Chapter 154 |
2019 -- S 0981 Enacted 07/08/2019 |
A N A C T |
RELATING TO FOOD AND DRUGS - UNIFORM CONTROLLED SUBSTANCES ACT |
Introduced By: Senator Dominick J. Ruggerio |
Date Introduced: June 13, 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 |
supervision. |
(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 |
record. |
(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 |
disorder; |
(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. |
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LC002839 |
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