OLR Bill Analysis
AN ACT CONCERNING PRESCRIPTIONS FOR AND THE DISPENSING OF OPIOID ANTAGONISTS AND OPIOID DRUGS.
This bill makes changes affecting the prescribing and dispensing of opioid antagonists and opioid drugs. Specifically, it:
1. allows a prescribing practitioner authorized to prescribe an opioid antagonist to issue a standing order (i.e., non-patient specific prescription) to a licensed pharmacist for certain opioid antagonists and
2. prohibits, with certain exceptions, a prescribing practitioner authorized to prescribe an opioid drug from issuing a prescription for more than a seven day supply to (a) an adult for the first time for outpatient use or (b) a minor.
By law, an “opioid antagonist” is naloxone hydrochloride (Narcan) or any other similarly acting and equally safe drug that the FDA has approved for treating a drug overdose.
The bill also makes technical and conforming changes.
EFFECTIVE DATE: Upon passage
OPIOID ANTAGONIST PRESCRIPTIONS
The bill allows a prescribing practitioner authorized to prescribe an opioid antagonist to issue a standing order to a licensed pharmacist for an opioid antagonist that is:
1. administered nasally or by auto-injection;
2. approved by the federal Food and Drug Administration (FDA); and
3. dispensed in good faith by the pharmacist to a (a) person at risk of an opioid drug overdose or (b) family member, friend, or other person who may assist a person at risk of such an overdose.
Existing law allows pharmacists to prescribe opioid antagonists if they are trained and certified by the Department of Consumer Protection to do so. When dispensing an opioid antagonist, the pharmacist must train the person on how to administer it. The pharmacist must also keep a record of the dispensing and training under the law's recordkeeping requirements.
Professional Standards of Care
Under the bill, if a prescribing practitioner issues a standing order for an opioid antagonist, the practitioner is considered to have done so for a legitimate medical purpose in the usual course of his or her professional practice. Additionally, a pharmacist who accepts the standing order and dispenses the opioid antagonist is deemed not to have violated his or her professional standard of care.
OPIOID DRUG PRESCRIPTIONS
The bill prohibits a prescribing practitioner authorized to prescribe an opioid drug from issuing a prescription for more than a seven-day supply to (1) an adult for the first time for outpatient use or (2) a minor. When prescribing an opioid drug to a minor, the bill requires the practitioner to discuss with the minor's parent, guardian, or legal custodian the associated risks of using the drug and reasons why the prescription is necessary.
The bill defines an “opioid drug” as any drug having an addiction-forming or addiction-sustaining liability similar to morphine or being capable of conversion into a drug having such addiction-forming or addiction-sustaining liability.
The bill allows the practitioner to prescribe more than a seven-day supply to an adult or minor if, in his or her professional judgment, the opioid drug is required to treat the person's medical condition, chronic pain, cancer-associated pain, or for palliative care. The practitioner must document the patient's condition in his or her medical record and indicate that an alternative to the opioid drug was not appropriate to treat the patient's condition.
The bill's provisions regarding opioid drug prescriptions do not apply to medications to treat opioid drug dependence or abuse, including opioid antagonists and agonists (e.g., medications such as morphine that activate the same areas of the brain as other opioids).
Under existing law, the following health providers may prescribe medication within the scope of their practice: physicians, dentists, podiatrists, optometrists, physician assistants, advanced practice registered nurses, nurse-midwives, and veterinarians (CGS § 20-14c).
sSB 353, favorably reported by the Public Health Committee, contains various provisions on opioid abuse prevention and treatment and related issues.
sSB 129, favorably reported by the Public Health and Insurance and Real Estate committees, requires the insurance commissioner to study and report on opioid analgesics and non-abuse deterrent opioid analgesics.
sHB 5053 (File 7), favorably reported by the Public Health and Planning and Development committees, contains various provisions on access to opioid antagonists, such as expanding to any licensed health care professionals existing law's immunity when administering the drug.
HB 5301 (File 143), favorably reported by the Children's Committee, sets requirements for practitioners when prescribing opioids to a minor, including obtaining specific written consent from the parent or guardian.
Public Health Committee
Joint Favorable Substitute