An Act Regulating Opioid Drugs

The Oklahoma Legislature recently passed Senate Bill 1446. It was signed into law by Governor Mary Fallin and effective November 1, 2018. This law is an attempt to address the opioid crisis in Oklahoma and imposes new restrictions on physicians and healthcare providers in the prescribing of Schedule II and opioid medications. Although Senate Bill 1446 mandates that the medical licensing boards require one hour of continuing medical education in pain management every year, the majority of SB1446 falls under the Oklahoma Uniform Controlled Dangerous Substances Act in Title 63. SB1446 allows the Oklahoma Bureau of Narcotics and Dangerous Drugs (OBNDD) to provide unsolicited referrals to the licensing boards of any physician if a patient receives one or more prescriptions in quantities or frequency inconsistent with accepted standards of safe practice. Its requirements do not apply to patients receiving active treatment for cancer, hospice, palliative care or residents of long-term care facilities.

Prior to Prescribing

Prior to prescribing any Schedule II or opioid medication, the physician or practitioner shall take and document a thorough medical history of the patient; conduct and document a physical exam; develop a treatment plan; access the prescription monitoring program data; limit supply to no more than seven (7) days and enter into a pain management/physician-patient agreement if the patient is under 18 years of age and/or pregnant.

Acute Pain

SB1446 limits an initial prescription for acute pain to a seven (7) day supply. The prescription shall be for the lowest effective dose of an immediate-release opioid drug. Following the initial seven (7) day supply, a second 7-day prescription may be issued, after consultation with the healthcare provider by telephone or in-person, if the practitioner determines the prescription is necessary and appropriate. The healthcare provider must also document the rationale for the prescription and that the prescription does not present an undue risk of abuse, addiction or diversion. The OBNDD adopted Emergency Rules allowing the second 7-day prescription to be issued at the same time as the first, provided the prescription is for a major surgical procedure and/or “confined to the home” status and restrictions are placed on the time frame in which it can be filled. If a third prescription is required, the patient will fall under requirements for the treatment of chronic pain.

Chronic Pain

If the patient needs continuing treatment for three (3) months or more, a practitioner shall review the course of treatment and progress toward treatment objectives every three (3) months. Practitioners shall assess and document the patient for dependency and periodically make reasonable efforts to decrease medication dosage or try other treatment modalities. Patients must also enter a pain management/physician-patient agreement.

Informed Consent

Prior to an initial prescription and again prior to the third prescription, practitioners must discuss with patients the risks of addiction and overdose; dangers of taking opioids with alcohol, benzodiazepines, and other central nervous system depressants; reason the prescription is necessary; alternative treatment available; risks which can include fatal respiratory depression.

SB1446 has been debated extensively among the medical licensing boards, OBNDD, medical societies, and practitioners. We can expect clarification and modification of portions of the law in future legislative sessions.