Assigned to HHS AS
PASSED BY COW
Assigned to HHS AS
PASSED BY COW
ARIZONA STATE SENATE
Fifty-Third Legislature, Second Regular Session
AMENDED
controlled substances; dosage limit
Purpose
Exempts, retroactive to April 25, 2018, opioid prescriptions issued following surgical procedures and that are limited to a 14-day supply from the 90 Morphine Milligram Equivalent (MME) limitation. Directs health care institutions, private offices and clinics to apply to the Department of Health Services (DHS) for licensure as a pain management clinic within 60 days of meeting the statutory definition of pain management clinic.
Background
Laws 2018, First Special Session, Chapter 1, Section 29, limits all initial prescriptions for opioids to a five-day supply, with certain exceptions, including that prescriptions for opioids following surgical procedures are limited to a 14-day supply. Additionally, new prescription orders for opioids cannot exceed 90 MMEs per day. The legislation provides exceptions to the 90 MME limitation for specified individuals and for continuations of existing prescriptions that were issued within the previous 60 days. If a health professionals determines that a prescription exceeding 90 MMEs is necessary, the health professional is required to consult with a physician who is board-certified in pain.
Laws 2018, First Special Session, Chapter 1, Section 34, establishes that pain management clinic includes a health care institution, private office or clinic of a licensed health care provider in which a majority of the facility's patients in any month are prescribed opioids, benzodiazepines, barbiturates or carisoprodol, for a use other than medication-assisted treatment, by a health care provider from the health care institution, private office or clinic for more than 90 days in a 12-month period. Hospitals, urgent care centers, ambulatory surgical centers, hospice facilities and nursing care instructions are excluded from the definition of pain management clinic.
There is no anticipated fiscal impact to the state General Fund associated with this legislation.
Provisions
1. Exempts, retroactive to April 25, 2018, opioid prescriptions that are issued following surgical procedures and that are limited to a 14-day supply from the 90 MME limitation, and specifies that the 90 MME limit applies to prescriptions that are filled or dispensed outside of a health care institution.
2. Permits, retroactive to April 25, 2018, a health professional to issue a prescription that exceeds the 90 MME limitation if the consulting physician who is board-certified in pain agrees with the higher dose.
3. Specifies that the 90 MME limitation applies to prescriptions, rather than prescription orders.
4. Prohibits naturopathic physicians from dispensing opioids and establishes dispensing opioids as an act of unprofessional conduct.
5. Establishes, retroactive to April 25, 2018, that a health professional who seeks to prescribe over the 90 MME limitation may consult with an opioid assistance and referral call service designated by DHS, and specifies that if the call service agrees with the higher dose that the health professional may prescribe in excess of the 90 MME limitation.
6. Permits, retroactive to April 25, 2018, allopathic physicians, osteopathic physicians, physician assistants, nurse practitioners, and nurse midwives to dispense implantable opioid devices.
7. Permits the Arizona Poison Control System (APCS) to provide opioid assistance and referral resources through a toll-free telephone service.
8. Requires a health care institution, private office or clinic to apply to DHS for licensure as a pain clinic within 60 days of meeting the statutory definition of a pain clinic.
9. Permits a licensed nurse practitioner who has advanced pain certification, and who is under an unrestricted and unencumbered license, to act as a medical director of a pain management clinic.
10. Makes conforming changes.
11. Becomes effective on the general effective date, with retroactive provisions as noted.
Amendments Adopted by Committee
1. Prohibits doctors of naturopathic medicine from dispensing opioids.
2. Permits APCS to provide opioid assistance and referral resources by telephone.
3. Allows APCS, if designated, to provide consultations to health professionals regarding
prescribing over the 90 MME limitation.
Amendments Adopted by Committee of the Whole
1. Exempts implantable devices from opioid dispensing prohibitions for certain health care professionals.
2. Adds a retroactivity clause.
House Action Senate Action
HEALTH 2/15/18 DPA 9-0-0-0 HHS 3/21/18 DPA 5-0-2
3rd Read 2/21/18 57-0-3
Prepared by Senate Research
March 28, 2018
CRS/lat