Opioid Legislation Update – Workgroup comes to an agreement

Posted on: 4/5/19

The opioid bill (SB 848, Radar/Echols) is an attempt to modify SB 1446 from the 2018 legislative session, which established a limited prescription of seven days for Schedule II and all opioid drugs. SB 848 applies only to patients who are filling prescriptions outside of a facility setting. It does not apply when a patient is an inpatient. During the interim, OHA worked with OSMA, OOA and other providers to craft an emergency rule at the Oklahoma Bureau of Narcotics and Dangerous Drugs (OBNDD). The OBNDD rule allowed for the prescribing of an opioid after a major surgical procedure or a homebound person a seven-day prescription upon discharge plus a “do not fill until” second seven-day prescription. In summary, SB 848 codifies in statute the OBNDD emergency rule from October 2018 and cleans up other opioid provisions from 2018.

What is in the latest version of SB 848?
A large and diverse group of health care providers met in mid-March with the Oklahoma attorney general and OBNDD to work on proposed language for SB 848. The proposed committee substitute drafted by the workgroup contains the following:

• Requires one hour of education on opioids for all the physician licensure boards beyond the allopathic physicians, which were mandated in 2018 and which include the following:
  Osteopathic physicians          
  Podiatrists
  Dentists               
  Physician Assistants
  Optometrists               
  Veterinarians

• If the prescription for an opioid is filled by the pharmacist, it must be for the specific dosage, and the pharmacist shall not be permitted to fill a different dosage than prescribed. However, the pharmacist is allowed to not fill an opioid prescription.
• Modifies the definitions in the Controlled Dangerous Substance Act to include the advance practice registered nurse as a practitioner.
• Clarifies that only drugs used for pain are subject to the 7 + 7 pill limit. In 2018, SB 1446 used the term Schedule II and opioid drugs interchangeably as applying to the limits on prescribing. The workgroup discussion evolved to the current version of SB 848, which addresses limits for pills that are for the treatment of acute or chronic pain.

• Example, if Lomotil which is a schedule V drug, is prescribed for gastrointestinal issues, it is not subject to the pill limit.
• The licensure boards will provide guidance to practitioners.

• The OBNDD supplied language in Section 10 to address the reporting requirements of manufacturers and distributors of opioids.
• The Prescription Monitoring Program (PMP) is contained in Section 11 of SB 848 and the sunset date of Oct. 31, 2020 for compliance with PMP is eliminated. Also, the Oklahoma attorney general requested language clarifying that failure of the registrant to check the PMP may, after investigation, be grounds for the licensing board to take disciplinary action.
• Practitioners will designate if the prescription is for acute pain or chronic pain on the face of the prescription.
• Section 12 of SB 848 still limits a prescription for pain after a major surgical procedure or a homebound person to a seven-day prescription upon discharge plus a “do not fill until” second seven-day prescription. This is the language that OBNDD issued in its emergency rules in 2018 and was supported by health care. The second seven-day prescription expires after five days.
• Patient provider agreements that must be entered into upon the third prescription of an opioid are addressed in Section 12 of SB 848. The prescription will note “chronic pain” and the patient will be reviewed at a minimum of three months. After one year of compliance with the patient provider agreement, the practitioner still assesses every three months.
• The exclusion for limits on opioids for cancer care is clarified.
• SB 848 contains an emergency clause to go into effect upon signature.

Next steps?
The next step in the process is for SB 848 to be heard April 9 in the House Public Health Committee. If SB 848 passes out of the House Public Health Committee, it will need to pass the House floor by April 25 and be sent to the Senate to accept the amendments outlined herein. (Sandra Harrison)