2022 -- H 7131

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LC003678

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2022

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A N   A C T

RELATING TO HEALTH AND SAFETY -- OPIOID ALTERNATIVES

     

     Introduced By: Representatives Caldwell, and Edwards

     Date Introduced: January 20, 2022

     Referred To: House Health & Human Services

     It is enacted by the General Assembly as follows:

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     SECTION 1. Legislative findings. The general assembly finds that:

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     Every competent adult has the fundamental right to self-determination regarding decisions

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pertaining to his or her own health, including the right to refuse an opioid drug listed as a Schedule

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II controlled substance pursuant to the provisions of § 21-28-2.02.

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     SECTION 2. Title 23 of the General Laws entitled "HEALTH AND SAFETY" is hereby

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amended by adding thereto the following chapter:

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CHAPTER 1.12

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OPIOID ALTERNATIVES

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     23-1.12-1. Educational pamphlet.

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     (a) The department shall develop and publish on its website an educational pamphlet

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regarding the use of opioid alternatives for the treatment of pain. The pamphlet shall, at a minimum,

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include:

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     (1) Information on available opioid alternatives for the treatment of pain, including non-

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opioid medicinal drugs or drug products and nonpharmacological therapies.

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     (2) The advantages and disadvantages of the use of opioid alternatives.

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     23-1.12-2. Rules and regulations.

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     The department may adopt rules and regulations requiring health care practitioners to post

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or disseminate the information contained in the educational pamphlet developed and published

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pursuant to the provisions of § 23-1.12-1.

 

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     SECTION 3. 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 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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     (2) When issuing an initial prescription for an opiate to an adult patient, a practitioner shall

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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 opiate

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

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

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shall document his or her 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 the

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

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

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management, sickle cell related pain, intractable pain treatment as defined in chapter 37.4 of title

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5, pain associated with a cancer diagnosis, or for palliative care, then the practitioner may issue a

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prescription for the quantity needed to treat the acute medical condition, chronic pain, sickle cell

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related pain, intractable pain, pain associated with a cancer diagnosis, or pain experienced while

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the patient is in palliative care, provided that this dosage shall not exceed the maximum daily

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dosage permitted for the treatment of this pain as set forth in the department of health regulations.

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The condition triggering the prescription of an opiate shall be documented in the minor patient's

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medical record, and the practitioner shall indicate that a non-opiate alternative was not appropriate

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to address the medical condition.

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

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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 § 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 pain

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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 acute

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

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

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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, intractable

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or chronic intractable pain, as provided in § 5-37.4-2, or other exception in accordance with

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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 available

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to healthcare practitioners, information on best practices for co-prescribing opioid antagonists to

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patients. The best practices information shall identify situations in which co-prescribing an opioid

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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 healthcare 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 therapy

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

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     (3) Under any other circumstances in which a healthcare practitioner identifies a patient as

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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 shall

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

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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 executive

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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, 20,

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and 41 of title 27, and the Rhode Island medical assistance program, as defined under chapter 7.2

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of title 42.

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     (i) Except in the provision of emergency services and care, before providing anesthesia or

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prescribing, ordering, dispensing, or administering an opioid drug listed as a Schedule II controlled

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substance pursuant to the provisions of chapter 28 of title 21, for the treatment of pain, a health care

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practitioner, excluding those licensed under chapter 19.1 of title 5, shall:

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     (A) Inform the patient of available opioid alternatives for the treatment of pain, which may

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include non-opioid medicinal drugs or drug products, interventional procedures or treatments,

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acupuncture, chiropractic treatments, massage therapy, physical therapy, occupational therapy,

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osteopathic care or any other appropriate therapy as determined by the health care practitioner.

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     (B) Discuss the advantages and disadvantages of the use of opioid alternatives, including

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whether the patient is at a high risk of, or has a history of, controlled substance abuse or misuse and

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the patient's personal preferences.

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     (C) Provide the patient with the educational pamphlet developed and published pursuant

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to § 23-1.12-1.

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     (D) Document the opioid alternatives considered in the patient's record.

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     SECTION 4. Section 5-19.1-34 of the General Laws in Chapter 5-19.1 entitled

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"Pharmacies" is hereby amended to read as follows:

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     5-19.1-34. Notice of warning regarding use of Schedule II controlled substances to be

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posted.

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     (a) The director of the department of health shall compile a list of at least the ten (10) most

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prescribed drugs containing opioids and/or other Schedule II controlled substances as listed in §

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21-28-2.08 and forward it to the board of pharmacy which shall distribute that list to all pharmacies

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in the state. The list shall also contain warnings relating to the overuse, misuse, and mixing of those

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drugs with other drugs, specifically benzodiazepines, and/or alcohol, including, but not limited to,

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dependence, addiction, or death.

 

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     (b) Each pharmacy shall conspicuously display the list at or adjacent to the place in the

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pharmacy where prescriptions are presented for compounding and dispensing, and shall display

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with the list the information contained in the educational pamphlet developed and published

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pursuant to § 23-1.12-1.

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     (c) The pharmacist shall also inform the patient that the pharmacist may dispense a partial

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fill of the prescription if requested by the patient and the procedure for other partial fills until the

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full prescription is dispensed within thirty (30) days of the date on which the prescription was

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written.

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     SECTION 5. This act shall take effect on September 13, 2022.

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LC003678

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO HEALTH AND SAFETY -- OPIOID ALTERNATIVES

***

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     This act would provide that the department of health is to develop and publish an

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educational pamphlet regarding opioid alternatives. The department may adopt rules for the posting

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of the information by health care practitioners. The act would further provide that the information

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is to be posted at pharmacy locations.

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     This act would take effect on September 13, 2022.

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LC003678

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