Download Controlled Substance Abuse Prevention Act Section Summary

Controlled Substance Abuse Prevention Act
Section Summary
Section 1
Requires the State Board of Health to adopt regulations requiring certain persons and entities to
report cases or suspected cases of drug overdose. NRS Chapter 441A Infectious Disease; Toxic
Agents is amended to require the State Board of Health to collect data on reported cases of drug
overdose or suspected drug overdose.
This reporting would be similar to the reporting of other diseases and conditions of public health
importance to the State Board of Health as already required by NRS. Please note the amendment
requested to have the data reported directly to the Division of Public and Behavioral Health, as
opposed to the local health authorities.
Section 2
Requires the Department of Health and Human Service’s Chief Medical Officer to notify local
health officers of regulations adopted by the State Board of Health related to the reporting of
cases and suspected cases of drug overdose.
Section 3
Requires providers of health care, medical facilities, and persons who have knowledge of a drug
overdose or a suspected drug overdose to report to the appropriate health authority.
Section 4
Requires each health authority to report weekly to the Chief Medical Officer the total number of
cases or suspected cases of drug overdose reported to it pursuant to Section 3. Reports must be
drug specific.
Section 5
Provides for the confidentiality of information reported to a health authority pursuant to Section
3.
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Section 6
Provides for administrative fines, not to exceed $1,000 per violation, against a provider of health
care, a medical facility or a medical laboratory that willfully fails to report a drug overdose or
suspected drug overdose as required by this Act. The State Board of Health will determine
whether a violation has occurred and, where appropriate, the fine to be imposed.
Section 7
The State Board of Pharmacy currently maintains a computerized program (the Prescription Drug
Monitoring Program (PDMP or PMP)) to track prescriptions of controlled substances schedule II,
III, and IV filled by a pharmacy or dispensed by a licensed dispensing practitioner. This section
expands the information that the PDMP system reports to include:

The number of days for which a prescription is written if the patient consumes the
maximum dosage as prescribed,

Each state in which the patient received a controlled substance prescription, and

The corresponding ICD10 code for each prescription.
Section 8
This section provides clarification to the Controlled Substance Act. Only prescriptions for
controlled substances, schedules II, III and IV that are dispensed for human consumption are
required to be monitored by the PDMP.
Section 9
This section expands access to the Prescription Drug Monitoring Program (PDMP) to paramedics.
This section clarifies that practitioner occupational licensing boards can access the PDMP
database and authorizes them to use PDMP data for investigative purposes.
This section clarifies the PDMP’s authority to report to law enforcement where it suspects
fraudulent, illegal or unauthorized activities involving controlled substances.
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Section 10
Provides a statue reference change.
Section 11
Existing law requires each practitioner who dispenses controlled substances to register with the
Board of Pharmacy for a controlled substance registration every two years. The new language in
the Act requires practitioners to prove that they are registered with the PDMP before the Board
of Pharmacy may issue or renew a practitioner’s controlled substance registration.
Section 12
Amends felony statutes to allow law enforcement and prosecutors to consider the aggregate
amount of a drug involved or collected by law enforcement during the course of an investigation
when charging a person for knowingly or intentionally selling, manufacturing, delivering or
bringing illicit drugs in to the State.
Section 13
Revises statutes to indicate that when records are requested by the attorney general or licensing
board investigators they must be provided:

In state: at the time of request, or within a reasonable time. (This is a change from a 5day requirement.)

Out of state: Within 5 working days. (This is a change from a 10-day requirement.)
Section 14
Makes changes to Chapter 630 of the NRS, Physicians, Physician Assistants, Medical Assistants,
Perfusionists, and Practitioners of Respiratory Care. (The Board of Medical Examiners.)
Section 15
Requires the Executive Director of the Board or his or her designee to review and, where
appropriate, investigate complaints and information received from the Board of Pharmacy and
other sources in which it is suspected a licensee may be inappropriately prescribing or dispensing
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schedule II, III or IV controlled substances. This section also requires the Executive Director of
the Board or his or her designee to notify the licensee and to review and evaluate information
relevant to the complaint of inappropriate prescribing. Additionally, this section allows the
Board Executive Director or his or her designee to forward a complaint regarding inappropriate
prescribing to an appropriate investigatory committee. Further, this section allows for a process
to review for conflicts between the Board and law enforcement to avoid interfering with any
pending administrative or criminal investigations. Finally, this section requires the Board to
adopt regulations providing for disciplinary action against a licensee for inappropriately
prescribing controlled substances, schedule II, III and IV, or for violations of the prescribing
protocols outlined in Section 52 through 58 of this Act.
Section 16
Allows for the summary suspension of a licensee’s practice license if the health, welfare or safety
of the public or a patient is at risk of imminent or continued harm because of the practitioner’s
manner of the prescribing. This section requires due process regarding the summary
suspension.
Section 17
Requires the Board to adopt, by regulation, a mandate that each practitioner who is registered
to write for a controlled substance to complete at least two hours of continuing education
training on the prescribing of opioids or on prescription drug misuse and abuse. (This is a change
from existing permissive language suggesting one hour of such training.)
Section 18
Adds, as grounds for discipline against a practitioner’s license, the practitioner’s failure to comply
with the prescribing and administering protocols set forth in this Act, specifically sections 52 to
58, and any corresponding regulations adopted by the Board of Pharmacy pursuant to this Act.
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Section 19
Clarifies that a practitioner is not subject to discipline for prescribing a controlled substance if
the practitioner prescribed the controlled substance lawfully pursuant to the prescribing and
administering protocols set forth in this Act, Sections 52 to 58, and any corresponding
regulations adopted by the Board of Pharmacy pursuant to this Act.
Section 20
Requires due process during the course of an investigation.
Sections 21 to 26
Apply to Chapter 631 of the NRS, Dentistry and Dental Hygiene. They provide for the same
changes to Chapter 631 regarding the practice of dentistry that are proposed in Sections 14 to
20 for the practice of Allopathic Medicine.
Section 27 to 31
Apply to Chapter 632 of the NRS, Nursing. They provide for the same changes to Chapter 632
regarding the practice of nursing that are proposed in Sections 14 to 20 for the practice of
Allopathic Medicine.
Section 32 – 38
Apply to Chapter 633 of the NRS, Osteopathic Medicine. They provide for the same changes to
Chapter 633 regarding the Osteopathic Medicine that are proposed in Sections 14 to 20 for the
practice of Allopathic Medicine.
Section 39-43.
Apply to Chapter 635 of the NRS, Podiatric Physicians and Podiatry Hygienists. They provide for
the same changes to Chapter 635 regarding the practice of podiatry that are proposed in
Sections 14 to 20 for the practice of Allopathic Medicine.
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Sections 44-49
Apply to Chapter 636 of the NRS, Optometry. They provide for the same changes to Chapter 636
regarding the practice of optometry that are proposed in Sections 14 to 20 for the practice of
Allopathic Medicine.
Section 50
Provides for changes to Chapter 639 of the NRS, Pharmacists and Pharmacy.
Section 51
Provides for the definition of an “Initial Prescription.”
Section 52
Requires a practitioner who prescribes in excess of certain limits to document in the patient
record the practitioner’s reason(s) for prescribing such quantities. Instances that require
additional documentation include: (1) prescribing more of a controlled substance listed in
schedules II, III, and IV in a 365 day period than the patient would need during that 365 day
period if following the practitioner’s instructions, and (2) prescribing at any one time a controlled
substance listed in schedules II, III, and IV in a quantity that exceeds a 90-day supply if the
patient adheres to the practitioner’s instructions.
This section also limits initial prescriptions for acute pain to no more than a 14-day supply and to
no greater than a 90 morphine milligram equivalent (MME) per day unless the patient received
and filled a prescription for a controlled substance within a 19 day period before the date of the
initial prescription. (This requirement is designed to protect patients who are opioid naïve, and
to accommodate treatment of patients who is not opioid naïve.)
Section 53
Establishes requirements a practitioner must follow prior to issuing a prescription for a
controlled substance listed in schedule II, III or IV.
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This section requires the practitioner to establish a bona fide prescriber/patient relationship with
the patient, perform a risk assessment of the patient, establish a preliminary diagnosis of the
patient’s condition, and to document in the patient record the reason(s) for prescribing a
controlled substance for the treatment of pain instead of an alternative pain treatment. The
practitioner must also obtain a signed informed consent form where required. The
requirements for the informed consent form are found in Subsection 2 of Section 54.
Section 54
Requires an evaluation and risk assessment of a patient before prescribing a controlled
substance. The patient risk assessment must include:

Obtaining and reviewing a medical history of the patient,

Conducting a physical exam of the patient,

Making a good faith effort to obtain and review the patient’s medical records from other
providers of health care. The practitioner shall document all efforts to obtain such
medical records, and

Assessing the mental health and risk of abuse, dependency and addiction of the patient.
This section also outlines the requirements for the informed consent form. This form should
include without limitation, the following,

The potential risks and benefits of treatments using controlled substances,

Proper use of the controlled substance,

Any alternative means of treating the patient’s symptoms,

Important provisions of the treatment plans,

Methods to safely store and legally dispose of the controlled substance,

The manner in which the practitioner will provide additional medication, including refills,

If the patient is a woman between ages 15 and 45, information about the risks to a fetus
of chronic exposure to controlled substances,

If the controlled substance is a opioid, the form should include information about the
availability of opioid antagonists,
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
If the patient is a minor, the form shall include information about the risk that the minor
may misuse, abuse or divert.
Section 55
Establishes requirements for practitioners treating patients with a schedule II, III or IV controlled
substance for longer than 90 consecutive days. This section requires a practitioner to complete a
validated peer reviewed assessment about the patient’s risk for abuse, dependency and
addiction. It also requires a practitioner to conduct an investigation to determine an evidence
based diagnosis of the patient’s condition. Additionally, this section requires the practitioner to
meet with the patient to determine if continuation of the treatment with controlled substances
is necessary. If the patient has been prescribed a dose of 90 morphine milligram equivalents
(MME) per day for 90 days or longer, the practitioner should consider referring the patient to a
specialist. If, after conducting a review of the patient’s treatment plan, the practitioner decides
against referring the patient to a pain specialist and to continue with the patient’s treatment
plan, the practitioner must develop and document in the patient’s medical record a revised
treatment, which must include, without limitation, an assessment of the increased risk for
adverse outcomes. Finally, this section establishes that the daily dose of a controlled substance
is to be calculated in accordance with the guidelines established by the Center for Disease
Control for calculating morphine milligram equivalents (MME).
Section 56.
Requires a practitioner to document a prescription medication agreement in the patient’s
records after 30 consecutive days of use of a schedule II, III, or IV controlled substance for the
treatment of pain. The medication agreement must include, without limitation, the following:

The goals of the treatment plan,

Consent to drug testing, when deemed medically necessary,

A requirement that the patient take the controlled substance only as prescribed,

A requirement that the patient inform the practitioner of any other controlled
substances they are taking, and whether or not the patient drinks alcohol, uses marijuana
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or any other controlled substances, if they have been treated for side effects relating to
controlled substances, or if the patient has been treated for an overdose. The patient
must also inform the practitioner or any other states they have filled prescriptions,

Authorization that the practitioner can conduct random pill counts,

The reasons the practitioner may change or discontinue a controlled substance
treatment, and

Any other requirements that the practitioner may impose.
Section 57.
Requires a practitioner to consider whether there is reason to believe the patient is not using
prescribed controlled substances as instructed, is diverting the medication and whether there is
reason to believe that the patient is using other drugs, alcohol and or controlled substances,
including schedule I controlled substances.
This section also outlines the following provisions that a practitioner should consider:

Whether there is reason to believe the patient is not using the controlled substance as
prescribed, or diverting,

Whether the controlled substance has had the expected effect on the symptoms of the
patient,

Whether there is any reason to believe the patient is using other drugs, including alcohol,
or other schedule 1 controlled substances that may interact negatively to the prescribed
controlled substances, have not been prescribed by a practitioner who is treating the
patient,

The number of attempts by the patient to obtain a refill,

The number of times, if any, that the patient has claimed that his or her controlled
substance medication has been lost or stolen,

Information from the PDMP that is irregular or inconsistent,

Whether pervious blood or urine tests indicated inappropriate medication use,

The necessity to verify substances that are in the patient’s body,

Whether or not the patient has demonstrated aberrant behavior or intoxication,
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
Whether the patient has increased his or her dose without the practitioner’s
authorization,

Whether the patient has been reluctant to stop using the controlled substance or has
requested or demanded controlled substances that are likely to be abused,

Whether the patient has been reluctant to cooperate with the practitioner,

Whether the patient has a history of substance abuse,

Any major change in the health of the patient, including pregnancy, or any diagnosis
concerning the mental health of the patient, that would affect the medical
appropriateness of prescribing the controlled substance, and

Any other factor that the practitioner determines is necessary to make an informed
professional judgment concerning the medical appropriateness of the prescription.
Section 58.
Gives the Nevada Board of Pharmacy the authority to adopt any regulations necessary or
convenient to enforce the provisions in Section 52-58 of this Act. This section also states that a
practitioner who violates Sections 52 to 58 of this Act is not guilty of a misdemeanor, but is
subject to professional discipline.
Section 59.
This section adds the definition of “Initial Prescription” to certain sections of Chapter 639 of the
NRS, Pharmacy.
Section 60.
Requires a practitioner to check a patient’s PDMP before issuing an initial prescription and again
every 90 days thereafter. This section strikes language exempting a practitioner from checking a
patient’s PDMP report when writing a prescription for seven days or less where the patient is
new to the practitioner or if the prescription is for a new course of treatment. This section also
requires a practitioner to check the system to determine if a patient is receiving controlled
substances from another practitioner. The practitioner shall not prescribe the controlled
substance if the patient has received that controlled substance from another practitioner.
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Section 61.
Requires additional information to be included on prescriptions for controlled substances. The
additional information includes the practitioner’s DEA number, the patient’s date of birth, and
instructions stating the number of days that the drug is to be used, beginning on the day that the
prescription is filled. This section also requires the dosing, administration and refill information.
Finally, this section requires the prescription to include the ICD10 code.
Section 62.
Allows representatives and investigators of the State’s licensing boards to request certain
documents pertaining to a patient. This section also allows for the duplication or removal of
records if the record is being used as evidence in a criminal, civil, or administrative proceeding.
Section 63.
Provides for a statute reference change.
Section 64.
This bill becomes effective upon passage and approval for the purposes of adopting regulations
and performing other administrative tasks to carry out the provision of this act, and on January
1, 2018 for all other purposes.
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Prescribe 365
Prescriber Requirements
Initial
Prescription
30 days
•PDMP Check
•14 day limit
•dose not to
exceed
90mme for
opiate niave
•Patient Risk
Assessment
•Signed
informed
concent form
Submitted by: Elyse Monroy
Office of Governor Brian Sandoval
•medication
agreement
90 days
•PDMP Review
•Patient risk
Assessment
•Treatment
plan review;
with face to
face visit
•Evidence
Based
Diagnosis
Annual
Requirements
•Review of
treatment
plan
•updated
medication
agreement
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