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.