Opioid Policies and Mandates

Requirement to check database.

2018 Arizona Opioid Epidemic Act

CalACEP sponsoring legislation in 2023 to exempt buprenorphine from PDMP lookup requirement.

Seven-day supply prescribing limit for a patient who has not had a prescription in the prior 12 months. Physician discretion on second fill. Exceptions made by condition. Mandatory PDMP checks.

2020

A measure (HB 743) passed and signed into law in 2020 requires some healthcare providers who provide opioid prescriptions to inform patients about possible nonopioid alternatives, and to discuss their advantages and disadvantages.

2018

A high profile 2018 bill (HB 21) limited opioid prescriptions to three days, or seven days if a doctor documents medical necessity, for some patients. To get a refill, those patients would have to be reassessed by a doctor. Patients with chronic, long-term debilitating pain, including those with cancer pain and those needing palliative and end-of-life care, weren't limited to the three-day or seven-day prescriptions by the measure. Doctors can only prescribe a three-day  supply of opioids for acute pain unless there is an "acute pain exemption". State is reviewing best-practices and cost reviews in local/regional efforts and can apply it more broadly.

2019 - INSPECT implementation. Required to review filled controlled substances prior to prescribing any opioids of any duration.

Required CME for state licensure in "Chronic Pain Management and end-of-life care."

There are many bills filed in this session that aim to prevent overdose deaths and increase access to treatment, however, being so early in the session, and with the hearing season just getting underway, none have emerged as a lead or been prioritized by the House or Senate.

Public Act 246-248 passed in 2017 requires mandatory checking MAPS before
prescribing more than three days of meds. Also requires completion of "Start Talking" form (opiate use precautions, etc.).

MNACEP supports SF# 3532 on prior authorization which would allow payment without prior authorizations for addiction services.

We expect disscusion during the upcoming 2024 session.

Requirement to check database.

Must check database, 5-day limit for acute Rx NJACEP (Dr. Rosenberg) created ALTO in 2016 to reduce opioid prescribing.

NC Physicians are required to check the NC registry before prescribing an opioid - this became effective only after they improved the user interface and allowed other support staff to check the system.

HB 275 has been reintroduced to eliminate the exemption for a required OARRS check for prescriptions written for under 7-day supplies of opioids.

The bill also adds some patient education requirements for a prescriber who issues a prescription for an opioid in an amount indicated for a period of five or more days.

The bill states the patient or the patient's representative must be educated on the risks of opioid addiction and the importance of proper medication storage and disposal.

This bill is being considered by the House Health Provider Services Committee. Ohio ACEP has assisted The Naloxone Project with their efforts to introduce a bill next year to distribute naloxone to at-risk patients before departure from the hospital.

OR-ACEP successfully advocated for HB 2395, opioid harm reductions package and SB 1043, Opioid poisoning medication distribution in 2023.

None active; PACEP has an opioid expert task force at the ready.

There have been a number of opiate bills but none impacted Emergency Medicine.

Prescribers must query the Prescription drug monitoring program database when prescribing schedule 2 drugs. Standing order available to third parties (such as pharmacies) for Naloxone since SB 1462 passed in 2015.

Legislation is pending that would require emergency physicians to provide patients information on pharmacological treatments for opioid use disorder, and upon request by a patient, the patient’s preferred pharmacological treatment. WA-ACEP is actively opposing this legislation.

Mandated to check database.

Clinicians have to check PDMP for Rx >3d and need 2h/y in opioid CME, but this was implemented several years ago, nothing active. Potential for new legislation, but not sure what that would be right now.