Effective January 1, 2019, Business and Professions Code Section 740 became new California law (Assembly Bill 2760 was signed by then Governor Brown on September 10, 2018) requiring those who prescribe medication to be more vigilant of patients who have an increased risk of substance abuse.
A prescriber is now required to provide education to a patient for overdose prevention, as well as the use of Naloxone Hydrochloride (commonly referred to as Narcan, which is available in generic form, is an opioid antagonist used for the reversal of opioid overdose, including respiratory depression. Narcan is also used for diagnosis of suspected or known acute opioid overdose) or a comparable drug approved by the United States Food and Drug Administration [FDA].
Business & Professions Code section 740 specifies the applicable criteria as the following:
- the prescription dosage for a patient is 90 or more morphine milligram equivalents of an opioid medication per day; and/or
- an opioid medication is prescribed concurrently with a prescription for benzodiazepine; and/or
- a patient has the indications of an increased risk for overdose.
Section 741(a)(1)(C) offers the following examples that indicate an” increased risk of overdose,” including but not limited to:
- a patient with a history of overdose;
- a patient with a history of substance use disorder; or
- a patient at risk for returning to a high dose of opioid medication to which the patient is no longer tolerant
Business & Professions Code section 742 states that a prescriber who fails to abide by the prescription or education requirements shall be referred to the appropriate state licensing board for the disciplinary action. Notably, the focus of Spital and Associates is on representing those who have a professional license in California, whether in the investigative stage or written and published Accusation, such as one filed by the Medical Board of California.
All opiates come from the poppy plant. Opioids have a similar effect to an opiate, but are often synthetic or partially synthetic. Both opiates and opioids are classified by the U.S. Drug Enforcement Agency as Schedule II drugs, which are considered acceptable for certain medical purposes, such as for relief of pain, but are deemed highly addictive, including Dilaudid (hydromorphone), Demerol (meperidine), Dolophine (methadone), Duragesic or Sublimaze (fentanyl), morphine, opium, OxyContin and Percocet (oxycodone), Vicodin and other medications with hydrocodone, and various drugs with Codeine. On the other hand, Heroin, LSD, marijuana (cannabis) and Ecstasy are Schedule I drugs, and these are considered the most dangerous and have no acceptable medical or safe use.
There is no question but that acute and chronic pain are debilitating medical conditions. Approximately two (2) million individuals in the United States suffer from SUBSTANCE USE disorders related to prescription opioid pain relievers. It is noteworthy that prescription drugs are the “second” most commonly abused substances, alcohol being number one. The number of deaths from opioid pain relievers that have been prescribed by physicians represent more than the number of overdose deaths involving heroin or cocaine.
Some individuals are predisposed to develop problems as a result of using drugs because they have lower levels of self-control. Notwithstanding the above, there are others who become addicted because of one or more set of personality behaviors when utilizing certain narcotics, even though lawfully prescribed by a physician. It is hoped the mandate set forth above and a new law in California will result in a substantial decline in deaths and, of course, it will increase the nature and scope of effective and alternative modalities for pain management.