House File 181 - Introduced HOUSE FILE 181 BY HEATON A BILL FOR An Act relating to the adoption of guidelines relating to the 1 use and prescribing of opiates by emergency departments. 2 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 3 TLSB 2001YH (7) 85 pf/nh

H.F. 181 Section 1. NEW SECTION . 135.39D Opiate prescribing and use 1 in emergency departments. 2 The department shall adopt by rule in accordance with 3 chapter 17A guidelines for the prescribing of opiates in the 4 emergency departments of hospitals in order to assist emergency 5 departments in reducing the inappropriate use of opiates 6 while preserving the vital role of the emergency department 7 in treating patients with emergent medical conditions. At a 8 minimum, the guidelines shall provide for all of the following: 9 1. Designating one medical provider for the prescribing 10 of all opiates to treat a patient’s chronic pain and limiting 11 the prescribing of opiates to treat chronic pain to only the 12 immediate treatment of acute exacerbations of pain associated 13 with objective findings of uncontrolled pain. 14 2. Limiting the administration of intravenous and 15 intramuscular opiates in the emergency department for the 16 relief of acute exacerbations of chronic pain. 17 3. Limiting the replacement of prescriptions by emergency 18 departments of opiates that have been lost, destroyed, or 19 stolen. 20 4. Limiting the replacement by emergency departments of 21 doses of methadone for patients in a methadone treatment 22 program. 23 5. Prohibiting or discouraging the prescribing of 24 long-acting, controlled-release, or other opiates such as 25 oxycontin, fentanyl patches, methadone, and demerol by the 26 emergency department. 27 6. Utilizing an emergency department information exchange 28 to encourage the sharing of patient histories between emergency 29 departments. 30 7. Facilitating the sharing of patient pain histories 31 between a patient’s family physician and the emergency 32 department. 33 8. Requiring a patient to provide government-issued 34 identification when filling a prescription for an opiate 35 -1- LSB 2001YH (7) 85 pf/nh 1/ 4

H.F. 181 prescribed in the emergency department. 1 9. Providing for the photographing of patients prescribed 2 opiates in the emergency department by the emergency department 3 if the patient does not have government-issued identification. 4 10. Requiring the use of a care coordination program by 5 emergency departments for patients who frequently use the 6 emergency department and are prescribed opiates. 7 11. Requiring emergency departments to encourage use of 8 primary care providers by patients who frequently use the 9 emergency department and are prescribed opiates. 10 12. Requiring emergency departments to perform screening, 11 brief interventions, and treatment referrals for patients with 12 suspected opiate use disorders. 13 13. Requiring follow-up care with the patient’s primary 14 opiate prescriber following the emergency department visit and 15 limiting the amount of opiates prescribed to only the amount 16 necessary until the follow-up visit. 17 14. Limiting the amount of opiate pain medication 18 prescribed by the emergency department for acute injuries. 19 15. Requiring screening for substance use disorders prior 20 to prescribing opiates in the emergency department for acute 21 pain. 22 16. In accordance with the federal Emergency Medical 23 Treatment and Active Labor Act, using the clinical judgment of 24 the health care provider in determining whether to prescribe 25 opiates for pain. 26 EXPLANATION 27 This bill relates to the adoption of opiate use and 28 prescribing guidelines for emergency departments (ED) of 29 hospitals. 30 The bill directs the department of public health to adopt 31 by rule pursuant to Code chapter 17A guidelines for the use 32 and prescribing of opiates in the emergency departments of 33 hospitals. The intent of the guidelines is to assist emergency 34 departments in reducing the inappropriate use of opiates while 35 -2- LSB 2001YH (7) 85 pf/nh 2/ 4

H.F. 181 preserving the vital role of the emergency department in 1 treating patients with emergent medical conditions. 2 The guidelines, at a minimum, are to address: the 3 designation of one medical provider for the prescribing of 4 all opiates to treat a patient’s chronic pain and limiting 5 the prescribing of opiates to treat chronic pain to only the 6 immediate treatment of acute exacerbations of pain associated 7 with objective findings of uncontrolled pain; limiting the 8 administration of intravenous and intramuscular opiates in 9 the ED; limiting the replacement of opiate prescriptions by 10 EDs that have been lost, destroyed, or stolen; limiting the 11 replacement by EDs of doses of methadone for patients in a 12 methadone treatment program; prohibiting or discouraging the 13 prescribing of long-acting, controlled-release, or other 14 opiates by the ED; utilizing an ED information exchange 15 to encourage the sharing of patient histories between EDs; 16 facilitating the sharing of patient pain histories between a 17 patient’s family physician and the ED; requiring a patient 18 to provide government-issued identification when filling a 19 prescription for an opiate prescribed in the ED; providing for 20 the photographing of patients prescribed opiates in the ED if 21 the patient does not have government-issued identification; 22 requiring the use of a care coordination program by EDs for 23 patients who frequently use the ED and are prescribed opiates; 24 requiring EDs to encourage use of primary care providers by 25 patients who frequently use the ED and are prescribed opiates; 26 requiring EDs to perform screening, brief interventions, and 27 treatment referrals for patients with suspected opiate use 28 disorders; requiring follow-up care with the patient’s primary 29 opiate prescriber following the ED visit in order to limit 30 the amount of opiates prescribed in the ED to only the amount 31 necessary until the follow-up visit; limiting the amount of 32 opiates prescribed by the ED for acute injuries; requiring 33 screening for substance use disorders prior to prescribing 34 opiates in the ED for acute pain; and in accordance with the 35 -3- LSB 2001YH (7) 85 pf/nh 3/ 4

H.F. 181 federal Emergency Medical Treatment and Active Labor Act, 1 using the clinical judgment of the health care provider in 2 determining whether to prescribe opiates for pain. 3 -4- LSB 2001YH (7) 85 pf/nh 4/ 4