Revision: March 8, 2016, midnight
\t \t\tHB 1423-FN - AS INTRODUCED
2016 SESSION
\t16-2677
\t01/09
HOUSE BILL\t1423-FN
AN ACT\trelative to rulemaking for prescribing controlled drugs.
SPONSORS:\tRep. Rosenwald, Hills. 30; Rep. LeBrun, Hills. 32; Rep. MacKay, Merr. 14; Rep. Kurk, Hills. 2; Rep. Sherman, Rock. 24; Sen. Kelly, Dist 10; Sen. Stiles, Dist 24; Sen. Fuller Clark, Dist 21; Sen. Bradley, Dist 3
COMMITTEE:\tHealth, Human Services and Elderly Affairs
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ANALYSIS
\tThis bill requires the board of medicine, the board of dental examiners, the board of nursing, the board of registration in optometry, the board of podiatry, the naturopathic board of examiners, and the board of veterinary medicine to adopt rules for prescribing controlled drugs. This bill contains mandatory standards for such rules and requires using the controlled drug prescription health and safety program database.
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Explanation:\tMatter added to current law appears in bold italics.
\t\tMatter removed from current law appears [in brackets and struckthrough.]
\t\tMatter which is either (a) all new or (b) repealed and reenacted appears in regular type.
\t16-2677
\t01/09
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Sixteen
AN ACT\trelative to rulemaking for prescribing controlled drugs.
Be it Enacted by the Senate and House of Representatives in General Court convened:
\t1 New Section; Rulemaking for Prescribing Controlled Drugs; Controlled Drug Prescription Health and Safety Program. Amend RSA 318-B by inserting after section 38 the following new section:
\t318-B:39 Rulemaking for Prescribing Controlled Drugs; Use of Program Database.
\t\tI.(a) Before September 1, 2016, the following boards shall submit to the joint legislative committee on administrative rules, final proposed rules for prescribing controlled substances, specifically opioids, for the management or treatment of pain:
\t\t\t\t(1) The board of medicine, concerning physicians, including psychiatrists, and physician assistants.
\t\t\t\t(2) The board of dental examiners, concerning dentists.
\t\t\t\t(3) The board of nursing, concerning advanced practice registered nurses.
\t\t\t\t(4) The board of registration in optometry, concerning optometrists.
\t\t\t\t(5) The board of registration in podiatry, concerning podiatrists.
\t\t\t\t(6) The naturopathic board of examiners, concerning naturopaths.
\t\t\t(b) The rules required under paragraph I shall, at a minimum, contain mandatory standards for the practice components established in paragraph II.
\t\tII. The rules shall, at a minimum, contain mandatory standards for the following practice components:
\t\t\t(a) Conducting and documenting a complete patient evaluation and risk assessment to determine whether a patient is an appropriate candidate for a controlled substance prescription for the management or treatment of pain. A complete patient evaluation shall include the completion of an assessment of the pain or anticipated pain in the case of prescribing opioids in advance of a surgical procedure, a physical examination, and a detailed medical and substance abuse history. A risk assessment shall include the use of a screening tool to assess the patient's risk of opioid abuse, misuse, or addiction as low, moderate, or high. A patient may be prescribed a controlled substance for the treatment or management of chronic pain only when:
\t\t\t\t(1) Other physical, behavioral, and non-opioid medication measures have not resolved the patient's pain or, in the professional judgment of the prescriber, will not resolve the patient's pain;
\t\t\t\t(2) The potential benefits of opioid therapy are likely to outweigh the potential harm associated with it; and
\t\t\t\t(3) There is no contraindication to the use of a controlled substance for pain.
\t\t\t(b) Using the program database when writing an initial controlled substance prescription for the management or treatment of a patient's pain and then periodically as circumstances, such as aberrant drug behavior, dictate.
\t\t\t(c) Limiting prescriptions for the management or treatment of pain based on the patient evaluation, risk assessment, review of the program database, and other circumstances deemed appropriate. Limitations shall include, but not be limited to:
\t\t\t\t(1) Allowing no more than a 5-day controlled substance prescription for the management or treatment of pain in an emergency department or urgent care setting;
\t\t\t\t(2) Only prescribing long-acting opioids for acute pain after the use of short-acting opioids has been attempted or considered; and
\t\t\t\t(3) Prescribing at the lowest possible effective dosage and titrating slowly.
\t\t\t(d) Documenting informed consent such that the risks and potential benefits associated with the use of controlled substances for the management or treatment of pain are explained to, and understood by, the patient.
\t\t\t(e) Documenting controlled substance treatment agreements for treatment or management of chronic pain patients. Such agreements shall include, at a minimum, the patient's agreement to provide samples for drug screening upon request and to take medications at the dose and frequency prescribed, conduct that triggers the discontinuation or tapering of opioid prescriptions, and a requirement that all chronic pain management prescriptions are provided by a single practice and dispensed by a single pharmacy, if possible.
\t\t\t(f) Periodically reviewing patients being prescribed controlled substances for the management or treatment of chronic pain to ascertain compliance with treatment agreements and whether a change to, or discontinuance of, controlled substance therapy is warranted. Periodic reviews, which are conducted at reasonable intervals based on the patient's risk level of substance abuse, misuse, or addiction shall include, at a minimum, a documented:
\t\t\t\t(1) Evaluation of the patient;
\t\t\t\t(2) Assessment of progress or lack of progress in the relieving of pain in light of treatment objectives; and
\t\t\t\t(3) Assessment of the review of the program database and drug screen results. Tapering or weaning a pain patient off controlled substances, or discontinuing certain prescriptions altogether, occurs when the patient engages in aberrant drug behaviors, experiences no progress toward treatment objectives, or experiences intolerable adverse effects.
\t\t\t(g) Providing that patients addicted to controlled substances shall be considered for a referral for addiction treatment. Specialist consults or referrals shall be considered for high risk patients and those on long-term opioids.
\t\t\t(h) Providing that the content of medical records when a patient is prescribed a controlled substance for the management or treatment of pain includes, at a minimum, the medical history and the physical examination, diagnostic, therapeutic and laboratory results, evaluations and any consultations, treatment objectives, discussion of risks and benefits of the opioid prescriptions, informed consent of the patient, treatments, medications, including date, type, dosage and quantity prescribed, instructions and agreements, and details regarding any periodic reviews.
\t\t\t(i) Creating exemptions to the rules required under this section for situations in which a controlled substance is being prescribed for the management of chronic pain for:
\t\t\t\t(1) Patients with cancer.
\t\t\t\t(2) Patients with a terminal condition.
\t\t\t\t(3) Long-term, non-rehab residents of a nursing home facility.
\t\t\t\t(4) Patients in a hospice program.
\t\t\t\t(5) Patients in a hospital based palliative care program.
\t\t\t(j) Providing for the enforcement of the rules required under this section by specifying that any noncompliance with such rules shall constitute unprofessional conduct under the appropriate board's law.
\t\t\t(k) Demonstrating competency in the area of pain management or opioid prescribing every 2 years through either obtaining at least 4 continuing education credits or passing an approved online examination on pain management or opioid prescribing.
\t\tIII.(a) Before September 1, 2016, the board of veterinary medicine shall submit to the joint legislative committee on administrative rules, final proposed rules for prescribing controlled substances, specifically opioids, by veterinarians for the management or treatment of pain. For the practice components set forth in this paragraph, the term "patient" refers to the animal being prescribed controlled substances for the management or treatment of pain, and the term "owner" refers to the legal owner of the animal.
\t\t\t(b) The rules required under subparagraph (a) shall, at a minimum, contain mandatory standards for the practice components outlined in subparagraph (c).
\t\t\t(c) The rules required by subparagraph (a), shall, at a minimum, contain mandatory standards for the following practice components:
\t\t\t\t(1) Conducting and documenting a complete patient evaluation to determine whether or not a patient is an appropriate candidate for a controlled substance prescription for the management or treatment of pain. A complete patient evaluation shall include the completion of an assessment of the pain or anticipated pain in the case of prescribing opioids in advance of a surgical procedure, a physical examination and a detailed medical history. A patient can be prescribed a controlled substance for the treatment or management of chronic pain only when:
\t\t\t\t\t(A) Other non-opioid medication measures have not resolved the patient's pain or, in the professional judgment of the prescriber, will not resolve the patient's pain;
\t\t\t\t\t(B) The potential benefits of opioid therapy are likely to outweigh the potential harm associated with it; and
\t\t\t\t\t(C) There is no contraindication to the use of a controlled substance for pain;
\t\t\t\t(2) Using the program database to query the patient, its owner and the individual bringing the patient in to see the veterinarian, if applicable, when writing an initial controlled substance prescription for the management or treatment of a patient's pain and then periodically as circumstances dictate.
\t\t\t\t(3) Limiting prescriptions for the management or treatment of pain based on the patient evaluation, review of the program database and other circumstances deemed appropriate. Limitations shall include, but not be limited to, prescribing at the lowest possible effective dosage and titrating slowly.
\t\t\t\t(4) Documenting controlled substance treatment agreements between the veterinarian and the patient's owner. Such agreements include, at a minimum, the owner's agreement to give the medications to the patient at the dose and frequency prescribed, conduct that triggers the discontinuation of opioid prescriptions, and a requirement that all opioid prescriptions are provided by a single veterinary practice and dispensed by a single pharmacy, if possible.
\t\t\t\t(5) Periodically reviewing patients being prescribed controlled substances for the management or treatment of pain to ascertain whether or not a change to, or discontinuance of, controlled substance therapy, is warranted. Periodic reviews, which are conducted at reasonable intervals, shall include, at a minimum, a documented:
\t\t\t\t\t(A) Evaluation of the patient;
\t\t\t\t\t(B) Assessment of progress or lack of progress in the relieving of pain in light of treatment objectives; and
\t\t\t\t\t(C) Assessment of the review of the program database. Tapering or weaning a pain patient off controlled substances, or discontinuing certain prescriptions altogether, occurs when the patient experiences no progress toward treatment objectives, experiences intolerable adverse effects or when the veterinarian has a reason to believe that the patient's owner has been diverting the prescribed medications intended for the patient.
\t\t\t\t(6) Providing that the content of medical records when a patient is prescribed a controlled substance for the management or treatment of pain includes, at a minimum, the medical history and the physical examination, diagnostic, therapeutic and laboratory results, evaluations and any consultations, treatment objectives, treatments, medications, including date, type, dosage and quantity prescribed, instructions and agreements, and details regarding any periodic reviews.
\t\t\t\t(7) Providing for the enforcement of the rules by specifying that any non-compliance with the rules shall constitute unprofessional conduct under RSA 332-B.
\t\t\t\t(8) Demonstrating competency in the area of pain management or opioid prescribing every 2 years through either obtaining at least 4 continuing education credits or passing an approved online examination on pain management or opioid prescribing.
\t2 New Paragraph; Board of Medicine; Rulemaking; Rules for Prescribing Controlled Drugs. Amend RSA 329:9 by inserting after paragraph XIX the following new paragraph:
\t\tXX. Prescribing controlled drugs pursuant to RSA 318-B:39.
\t3 Board of Dental Examiners; Rulemaking; Rules for Prescribing Controlled Drugs. Amend RSA 317-A:12, XII-c and XIII to read as follows:
\t\tXII-c. Notwithstanding any other provision of law, rules, as the board deems necessary, relative to qualified dental assistants performing coronal polishing. Such rules shall not authorize a qualified dental assistant to perform a complete oral prophylaxis; [and]
\t\tXIII. Prescribing controlled drugs pursuant to RSA 318-B:39; and
\t\tXIV. Other matters related to the proper administration of this chapter.
\t4 New Paragraph; Board of Nursing; Rulemaking; Rules for Prescribing Controlled Drugs. Amend RSA 326-B:9 by inserting after paragraph XI the following new paragraph:
\t\tXII. Prescribing controlled drugs pursuant to RSA 318-B:39.
\t5 New Paragraph; Board of Registration in Optometry; Rulemaking; Prescribing Rules for Controlled Drugs. Amend RSA 327:31 by inserting after paragraph IX the following new paragraph:
\t\tX. Prescribing controlled drugs pursuant to RSA 318-B:39.
\t6 New Paragraph; Board of Podiatry; Rulemaking; Prescribing Rules for Controlled Drugs. Amend RSA 315:4 by inserting after paragraph XI the following new paragraph:
\t\tXII. Prescribing controlled drugs pursuant to RSA 318-B:39.
\t7 Naturopathic Board of Examiners; Rulemaking; Rules for Prescribing Controlled Drugs. Amend RSA 328-E:10, I(e) to read as follows:
\t\t\t(e) Prescribing controlled drugs pursuant to RSA 318-B:39.
\t\t\t(f) Any other rules which are necessary or proper for the administration of this chapter.
\t8 New Paragraph; Board of Veterinary Medicine; Rules for Prescribing Controlled Drugs. Amend RSA 332-B:7-a by inserting after paragraph XIV the following new paragraph:
\t\tXV. Prescribing controlled drugs pursuant to RSA 318-B:39.
\t\tI. RSA 318-B:39, II(b) and III(c)(2) as inserted by section 1 of this act shall take effect January 1, 2017.
\t\tII. The remainder of this act shall take effect upon its passage.
\t\t\t\t\t\t\t\t\t\t\t16-2677
\t\t\t\t\t\t\t\t\t\t\t10/29/15
HB 1423-FN- FISCAL NOTE
AN ACT\trelative to rulemaking for prescribing controlled drugs.
FISCAL IMPACT:
The Office of Professional Licensure and Certification states this bill, as introduced, may increase state expenditures by an indeterminable amount in FY 2016 and each year thereafter. There will be no fiscal impact on county and local expenditures or state, county, and local revenue.
METHODOLOGY:
The Office of Professional Licensure and Certification states this bill requires all Boards that regulate prescribers to draft administrative rules regarding the prescribing of controlled substances for the treatment of pain by September 1, 2016. This bill also requires the Office of Professional Licensure and Certification to develop and administer an online examination on pain management or opioid prescribing. The Office of Professional Licensure and Certification states this bill may result in additional indeterminable costs related to: