87R9723 LHC-F
	By: Price	H.B. No. 2117

	A BILL TO BE ENTITLED
	AN ACT
	relating to the prescribing of controlled substances and dangerous
	drugs for acute pain.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
	SECTION 1.  Subtitle A, Title 3, Occupations Code, is
	amended by adding Chapter 107A to read as follows:
	CHAPTER 107A. TREATMENT FOR ACUTE PAIN
	Sec. 107A.001.  DEFINITIONS. In this chapter:
	(1)  "Abuse" or "substance abuse" means the maladaptive
	pattern of substance use manifested by recurrent and significant
	adverse consequences related to the repeated use of controlled
	substances or other drugs.
	(2)  "Acute pain" means the normal, predicted,
	physiological response to a stimulus such as trauma, disease, and
	operative procedures.  Acute pain is time limited.  The term does
	not include:
	(A)  chronic pain;
	(B)  pain being treated as part of cancer care;
	(C)  pain being treated as part of hospice or
	other end-of-life care; or
	(D)  pain being treated as part of palliative
	care.
	(3)  "Addiction" means a primary, chronic, or
	neurobiological disease characterized by craving and compulsive
	use of drugs. Addiction is often characterized by impaired control
	over drug use, including taking more drugs more often than
	prescribed by a physician. It may also be characterized by
	continued use despite harm to oneself or others. Genetic,
	psychosocial, and environmental factors may influence the
	development and manifestation of addiction. Physical dependence
	and tolerance are normal physiological consequences of extended
	drug therapy for pain and, alone, do not indicate addiction.
	(4)  "Chronic pain" means a state in which pain
	persists beyond the usual course of an acute disease or healing of
	an injury. Chronic pain may be associated with a chronic
	pathological process that causes continuous or intermittent pain
	over months or years.
	(5)  "Controlled substance" has the meaning assigned by
	Section 481.002, Health and Safety Code.
	(6)  "Dangerous drug" has the meaning assigned by
	Section 483.001, Health and Safety Code.
	(7)  "Diversion" means the use of drugs by anyone other
	than the person for whom the drug was prescribed.
	(8)  "Pain" means an unpleasant sensory and emotional
	experience associated with actual or potential tissue damage.
	(9)  "Physical dependence" means a state of adaptation
	that is manifested by drug class-specific signs and symptoms that
	can be produced by abrupt cessation, rapid dose reduction,
	decreasing blood level of the drug, or administration of an
	antagonist.
	(10)  "Practitioner" means a person, other than a
	veterinarian, authorized to prescribe a controlled substance.
	(11)  "Tolerance" means a physiological state
	resulting from regular use of a drug in which an increased dosage is
	needed to produce a specific effect or in which a reduced effect is
	observed with a constant dose over time. Tolerance does not
	necessarily occur during opioid treatment and does not, alone,
	indicate addiction.
	(12)  "Withdrawal" means the physiological and mental
	readjustment that accompanies discontinuation of a drug for which a
	person has established a physical dependency.
	Sec. 107A.002.  EVALUATION OF PATIENT WITH ACUTE PAIN. (a)
	A practitioner's treatment of a patient's acute pain is evaluated by
	considering whether the treatment meets the generally accepted
	standard of care.
	(b)  A practitioner shall obtain a medical history and a
	physical examination that includes a problem-focused examination
	specific to the chief presenting complaint of the patient.  The
	patient's medical record must document the medical history and
	physical examination.
	(c)  The Texas Medical Board shall adopt rules governing what
	information a practitioner who is prescribing a controlled
	substance or dangerous drug for acute pain or creating a treatment
	plan for the treatment of acute pain must place in the patient's
	medical record regarding the medical history and physical
	examination of the patient. The rules adopted under this
	subsection may create different standards for practitioners
	treating patients with acute pain in an emergency department.
	(d)  Before prescribing a controlled substance or dangerous
	drug for the treatment of acute pain, a practitioner must review
	prescription data and history related to the patient under Section
	481.076, Health and Safety Code.
	(e)  If a practitioner determines that reviewing the
	patient's prescription data and history under Subsection (d) is not
	necessary before prescribing a controlled substance or dangerous
	drug to the patient, the practitioner must document in the
	patient's medical record the practitioner's rationale for not
	reviewing the data and history.
	Sec. 107A.003.  INFORMED CONSENT. (a) Each regulatory
	agency that issues a license, certification, or registration to a
	practitioner shall create specific written guidelines for a
	discussion between the practitioner and a patient with acute pain,
	or the patient's surrogate or guardian if the patient is unable to
	give consent for the patient's medical treatment, about the risks
	and benefits of the use of a controlled substance or dangerous drug
	to treat the patient's acute pain.
	(b)  The written guidelines must require that the
	discussion:
	(1)  be verbal;
	(2)  except as provided by Subsection (c), be completed
	before the prescription is issued;
	(3)  be documented by a signed document maintained in
	the patient's medical record or a contemporaneous notation included
	in the patient's medical record; and
	(4)  include an explanation of:
	(A)  the risk of addiction associated with the
	drug prescribed, including any risk of developing an addiction or a
	physical or psychological dependence on the drug;
	(B)  the risk of taking the drug in a dosage
	greater than the dosage prescribed;
	(C)  the danger of taking the drug with
	benzodiazepines, alcohol, or other central nervous system
	depressants;
	(D)  the reasons why the prescription is
	necessary;
	(E)  the responsibility of the patient to
	safeguard all drugs in a secure location;
	(F)  methods for safely disposing of an unused
	portion of a controlled substance or dangerous drug prescription;
	(G)  the patient's diagnosis;
	(H)  the proposed treatment plan;
	(I)  any anticipated therapeutic results,
	including realistic expectations for sustained pain relief and
	improved functioning and possibilities for lack of pain relief;
	(J)  therapies available in addition to or instead
	of drug therapy, including non-pharmacological therapeutic
	modalities or psychological techniques;
	(K)  potential side effects and techniques for
	managing the side effects;
	(L)  possible adverse effects, including the
	potential for tolerance and withdrawal; and
	(M)  the potential for impairment of judgment and
	motor skills.
	(c)  In the case of prescribing a controlled substance or
	dangerous drug to a patient for acute pain following surgery, the
	written guidelines must:
	(1)  allow the practitioner to discuss the information
	described by Subsection (b)(4) with the patient at different phases
	of the healing process, at the time when receiving that information
	would be most effective, regardless of whether some or all of the
	information is discussed with the patient after the prescription is
	issued and the patient has begun taking the controlled substance or
	dangerous drug;
	(2)  provide recommendations as to when each piece of
	information described by Subsection (b)(4) should be discussed with
	the surgical patient;
	(3)  allow the practitioner to determine when each
	explanation described by Subsection (b)(4) should occur, based on
	the patient's best interest; and
	(4)  allow the practitioner to delegate to a licensed
	physician assistant, nurse practitioner, or registered nurse any
	explanation described by Subsection (b)(4).
	(d)  A regulatory agency described by Subsection (a) may
	develop written guidelines for written information to be provided
	to the patient about the risks and benefits of a controlled
	substance or dangerous drug used to treat the patient's acute pain.
	The guidelines may not authorize the practitioner to provide the
	written information under this subsection in lieu of discussing the
	information verbally with the patient as described by Subsection
	(b).
	Sec. 107A.004.  PERIODIC REVIEW OF TREATMENT OF ACUTE PAIN;
	CONSULTATION AND REFERRAL. (a)  If necessary, the practitioner
	shall:
	(1)  see the patient being treated for acute pain for
	periodic review at reasonable intervals; or
	(2)  subject to Subsection (c), refer the patient to
	another practitioner for further evaluation and treatment.
	(b)  The practitioner shall review the patient's compliance
	with the prescribed treatment plan and reevaluate the potential for
	substance abuse or diversion.
	(c)  Patients who are at risk for substance abuse or
	addiction and patients with acute pain and histories of substance
	abuse or addiction or with comorbid psychiatric disorders require
	the consideration of a consultation with or referral to an expert in
	the management of those patients.
	SECTION 2.  The Texas Medical Board shall adopt and
	implement the rules described by Section 107A.002(c), Occupations
	Code, as added by this Act, not later than March 1, 2022.
	SECTION 3.  Each regulatory agency that issues a license,
	certification, or registration to a practitioner as defined by
	Section 107A.001, Occupations Code, as added by this Act, shall
	create and make available to the practitioner the specific written
	discussion guidelines required by Section 107A.003, Occupations
	Code, as added by this Act, not later than March 1, 2022.
	SECTION 4.  The change in law made by this Act applies only
	to a prescription issued on or after March 1, 2022. A prescription
	issued before that date is governed by the law in effect immediately
	before March 1, 2022, and the former law is continued in effect for
	that purpose.
	SECTION 5.  This Act takes effect September 1, 2021.