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Capital IconMinnesota Legislature

HF 3746

as introduced - 91st Legislature (2019 - 2020) Posted on 02/24/2020 02:40pm

KEY: stricken = removed, old language.
underscored = added, new language.
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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 causes
new 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 beginor treating new text endphysician and one or more physicians specializing in pain medicine
or the treatment of the area, system, new text begindisease, new text endor 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 disorder
new text end causing intractable pain. No physician deleted text beginshall bedeleted text endnew text begin or licensed prescriber
is
new 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 Services
new 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 beginwhat the physician or licensed prescriber, after careful and lawful
consideration, has deemed to be a medically necessary
new text endtreatment of an individual for
intractable pain, provided the physician keeps accurate records of the new text beginpatient's diagnosis
and any
new text endpurpose, use, deleted text beginprescriptiondeleted text endnew text begin prescriptions givennew text end, and disposal of controlled substancesdeleted text begin,
writes accurate prescriptions
deleted text endnew text begin follows state protocol for the prescription drug monitoring
program
new 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 endPrior to treating deleted text beginan individualdeleted text endnew 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 endnew 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 beginan individual, and documentdeleted text end new text beginthe
patient's intractable pain.
new text endThe discussion new text beginmust be documented new text endin the deleted text beginindividual'sdeleted text endnew 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