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House Engrossed |
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State of Arizona House of Representatives Fifty-third Legislature Second Regular Session 2018
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HOUSE BILL 2549 |
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AN ACT
Amending section 32‑3248.01, Arizona Revised Statutes, as added by laws 2018, first special session, chapter 1, section 29; Amending section 36‑448.02, Arizona Revised Statutes, as added by Laws 2018, first special session, chapter 1, section 34; relating to controlled substances.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section 1. Section 32-3248.01, Arizona Revised Statutes, as added by Laws 2018, first special session, chapter 1, section 29, is amended to read:
32-3248.01. Schedule II controlled substances; dosage limit; exceptions; morphine; opioid antagonist
A. A health professional who is authorized under this title to prescribe controlled substances may not issue a new prescription order to be filled or dispensed for a patient outside of a health care institution for a schedule II controlled substance that is an opioid that exceeds ninety morphine milligram equivalents per day.
B. The limit prescribed by subsection A of this section does not apply to:
1. A continuation of a prior prescription order that was issued within the previous sixty days.
2. An opioid with a maximum approved total daily dose in the labeling as approved by the United States food and drug administration.
3. A prescription that is issued following a surgical procedure and that is limited to not more than a fourteen‑day supply.
3. 4. A patient who:
(a) Has an active oncology diagnosis.
(b) Has a traumatic injury, not including a surgical procedure.
(c) Is receiving hospice care.
(d) Is receiving end‑of‑life care.
(e) Is receiving palliative care.
(f) Is receiving skilled nursing facility care.
(g) Is receiving treatment for burns.
(h) Is receiving medication‑assisted treatment for a substance use disorder.
(i) Is hospitalized.
C. If a health professional believes that a patient requires more than ninety morphine milligram equivalents per day and the patient is not exempt from the limit pursuant to subsection B of this section, the health professional shall first consult with a physician who is licensed pursuant to chapter 13 or 17 of this title and who is board‑certified in pain. The consultation may be done by telephone or through telemedicine. If the consulting physician agrees with the higher dose, the health professional may issue a prescription for more than ninety morphine milligram equivalents per day. If the consulting physician is not available to consult within forty‑eight hours after the request, the health professional may prescribe the amount that the health professional believes the patient requires and subsequently have the consultation. If the health professional is a physician who is licensed pursuant to chapter 13 or 17 of this title and is board‑certified in pain, the health professional may issue a prescription order for more than ninety morphine milligram equivalents per day without a consultation under this subsection.
D. If a patient is prescribed more than ninety morphine milligram equivalents per day pursuant to subsection B or C of this section, the prescribing health professional shall also prescribe for the patient naloxone hydrochloride or any other opioid antagonist that is approved by the United States food and drug administration for the treatment of opioid‑related overdoses.
E. For the purposes of this section, "prescription order" has the same meaning prescribed in section 32‑1901.
Sec. 2. Section 36‑448.02, Arizona Revised Statutes, as added by Laws 2018, first special session, chapter 1, section 34, is amended to read:
36-448.02. Pain management clinics; licensure requirements; rules
A. Beginning January 1, 2019, a pain management clinic shall meet the same licensure requirements as prescribed in article 2 of this chapter for health care institutions. At the time of licensure, a pain management clinic shall submit to the director all documentation required by this article.
B. The department shall adopt rules that prescribe the following for pain management clinics:
1. Informed consent requirements.
2. The responsibilities of the medical director.
3. Record maintenance.
4. Reporting requirements.
5. Physical examination requirements.
C. Within sixty days after a health care institution or a private office or clinic of a health care provider that is licensed pursuant to title 32 meets the definition of pain management clinic, the health care institution or private office or clinic shall apply for licensure pursuant to this section.
C. D. Each pain management clinic shall:
1. On or before each anniversary of the issue date of the pain management clinic's license, submit to the director all documentation required by this article.
2. Comply with all department rules that govern pain management clinics.
3. Have a medical director who is a physician licensed pursuant to title 32, chapter 13 or 17 and who is under an unrestricted and unencumbered license or a registered nurse practitioner who is licensed pursuant to title 32, chapter 15, who has advanced pain certification from a nationally recognized accreditation or certification entity and who is under an unrestricted and unencumbered license.