substances, or he or she may cause the
controlled substances to be administered by a nurse or intern under his or her direction and
     (2) When issuing an initial prescription for an opiate to an adult patient, a practitioner
shall not exceed the maximum daily dose requirements established by the department of health.
     (3) Except as provided in subsection (a)(4) of this section, a practitioner shall not issue an
opiate prescription to a minor for more than twenty (20) doses at any time. Prior to issuing an
opiate prescription to a minor, a practitioner shall discuss with the parent or guardian of the minor
the risks associated with opiate use and the reasons why the prescription is necessary. The
practitioner shall document their his or her discussion with the parent or guardian in the medical
     (4) Notwithstanding the limitations referenced in subsection (a)(3) of this section, if, in
the professional medical judgment of a practitioner, a greater dosage or supply of an opiate is
required to treat the minor patient's acute medical condition or is necessary for the treatment of
chronic pain management, sickle cell related pain, intractable pain treatment as defined in chapter
37.4 of title 5, pain associated with a cancer diagnosis, or for palliative care, then the practitioner
may issue a prescription for the quantity needed to treat such the acute medical condition, chronic
pain, sickle cell related pain, intractable pain, pain associated with a cancer diagnosis, or pain
experienced while the patient is in palliative care, provided that this dosage shall not exceed the
maximum daily dosage permitted for the treatment of this pain as set forth in the department of
health regulations. The condition triggering the prescription of an opiate shall be documented in
the minor patient's medical record, and the practitioner shall indicate that a non-opiate alternative
was not appropriate to address the medical condition.
     (5) Notwithstanding subsections (a)(2) and (a)(3) of this section, this section shall not
apply to medications designed for the treatment of substance abuse or opioid dependence.
     (b) The prescription-monitoring program shall be reviewed prior to starting any opioid. A
prescribing practitioner, or designee as authorized by ยง 21-28-3.32(a)(3), shall review the
prescription-monitoring program prior to refilling or initiating opioid therapy with an intrathecal
pump. For patients the prescribing practitioner is maintaining on continuous opioid therapy for
pain for three (3) months or longer, the prescribing practitioner shall review information from the
prescription-monitoring program at least every three (3) months. Documentation of that review
shall be noted in the patient's medical record.
     (c) The director of health shall develop regulations for prescribing practitioners on
appropriate limits of opioid use in acute pain management. Initial prescriptions of opioids for
acute pain management of outpatient adults shall not exceed thirty (30) morphine milligram
equivalents (MMEs) total daily dose per day for a maximum total of twenty (20) doses, and, for
pediatric patients, the appropriate opioid dosage maximum per the department of health.
     (d) For the purposes of this section, acute pain management shall not include chronic pain
management, pain associated with a cancer diagnosis, palliative or nursing home care, or other
exception in accordance with department of health regulations.
     (e) Subsection (c) shall not apply to medications designed for the treatment of substance
abuse or opioid dependence.
     (f) On or before September 1, 2018, the director of health shall develop, and make
available to health-care healthcare practitioners, information on best practices for co-prescribing
opioid antagonists to patients. The best practices information shall identify situations in which co-
prescribing an opioid antagonist may be appropriate, including, but not limited to:
     (1) In conjunction with a prescription for an opioid medication, under circumstances in
which the health-care healthcare practitioner determines the patient is at an elevated risk for an
opioid drug overdose;
     (2) In conjunction with medications prescribed pursuant to a course of medication
therapy management for the treatment of a substance use disorder involving opioids; or
     (3) Under any other circumstances in which a health-care healthcare practitioner
identifies a patient as being at an elevated risk for an opioid drug overdose.
     (g) The best practices information developed pursuant to subsection (f) of this section
shall include guidelines for determining when a patient is at an elevated risk for an opioid drug
overdose, including, but not limited to, situations in which the patient:
     (1) Meets the criteria provided in the opioid overdose toolkit published by the federal
substance abuse and mental health service administration;
     (2) Is receiving high-dose, extended-release, or long-acting opioid medications;
     (3) Has a documented history of an alcohol or substance use disorder, or a mental health
     (4) Has a respiratory ailment or other co-morbidity that may be exacerbated by the use of
opioid medications;
     (5) Has a known history of intravenous drug use or misuse of prescription opioids;
     (6) Has received emergency medical care or been hospitalized for an opioid overdose; or
     (7) Uses opioids with antidepressants, benzodiazepines, alcohol, or other drugs.
     (h) On or before September 1, 2018, the director of health and the secretary of the
executive office of health and human services shall develop strategies that include:
     (1) Allowing practitioners in non-pharmacy settings to prescribe and dispense opioid
antagonists; and
     (2) Ensuring that opioid antagonists that are distributed in a non-pharmacy setting are
eligible for reimbursement from any health insurance carrier, as defined under chapters 18, 19,
20, and 41 of title 27, and the Rhode Island medical assistance program, as defined under chapter
7.2 of title 42.
     SECTION 2. This act shall take effect upon passage.
LC001484/SUB A/3