Minnesota Legislature
HF 3746
as introduced - 91st Legislature (2019 - 2020) Posted on 02/24/2020 02:40pm
Current Version - as introduced
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3.33
A bill for an act
relating to health; changing intractable pain provisions; amending Minnesota
Statutes 2018, section 152.125.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1.
Minnesota Statutes 2018, section 152.125, is amended to read:
152.125 INTRACTABLE PAIN.
Subdivision 1.
Definition.
For purposes of this section, "intractable pain" means a pain
statenew text begin , that includes but is not limited to noncancer pain and rare diseases,new text end in which the causenew text begin
or causesnew text end of the pain cannot be removed or otherwise treated with the consent of the patient
and in which, in the generally accepted course of medical practice, no relief or cure of the
cause of the pain is possible, or none has been found after reasonable efforts. Reasonable
efforts for relieving or curing the cause of the pain may be determined on the basis of, but
are not limited to, the following:
(1) when treating a nonterminally ill patient for intractable pain, evaluation by the
attending new text begin or treating new text end physician and one or more physicians specializing in pain medicine
or the treatment of the area, system, new text begin disease, new text end or organ of the body perceived as the source
of the pain; or
(2) when treating a terminally ill patient, evaluation by the attending physician who does
so in accordance with the level of care, skill, and treatment that would be recognized by a
reasonably prudent physician under similar conditions and circumstances.
Subd. 2.
Prescription and administration of controlled substances for intractable
pain.
Notwithstanding any other provision of this chapter, a physician may prescribe or
administer a controlled substance in Schedules II to V of section 152.02 to an individual in
the course of the physician's treatment of the individual for a diagnosed conditionnew text begin , injury,
disease, or disordernew text end causing intractable pain. No physician deleted text begin shall bedeleted text end new text begin or licensed prescriber
isnew text end subject to disciplinary action by the Board of Medical Practicenew text begin , or the prescriber's licensing
board, or disenrollment by the Departments of Health and Human Servicesnew text end for appropriately
prescribing or administering a controlled substance in Schedules II to V of section 152.02
in the course of new text begin what the physician or licensed prescriber, after careful and lawful
consideration, has deemed to be a medically necessary new text end treatment of an individual for
intractable pain, provided the physician keeps accurate records of the new text begin patient's diagnosis
and any new text end purpose, use, deleted text begin prescriptiondeleted text end new text begin prescriptions givennew text end , and disposal of controlled substancesdeleted text begin ,
writes accurate prescriptionsdeleted text end new text begin follows state protocol for the prescription drug monitoring
programnew text end , and prescribes medications in conformance with chapter 147.new text begin No physician or
licensed prescriber complying with this section in a lawful, responsible manner shall be
charged with overprescribing based solely on the dosage of morphine milligram equivalent
without any other contributing factors. There is no state or federal law on morphine milligram
equivalent dosing.
new text end
new text begin Subd. 2a. new text end
new text begin
Morphine milligram equivalent dosage when prescribing or administering
a controlled substance for intractable pain.
new text end
new text begin
(a) A treating physician's patient care,
prescribing, or administering of a controlled substance or opioid analgesic shall not be
dictated by predetermined morphine milligram equivalent (MME) dosages and hard
thresholds that are outside of the United States Food and Drug Administration labeling for
the specific prescribed medication. Physicians and licensed prescribers must take into
account the health care needs, metabolism, genetic factors, and specific complexities of
each individual patient. Physicians treating intractable pain shall not taper patient dosage
or refuse to continue to treat or prescribe solely to meet state or federal guidelines,
recommendations, or thresholds outlined in the Department of Health quality improvement
program.
new text end
new text begin
(b) Physicians, clinics, hospitals, and facilities who treat intractable pain are exempt
from mandatory compliance with MME recommendations and thresholds, including the
Centers for Disease Control and Prevention guidelines, Minnesota guidelines, and the quality
improvement program guidelines as they neglect to address intractable pain and the
complications of untreated intractable pain.
new text end
new text begin Subd. 2b. new text end
new text begin Guidelines for physicians treating intractable pain. new text end
new text begin
For the purpose of
establishing intractable pain guidelines, physicians and licensed prescribers treating patients
diagnosed with intractable pain must comply with this section. This section constitutes the
state's intractable pain guidelines for prescribing opioid pain medication.
new text end
Subd. 3.
Limits on applicability.
This section does not apply to:
(1) a physician's treatment of an individual for chemical dependency resulting from the
use of controlled substances in Schedules II to V of section 152.02;
(2) the prescription or administration of controlled substances in Schedules II to V of
section 152.02 to an individual whom the physician knows to be using the controlled
substances for nontherapeutic purposes;
(3) the prescription or administration of controlled substances in Schedules II to V of
section 152.02 for the purpose of terminating the life of an individual having intractable
pain; or
(4) the prescription or administration of a controlled substance in Schedules II to V of
section 152.02 that is not a controlled substance approved by the United States Food and
Drug Administration for pain relief.
Subd. 4.
Notice of risks.
new text begin (a) new text end Prior to treating deleted text begin an individualdeleted text end new text begin a patientnew text end for intractable pain
in accordance with subdivision 2, a physiciannew text begin or licensed prescribernew text end shall discuss with the
deleted text begin individualdeleted text end new text begin patient, or the guardian of a patient who is under the age of 18,new text end the risks associated
with the controlled substances in Schedules II to V of section 152.02 to be prescribed or
administered in the course of the physician's treatment of deleted text begin an individual, and documentdeleted text end new text begin the
patient's intractable pain. new text end The discussion new text begin must be documented new text end in the deleted text begin individual'sdeleted text end new text begin patient'snew text end
record.
new text begin
(b) The physician or licensed prescriber and the patient or guardian must execute an
informed consent to be treated with opioid medications deemed medically necessary by the
physician and agreed to by the patient or guardian to treat the patient's intractable pain.
Informed consent must include information on the possible risks and outline expected
benefits for the specific opioid medication that is being prescribed in addition to attaching
a printout of the specific prescribed opioid medication with FDA labeling, including any
black box warnings. The informed consent is valid for one year after the date of consent.
new text end
new text begin
(c) A new informed consent is required for a change of the type or brand of opioid
medication, including a dosage change, whether increased or decreased. An executed
informed consent is not required in emergency situations but is recommended if a request
is reasonable based on emergency circumstances.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end