PA 15-198—sHB 6856

Public Health Committee

Appropriations Committee

AN ACT CONCERNING SUBSTANCE ABUSE AND OPIOID OVERDOSE PREVENTION

SUMMARY: This act makes various changes affecting prescription drugs, drug abuse prevention, and related topics. It:

1. requires practitioners, before prescribing more than a 72-hour supply of a controlled substance, to check the patient's record in the prescription drug monitoring program;

2. requires practitioners to review the patient's record at least every 90 days if prescribing for prolonged treatment;

3. makes other changes to the prescription drug monitoring program, including exempting opioid agonists from its reporting requirements in certain situations;

4. allows pharmacists to prescribe opioid antagonists, used to treat drug overdoses, if they receive special training and certification to do so, and expands the existing immunity for all prescribers when prescribing, dispensing, or administering opioid antagonists;

5. requires physicians, advanced practice registered nurses (APRNs), dentists, and physician assistants (PAs) to take continuing education in pain management and prescribing controlled substances;

6. makes changes to membership and other matters concerning the Connecticut Alcohol and Drug Policy Council; and

7. adds pharmacists to the definition of “healing arts” in the health care center (HMO) statutes.

The act also makes technical and conforming changes.

EFFECTIVE DATE: Upon passage, except the provisions on the prescription drug monitoring program and continuing education are effective October 1, 2015.

5 — ELECTRONIC PRESCRIPTION DRUG MONITORING PROGRAM

Requirements for Prescribers

Under the electronic prescription drug monitoring program, the Department of Consumer Protection (DCP) collects information on controlled substance prescriptions to prevent improper or illegal drug use or improper prescribing. There are certain exemptions, such as controlled substances dispensed to hospital inpatients.

Under the act, before prescribing more than a 72-hour supply of a controlled substance subject to the program, the prescribing practitioner or his or her authorized agent must review the patient's records in the prescription drug monitoring program. (The agent must also be a licensed health care professional. ) If the program is not operational, the prescriber may prescribe more than a 72-hour supply, as long as the prescriber or agent reviews the patient's records in the program within 24 hours after regaining access to the program. Additionally, the act requires the prescribing practitioner or agent to review a patient's records in the program at least every 90 days when the practitioner prescribes controlled substances for continuous or prolonged treatment.

By law, various health care professionals are authorized to prescribe controlled substances, including physicians, APRNs, dentists, nurse-midwives, optometrists, PAs, podiatrists, and veterinarians.

Prescription Reporting

By law, pharmacists and other controlled substance dispensers must generally report certain prescription information to DCP under the program, such as the dispensing date, dispenser identification and prescription numbers, and patient identifying information.

Existing law requires the DCP commissioner to release the information, on written request, to a prescribing practitioner who is treating or has treated a specific patient, if the information is for treatment purposes (including drug monitoring). The act requires the commissioner to also release the information to such a practitioner's authorized agent who is also a licensed health care professional.

Prior law exempted from the program's reporting requirements institutional pharmacies or pharmacists' drug rooms operated by licensed institutions, when dispensing or administering opioid antagonists directly to patients to treat a substance use disorder. The act removes this exemption and instead applies the exemption to opioid agonists.

Opioid agonists are medications such as morphine that activate the same areas of the brain as other opioids. Opioid antagonists block the effect of opioids and are often used to treat drug overdoses (see below).

6 & 8 — OPIOID ANTAGONISTS

Prescriptive Authority for Pharmacists

Under certain conditions, the act allows licensed pharmacists to prescribe opioid antagonists. To do so, the pharmacist must (1) have been trained and certified by a program approved by the DCP commissioner and (2) act in good faith.

Under the act, a pharmacist who dispenses an opioid antagonist must train the recipient in how to administer it. The pharmacist must also maintain a record of the dispensing and training under the law's recordkeeping requirements. The act prohibits a pharmacist from delegating to or directing another person to prescribe an opioid antagonist or provide this training.

The act specifies that a pharmacist who prescribes an opioid antagonist and meets these requirements is not deemed to have violated any standard of care for pharmacists (see below for more on immunity from liability).

The DCP commissioner may adopt implementing regulations.

By law, an “opioid antagonist” is naloxone hydrochloride (e. g. , Narcan) or any other similarly acting and equally safe drug that the federal Food and Drug Administration has approved for treating a drug overdose.

Immunity from Liability

The act expands the civil and criminal immunity for licensed health care professionals authorized to prescribe an opioid antagonist, when prescribing, dispensing, or administering it to treat or prevent a drug overdose. (The immunity applies to these actions or the subsequent use of the antagonist. ) It does this by removing the condition that the immunity applies only if the professional acts with reasonable care.

The act also specifies that a professional who prescribes, dispenses, or administers an opioid antagonist in accordance with these provisions is deemed not to have violated the applicable standard of care. Finally, it makes a technical change to clarify that these professionals may prescribe, dispense, or administer the antagonist to anyone.

1-4 — CONTINUING EDUCATION

The act requires physicians, APRNs, dentists, and PAs to take continuing education in pain management and prescribing controlled substances, as follows.

For physicians, this applies as part of the existing requirement that they take at least one contact hour (i. e. , at least 50 minutes of continuing education) of risk management training or education (1) during their first license renewal period in which continuing education is required and (2) at least once every six years after that. For APRNs, the act's requirement applies as part of the existing requirement that they take at least one contact hour of substance abuse training or education every two years. (Both physicians and APRNs generally must complete 50 hours of continuing education every two years, starting with their second license renewal. )

The act specifies that its requirement applies to physicians for registration periods beginning on or after October 1, 2015.

For dentists, the act requires at least one contact hour every two years of training or education in pain management and prescribing controlled substances. The act makes a corresponding change by providing that dentists' other continuing education must include at least one contact hour in any four, rather than five, of the 10 mandatory topics prescribed by the public health commissioner. (Dentists generally must complete 25 hours of continuing education every two years, starting with their second license renewal. )

For PAs, the act requires at least one contact hour every two years of training or education in pain management and prescribing controlled substances. (By law, to renew their licenses, PAs must have completed the mandatory continuing education requirements needed to maintain national certification. )

9 — ALCOHOL AND DRUG POLICY COUNCIL

By law, the Connecticut Alcohol and Drug Policy Council is charged with (1) reviewing state policies on substance abuse treatment and prevention programs, as well as criminal sanctions and programs, and (2) developing and coordinating a statewide plan for these matters.

The act moves the council to the Department of Mental Health and Addiction Services (DMHAS). Previously, it was in the Office of Policy and Management (OPM) for administrative purposes only. It thus eliminates the requirement that OPM provide staff for the council within available appropriations.

The act also makes several changes in the council's membership. It adds the aging commissioner, chairperson of the Board of Regents for Higher Education, and UConn president, or their designees. It removes the higher education, motor vehicles, and transportation commissioners and the chairperson of the board of pardons and paroles, or their designees. (The position of higher education commissioner was eliminated in 2011. )

The act also allows the council's co-chairpersons (the DMHAS and children and families commissioners) to jointly appoint up to seven members, including:

1. two people in recovery from a substance use disorder or who represent an advocacy group for people with these disorders,

2. a provider of community-based substance abuse services for adults,

3. a provider of these services for adolescents,

4. an addiction medicine physician,

5. a relative of someone in recovery, and

6. an emergency medicine physician currently practicing at a hospital in the state.

7 — HEALING ARTS IN HMO STATUTES

The act adds pharmacists to the definition of “healing arts” in the HMO statutes. Various provisions in the HMO statutes refer to healing arts, including provisions on:

1. training provided under the direction of people licensed to practice a healing art (CGS 38a-176 and -177),

2. required representation for healing arts practitioners on the boards of HMOs organized as nonprofit corporations (CGS 38a-179), and

3. allowing (a) healing arts practitioners to be employed by and participate in HMOs and (b) patients to choose healing arts practitioners in the HMO (CGS 38a-180).

Pharmacists are not included in the more general statutory definition of healing arts (CGS 20-1).

BACKGROUND

Related Act

PA 15-5, June Special Session, 354, requires pharmacists and other controlled substance dispensers, starting July 1, 2016, to report to the monitoring program immediately after dispensing controlled substances but in no event more than 24 hours after doing so, rather than at least weekly as under prior law.

OLR Tracking: JO; KS; VR; BS