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A BILL TO BE ENTITLED
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AN ACT
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relating to the prescribing of controlled substances and dangerous |
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drugs for acute pain. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subtitle A, Title 3, Occupations Code, is |
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amended by adding Chapter 107A to read as follows: |
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CHAPTER 107A. TREATMENT FOR ACUTE PAIN |
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Sec. 107A.001. DEFINITIONS. In this chapter: |
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(1) "Abuse" or "substance abuse" means the maladaptive |
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pattern of substance use manifested by recurrent and significant |
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adverse consequences related to the repeated use of controlled |
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substances or other drugs. |
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(2) "Acute pain" means the normal, predicted, |
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physiological response to a stimulus such as trauma, disease, and |
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operative procedures. Acute pain is time limited. The term does |
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not include: |
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(A) chronic pain; |
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(B) pain being treated as part of cancer care; |
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(C) pain being treated as part of hospice or |
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other end-of-life care; or |
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(D) pain being treated as part of palliative |
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care. |
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(3) "Addiction" means a primary, chronic, or |
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neurobiological disease characterized by craving and compulsive |
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use of drugs. Addiction is often characterized by impaired control |
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over drug use, including taking more drugs more often than |
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prescribed by a physician. It may also be characterized by |
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continued use despite harm to oneself or others. Genetic, |
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psychosocial, and environmental factors may influence the |
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development and manifestation of addiction. Physical dependence |
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and tolerance are normal physiological consequences of extended |
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drug therapy for pain and, alone, do not indicate addiction. |
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(4) "Chronic pain" means a state in which pain |
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persists beyond the usual course of an acute disease or healing of |
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an injury. Chronic pain may be associated with a chronic |
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pathological process that causes continuous or intermittent pain |
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over months or years. |
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(5) "Controlled substance" has the meaning assigned by |
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Section 481.002, Health and Safety Code. |
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(6) "Dangerous drug" has the meaning assigned by |
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Section 483.001, Health and Safety Code. |
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(7) "Diversion" means the use of drugs by anyone other |
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than the person for whom the drug was prescribed. |
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(8) "Pain" means an unpleasant sensory and emotional |
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experience associated with actual or potential tissue damage. |
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(9) "Physical dependence" means a state of adaptation |
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that is manifested by drug class-specific signs and symptoms that |
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can be produced by abrupt cessation, rapid dose reduction, |
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decreasing blood level of the drug, or administration of an |
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antagonist. |
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(10) "Practitioner" means a person, other than a |
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veterinarian, authorized to prescribe a controlled substance. |
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(11) "Tolerance" means a physiological state |
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resulting from regular use of a drug in which an increased dosage is |
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needed to produce a specific effect or in which a reduced effect is |
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observed with a constant dose over time. Tolerance does not |
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necessarily occur during opioid treatment and does not, alone, |
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indicate addiction. |
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(12) "Withdrawal" means the physiological and mental |
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readjustment that accompanies discontinuation of a drug for which a |
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person has established a physical dependency. |
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Sec. 107A.002. EVALUATION OF PATIENT WITH ACUTE PAIN. (a) |
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A practitioner's treatment of a patient's acute pain is evaluated by |
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considering whether the treatment meets the generally accepted |
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standard of care. |
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(b) A practitioner shall obtain a medical history and a |
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physical examination that includes a problem-focused examination |
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specific to the chief presenting complaint of the patient. The |
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patient's medical record must document the medical history and |
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physical examination. |
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(c) The Texas Medical Board shall adopt rules governing what |
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information a practitioner who is prescribing a controlled |
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substance or dangerous drug for acute pain or creating a treatment |
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plan for the treatment of acute pain must place in the patient's |
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medical record regarding the medical history and physical |
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examination of the patient. The rules adopted under this |
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subsection may create different standards for practitioners |
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treating patients with acute pain in an emergency department. |
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(d) Before prescribing a controlled substance or dangerous |
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drug for the treatment of acute pain, a practitioner must review |
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prescription data and history related to the patient under Section |
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481.076, Health and Safety Code. |
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(e) If a practitioner determines that reviewing the |
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patient's prescription data and history under Subsection (d) is not |
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necessary before prescribing a controlled substance or dangerous |
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drug to the patient, the practitioner must document in the |
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patient's medical record the practitioner's rationale for not |
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reviewing the data and history. |
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Sec. 107A.003. INFORMED CONSENT. (a) Each regulatory |
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agency that issues a license, certification, or registration to a |
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practitioner shall create specific written guidelines for a |
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discussion between the practitioner and a patient with acute pain, |
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or the patient's surrogate or guardian if the patient is unable to |
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give consent for the patient's medical treatment, about the risks |
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and benefits of the use of a controlled substance or dangerous drug |
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to treat the patient's acute pain. |
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(b) The written guidelines must require that the |
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discussion: |
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(1) be verbal, except the practitioner may also |
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provide to the patient written information about the risks and |
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benefits; |
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(2) be documented by a signed document maintained in |
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the patient's medical record or a contemporaneous notation included |
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in the patient's medical record; and |
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(3) include an explanation of: |
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(A) the risk of addiction associated with the |
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drug prescribed, including any risk of developing an addiction or a |
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physical or psychological dependence on the drug; |
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(B) the risk of taking the drug in a dosage |
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greater than the dosage prescribed; |
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(C) the danger of taking the drug with |
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benzodiazepines, alcohol, or other central nervous system |
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depressants; |
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(D) the reasons why the prescription is |
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necessary; |
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(E) the responsibility of the patient to |
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safeguard all drugs in a secure location; |
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(F) methods for safely disposing of an unused |
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portion of a controlled substance or dangerous drug prescription; |
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(G) the patient's diagnosis; |
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(H) the proposed treatment plan; |
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(I) any anticipated therapeutic results, |
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including realistic expectations for sustained pain relief and |
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improved functioning and possibilities for lack of pain relief; |
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(J) therapies available in addition to or instead |
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of drug therapy, including non-pharmacological therapeutic |
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modalities or psychological techniques; |
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(K) potential side effects and techniques for |
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managing the side effects; |
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(L) possible adverse effects, including the |
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potential for tolerance and withdrawal; and |
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(M) the potential for impairment of judgment and |
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motor skills. |
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Sec. 107A.004. PERIODIC REVIEW OF TREATMENT OF ACUTE PAIN; |
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CONSULTATION AND REFERRAL. (a) If necessary, the practitioner |
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shall: |
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(1) see the patient being treated for acute pain for |
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periodic review at reasonable intervals; or |
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(2) subject to Subsection (c), refer the patient to |
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another practitioner for further evaluation and treatment. |
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(b) The practitioner shall review the patient's compliance |
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with the prescribed treatment plan and reevaluate the potential for |
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substance abuse or diversion. |
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(c) Patients who are at risk for substance abuse or |
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addiction and patients with acute pain and histories of substance |
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abuse or addiction or with comorbid psychiatric disorders require |
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the consideration of a consultation with or referral to an expert in |
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the management of those patients. |
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SECTION 2. The Texas Medical Board shall adopt and |
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implement the rules described by Section 107A.002(c), Occupations |
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Code, as added by this Act, not later than March 1, 2020. |
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SECTION 3. Each regulatory agency that issues a license, |
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certification, or registration to a practitioner as defined by |
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Section 107A.001, Occupations Code, as added by this Act, shall |
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create and make available to the practitioner the specific written |
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discussion guidelines required by Section 107A.003, Occupations |
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Code, as added by this Act, not later than March 1, 2020. |
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SECTION 4. The change in law made by this Act applies only |
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to a prescription issued on or after March 1, 2020. A prescription |
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issued before that date is governed by the law in effect immediately |
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before March 1, 2020, and the former law is continued in effect for |
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that purpose. |
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SECTION 5. This Act takes effect September 1, 2019. |