2018 OKLAHOMA PROPER PRESCRIBING: A BRAVE NEW WORLD OR ALDOUS HUXLEY DOESN'T KNOW THE HALF OF IT

2018 OKLAHOMA PROPER
      PRESCRIBING:
  A BRAVE NEW WORLD
           OR
ALDOUS HUXLEY DOESN’T
  KNOW THE HALF OF IT

SB 1446 EFFECT ON
OSTEOPATHIC PHYSICIANS IN 2018

SB 1446 SECTION 1

MEDICAL BOARD ADDITIONAL CME

DO BOARD CONSIDERING OPTIONS

SB 1446 SECTION 2
MEDICAL BOARD UNPROFESSIONAL
     CONDUCT DEFINITION
 DO BOARD STATUTE? OR RULE?

SB 1446 SECTION 3
     NEW DEFINITIONS
        ACUTE PAIN
       CHRONIC PAIN
   INITIAL PRESCRIPTION
PATIENT PROVIDER AGREEMENT
     SERIOUS ILLNESS
   SURGICAL PROCEDURE

SB 1446 SECTION 4

STILL MUST CHECK PMP

SB 1446 SECTION 5
       7-7-LONGER DURATION

     CREATES A 3-STEP PROCESS

CDS SCHEDULE II OR ANY OPIOID DRUG

STEP ONE
INITIAL PRESCRIPTION UP TO 7 DAYS
      MAXIMUM DURATION

    NEW CHECK LIST CREATED

STEP ONE
 NEW CHECKLIST FOR SCHEDULE II CDS OR
          ANY OPIOID DRUG
1. DOCUMENTED MEDICAL HISTORY
2. DOCUMENTED PHYSICAL EXAM AS APPROPRIATE
3. DEVELOP TREATMENT PLAN
4. ACCESS PMP
5. LIMIT SUPPLY TO 7 DAYS
6. IF PATIENT UNDER AGE 18, PATIENT-PROVIDER
   AGREEMENT
7. IF PATIENT PREGNANT, PATIENT-PROVIDER AGREEMENT

STEP ONE CONTINUED
  PRIOR TO ISSUING INITIAL PRESCRIPTION
  PRACTIONER SHALL DISCUSS RISKS WITH
                 PATIENT
1. RISK OF ADDICTION AND OVERDOSE, AND MIXING WITH
   CNSD
2. REASONS WHY PRESCRIPTION IS NECESSARY
3. ALTERNATIVE TREATMENTS
4. RISKS WITH OPIOIDS

PRACTITIONER TO INCLUDE NOTE IN MEDICAL RECORD

STEP TWO
         FOLLOW UP PRESCRIPTION
          UP TO 7 ADDITIONAL DAYS
AFTER CONSULTATION WITH PATIENT, PRACTITIONER MAY
ISSUE SUBSEQUENT PRESCRIPTION NOT TO EXCEED 7 DAYS
PROVIDED:
1. SUBSEQUENT PRESCRIPTION NOT DEEMED THE INITIAL
   PRESCRIPTION
2. PRACTITIONER DETERMINES NECESSITY
3. SUBSEQUENT PRESCRIPTION DOES NOT PRESENT UNDUE
   RISK

STEP THREE
             LONGER DURATION
WRITTEN PAIN-MANAGEMENT AGREEMENT WITH PATIENT
IS REQUIRED
ANY SCHEDULE II CDS OR OPIOID IS CONTINUOUSLY
PRESCRIBED FOR 3 MONTH OR MORE FOR CHRONIC PAIN,
THE PRACTITIONER SHALL:
1. MINIMUM 3- MONTH REVIEW
2. ASSESS PATIENT PRIOR TO EVERY RENEWAL
3. PERIODIC EFFORTS TO STOP CDS AND DOCUMENT
4. REVIEW PMP
5. MONITOR PAIN-MANAGEMENT AGREEMENT
   COMPLIANCE

AND FINALLY UNDER SB 1446
FOR ANY “QUALIFYING OPIOID THERAPY PATIENT”
PROVIDER SHALL ADOPT AND MAINTAIN WRITTEN POLICY
THAT INCLUDES WRITTEN AGREEMENT OF INFORMED
CONSENT IF:
1. PATIENT REQUIRES OPIOID TREATMENT MORE THAN 3
   MONTHS
2. IF PRESCRIBED OPIOIDS AND BENZODIAZEPINES
   TOGETHER; OR
3. PATIENT PRESCRIBED OPIOID THAT EXCEEDS 100
   MORPHINE EQUIVALENT DOSES.

STATE QUESTION 788

MEDICAL MARIJUANA

“IT WAS IMPOSSIBLE TO GET A CONVERSATION GOING,
       EVERBODY WAS TALKING TOO MUCH.”

“It ain’t over till it’s over.”
***
“The future ain’t what it used to be.”
***
“You’ve got to be very careful if you don’t know where you are going,
because you might not get there.”
***
“If you ask me anything I don’t know, I’m not going to answer.”
***
“No one goes there now days, it’s too crowded.”
***

“I AM THE SOLE JUDGE OF MY OWN STANDARDS.”

                      BEN HOGAN

MEDICAL MARIJUANA

PERSON MUST OBTAIN STATE BOARD MEDICAL MARIJUANA LICENSE
IN ORDER:

  1. TO CONSUME MARIJUANA

  2. TO LEGALLY POSSESS MARIJUANA

LICENSE GOOD FOR 2 YEARS.

STATE QUESTION 788
                    SECTION 1 PART M

“ALL APPLICATIONS FOR MEDICAL LICENSE MUST BE SIGNED BY AN
OKLAHOMA BOARD CERTIFIED PHYSICIAN. THERE ARE NO
QUALIFYING CONDITIONS. A MEDICAL MARIJUANA LICENSE MUST BE
RECOMMENDED ACCORDING TO THE ACCEPTED STANDARDS A
REASONABLE AND PRUDENT PHYSICIAN WOULD FOLLOW WHEN
RECOMMENDING OR APPROVING ANY MEDICATION. NO PHYSICIAN
MAY BE UNDULY STIGMATIZED OR HARASSED FOR SIGNING A
MEDICAL MARIJUANA LICENSE APPLICATION.”

MEDICAL MARIJUANA
                        RULE 310:681-1-9

RECOMMENDING PHYSICIAN REGISTRATION WITH OKALHOMA STATE
DEPARTMENT OF HEALTH.

  1.   BOARD CERTIFIED

  2.   VALID UNRESTRICTED LICENSE IN GOOD STANDING

  3.   IF PRIOR DISCIPLINARY ACTION – EXPLAIN

  4.   DOCTOR DOES NOT HOLD ANY “DIRECT OR ECONOMIC INTEREST IN A
       COMMERCIAL ESTABLISHMENT, GROWER, COMMERCIAL GROWER,
       MANUFACTURER OR PROCESSOR.”

MEDICAL MARIJUANA
                            RULE 310:681-1-9

STANDARDS FOR RECOMMENDING PHYSICIAN

  1.    IN “GOOD STANDING” WITH THEIR LICENSURE BOARD.AND
        COMPLETE ALL REQUIRED TRAIING FOR THE RECOMMENDATION OF
        MEDICAL MARIJUANA.

  2.    COMPLY WITH ALL CONTINUING EDUCATION REQUIREMENTS
        GENERALLY AND SPECIFICALLY REQUIRED BY THEIR BOARD
        REGARDING MEDICAL MARIJUANA.

2. 3.   FOLLOW ACCEPTED STANDARDS A REASONABLE AND PRUDENT
        PHYSICIAN SHALL FOLLOW WHEN RECOMMENDING MEDICAL
        MARIJUANA TO INCLUDE THE FOLLOWING: ANY MEDICATION TO PATIENT.

        1.   ESTABLISHMENT OF A BONAFIDE PHYSICIAN-PATIENT RELATIONSHIP.

2.   DOCUMENTATION OF IN PERSON (TELEMEDICINE IS PROHIBITED)
     MEDICALLY REASONABLE ASSESSMENT OF PATIENT MEDICAL
     HISTORY AND CURRENT MEDICAL CONDITION INCLUDING
     PHYSICAL EXAMINATION WITHIN THE PAST 30 DAYS.

3.   DIAGNOSIS OF A MEDICAL CONDITION FINDING PATIENT LIKELY
     TO RECEIVE THERAPEUTIC OR PALLIATIVE BENEFIT FROM
     MEDICAL USE OF MARIJUANA.

4.   DISCUSSION OF RISKS AND BENEFITS WITH PATIENT.

       A.   RISK OF CANNABIS USE DISORDER.
       B.   RISK FOR EXACERBATION OF PSYCHOTIC DISORDERS.
       C. VARIABILITY AND LACK OF STANDARDIZATION OF MARIJUANA
          PREPARATIONS.
       D.   INCREASED RISK OF MOTOR VEHICLE CRASHES WHILE UNDER THE
            INFLUENCE.

5.   PROVISION OF FOLLOW UP CARE AND MANAGEMENT OF
     PATIENT’S MEDICAL CONDITION INCLUDING ANNUAL REVIEW.

6.   MAINTAIN ACCURATE AND COMPLETE MEDICAL RECORDS.

7.   SCREENING FOR SUBSTANCE ABUSE OR MENTAL HEALTH
     DISORDERS.

8. PROHIBITED APPROVAL OF MEDICAL MARIJUANA LICENSE TO
   FEMALES OF CHILD BEARING YEARS WITHOUT FIRST
   PERFORMING PREGNANCY TEST.

9. PHYSICIAN PROHIBITED FROM ISSUING A RECOMMENDATION
   FOR APPROVAL OF A PATIENT LICENSE TO THEMSELVES, THEIR
   FAMILY MEMBERS OF THE FIRST AND SECOND DEGREE, THEIR
   COWORKERS OR EMPLOYEES.

10. PHYCIAN WHO RECOMMENDS USE OF MEDICAL MARIJUANA
    SHALL NOT:

   A. ACCEPT, SOLICIT, OR OFFER ANY FORM OF PECUNIARY
       REMUNERATION FROM OR TO A CAREGIVER, DISPENSARY,
       PROCESSOR, OR COMMERCIAL GROWER;
   B. OFFER A DISCOUNT OR ANY OTHER THING OF VALUE TO A PATIENT
       WHO USES OR AGREES TO USE PARTICULAR CARE GIVER OR
       DISPENSARY;
   C. EXAMINE A PATIENT FOR PURPOSE OF RECOMMENDING MEDICAL
       MARIJUANA AT A LOCATION WHERE MEDICAL MARIJUANA IS
       DISPENSED;
   D. HOLD A PATIENT MEDCIAL MARIJUANA LICENSE IN HIS PERSONAL
       CAPACITY OR AS A CARE GIVER;
   E. NOT HOLD ANY ECONOMIC INTEREST IN AN ENTERPRISE THAT
       GROWS, TRANSPORTS, PROCESSES OR DISPENSES MEDICAL
       MARIJUANA;

11. IF FOLLOW UP EXAMINATION SHOWS PATIENT NO LONGER
    MEETS STANDARDS FOR MEDICAL MARIJUANA PHYSICIAN
    SHALL NOTIFY DEPARTMENT OF HEALTH.

12. CHECK THE PATIENT’S PROFILE ON PMP.

STATE QUESTION 788
                         SECTION 6

A. SCHOOL OR LANDLORD LIMITED ON PENALTY TO MEDICAL
   MARIJUANA LICENSE HOLDER.

B. EMPLOYER CANNOT DISCRIMINATE IN HIRE, TERMINATION OR TERM
   OR CONDITION OR OTHERWISE PENALIZE PERSON BASED ON:

  1.   STATUS AS MEDICAL MARIJUANA LICENSE HOLDER;

  2.   EMPLOYER MAY OR MAY NOT TAKE ACTION.

C. MEDICAL MARIJUANA LICENSE HOLDER USE OF MARIJUANA
   EQUIVALENT TO USE OF ANY OTHER MEDICATION UNDER DIRECTION
   OF PHYSICIAN.

D. NO BASIS TO DENY CUSTODY OF OR VISITATION OR PARENTING TIME
   WITH MINOR CHILD.

E.   NOT GROUNDS TO WITHHOLD STATE LICENSE, INCLUDING CONCEAL
     CARRY.

F.   CITY OR LOCAL MUNICIPALITY CANNOT RESTRICT ZONING LAWS ON
     RETAIL MARIJUANA ESTABLISHMENTS.