Proposed Law To Address Opioid Addiction

“Legislation scheduled for introduction during the 2018 Legislature will impact health care professionals who prescribe or dispense opiates,” said Richard Stevens, WVPA Executive Director and Lobbyist.

Titled Opioid Reduction Act, the proposed legislation calls for a variety of actions by practitioners and their licensing boards to reduce consumption of certain medications, according to Stevens.   Briefly, the proposed legislation contains, in part, the following proposals:

(1) reduce the use of opiates;

(2) provide reports to licensing board regarding abnormal prescribing practices;

(3) requiring the Board of Pharmacy to report quarterly to the various licensing boards;

(4) permitting the investigation and discipline for abnormal prescribing and dispensing of prescription drugs;

(5) allowing licensing boards who regulate prescribers to investigate abnormal prescribing and dispensing of prescription drugs based upon information.

The Office of Drug Control Policy, created by the 2017 Legislature, establishes a voluntary non-opiate advanced directive form.  The form shall indicate to a health care practitioner that an individual may not be administered or offered a prescription or medication order for an opiate.  The form may be submitted to the Board of Pharmacy who shall made a notation of the directive on the Board’s Controlled Substance Monitoring Program (CSMP) data base.  The indication may also be added to the individual’s electronic health records.  An individual may revoke the voluntary non-opiate directive form for any reason and may do so by written or oral means.

Prior to issuing a prescription for an opioid, a practitioner shall: (a) consult with the patient regarding the quality of the opioid and a patient’s option to fill the prescription in a lesser quantity; and (b) inform the patient of the risks associated with the opioid prescribed.

The proposed legislation calls for the following opioid prescription limitations:

(a) When issuing a prescription for an opiate to an adult patient seeking treatment in an emergency room setting for outpatient use, a health care practitioner may not issue a prescription for more than a three (3) day supply.

(b)  A health care practitioner may not issue an opiate prescription to a minor for more than a three (3) day supply at any time and shall discuss with the parent or guardian of the minor the risks associated with opiate use and the reasons why the prescription is necessary.

(c)  A dentist may not issue an opiate prescription to a minor for more than a three day supply at any time.

(d)  A physician may not issue an initial prescription for an opioid drug in a quantity exceeding a seven (7) day supply for treatment of acute pain.  Any prescription for acute pain pursuant to this subsection shall be for the lowest effective dose of immediate-release opioid drug.

(e)  Prior to issuing an initial prescription of a course of treatment that includes a Schedule II controlled substance in a course of treatment for acute pain, a practitioner shall:

  1.  Take and document the results of a thorough medical history, including the patient’s experience with non-opioid medication and non-pharmacological pain  management approaches and substance abuse history;
  2.  Conduct, as appropriate, and document the results of a physical examination;
  3.  Develop a treatment plan, with particular attention focused on determining the cause of the patient’s pain;
  4.  Access relevant prescription monitoring information under the Board of Pharmacy’s Controlled Substance Monitoring Program (CSMP) database; and
  5.  Limit the supply of any opioid drug prescribed for acute pain to a duration of no more than seven (7) days as determined by the directed dosage and frequency of dosage.

The proposed legislation permits a practitioner to issue a subsequent prescription for the drug to the patient in any quantity that complies with applicable State and federal law provided the practitioner determines the prescription is necessary and appropriate to the patient’s treatment and documents the rationale for the subsequent prescription.   The practitioner must also determine that issuance of the subsequent prescription does not present an undue risk of abuse, addiction or diversion and documents that determination.

At the time of the issuance of the third prescription for a prescription opioid drug the practitioner shall consider a referral to a chronic pain clinic.

If the patient remains a patient of the practitioner and the practitioner continues to prescribe a Schedule II controlled substance for three months or more for pain, the practitioner shall:

(a)  Review at a minimum of every three (3) months any new information about the etiology of the pain and the patient’s progress;

(b)  Assess the patient prior to every renewal to determine whether the patient is experiencing problems associated with physical and psychological dependence and document results of that assessment;

(c)  Periodically make reasonable efforts to either stop the use of the controlled substance, decrease the dosage, try other drugs or treatment modalities in an effort to reduce the potential for abuse or the development of physical or psychological dependence and document with specificity the efforts undertaken; and

(d)  Review the Board of Pharmacy’s Controlled Substance Monitoring Database as required by article nine, chapter sixty-A of this State’s code.

When patient seek treatment for any of the myriad conditions that cause chronic pain, a health care practitioner shall prescribe or recommend physical therapy, occupational therapy, acupuncture, massage therapy and chiropractic care before starting a patient on an opioid.

An insurance provider, Medicaid and PEIA shall provide time limited coverage for physical therapy, occupational therapy, acupuncture, massage therapy and chiropractic care when prescribed or recommended by a health care practitioner to treat conditions that cause chronic pain.

Practitioners may be disciplined or prosecuted for abnormal prescribing and/or dispensing patterns as identified by the Board of Pharmacy’s Controlled Substance Monitoring Program, as set forth in Chapter 60-A, Article Nine of the WV Code.   Such abnormal prescribing and/or dispensing is to be reported to the practitioner’s licensing board.  The respective board shall notify the practitioner that they have been identified as a potentially abnormal prescriber.  Upon a second consecutive report of abnormal prescribing and/or dispensing the licensing board shall commence an investigation in the alleged abnormal prescribing practices of the practitioner.  Upon a third report of the practitioner’s abnormal prescribing and/or dispensing, their licensing board shall commence disciplinary action.