Hb 249 - Controlled Substances and Prescription Drug Monitoring Database

• Citation: Vol. 34 No. 1
• Publication year: 2018

HB 249 - Controlled Substances and Prescription Drug Monitoring Database

Emily R. Polk
Georgia State University College of Law, emily.r.polk@gmail.com

Brandon M. Reed
Georgia State University College of Law, breed10@student.gsu.edu

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CRIMES AND OFFENSES

Controlled Substances: Amend Chapter 13 of Title 16, Code Section 116.2 of Article 6 of Chapter 4 of Title 26, Article 1 of Chapter 2A of Title 31, Article 1 of Chapter 1 of Title 31, and Article 2 of Chapter 16 of Title 45 of the Official Code of Georgia Annotated, Relating to Controlled Substances, the Authority of Licensed Health Practitioners to Prescribe Opioid Antagonists and Immunity from Liability, the Obligations of the Department of Public Health, General Provisions for Health, and Death Investigations, Respectively, so as to Change Provisions Relating to the Use of the Electronic Data Base; Transfer Responsibilities for the Electronic Data Base of Prescription Information of the Georgia Drugs and Narcotics Agency to the Department of Public Health; Provide for the Department's Authority to Continue the Maintenance and Development of the Electronic Data Base of Prescription Information; Provide for Definitions; Collect More Information Regarding the Dispensing and Use of Certain Controlled Substances; Change the Frequency of Reporting Certain Prescriptions in the Electronic Data Base of Prescription Information; Clarify Provisions Relating to Confidentiality; Change Provisions Relating to Liability and Duties; Change Provisions Relating to the Definitions of Dangerous Drugs; Require the Department of Public Health Have Responsibility for the Electronic Prescription Monitoring Data Base; Provide for Information to Patients by Prescribers when Prescribing Opioids; Provide for Immunity for the State Health Officer under Certain Circumstances; Change Provisions Relating to the State Health Officer; Provide for His or Her Authority in Connection to Certain Dangerous Drugs; Provide for a Coroner's Inquest when an Individual Dies of a Suspected Drug Overdose; Amend Section 2 of Chapter 12 of Title 31 of the Official Code of Georgia Annotated, Relating to Reporting Disease, Confidentiality, Reporting Required by Pharmacists, Immunity from Liability as to Information Supplied, and Notification of Potential Bioterrorism, so as to Add Neonatal Abstinence Syndrome Reporting; Amend Chapter 5 of Title 26 of the Official Code of Georgia Annotated, Relating to

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Drug Abuse Treatment and Education Programs, so as to Provide for Annual Inspection; Provide for Annual Reporting of Certain Data; Amend Part 2 of Article 6 of Chapter 2 of Title 20 of the Official Code of Georgia Annotated, Relating to Competencies and Core Curriculum in Elementary and Secondary Education, so as to Give a Short Title to a Code Section Relating to Cardiopulmonary Resuscitation and Use of Automated External Defibrillators in Schools; Provide for a Short Title; Provide for Related Matters; Repeal Conflicting Laws; and for Other Purposes

Code Sections: O.C.G.A. §§ 16-13-56.1 (new); -57, -58, -59, -60, -61, -62, -63, -64, -65 (amended); -71 (amended); 20-2-149.1 (amended); 26-4-116.2 (amended); 26-5-22 (new); -23 (new); 31-1-10 (amended); 31-2A-4 (amended); 31-12-2 (amended); 45-16-24 (amended); 45-16-27 (amended)

Bill Number: HB 249

Act Number: 141

Georgia Laws: 2017 Ga. Laws 319

Summary: The Act amends Georgia's controlled-substances statutes to expand medical provider requirements to record prescription drug information in an electronic prescription drug monitoring program database (PDMP). Medical providers are now required to use the PDMP to enter information about their prescription of certain types and quantities of opioids. The purpose of the act is to fight Schedule II opioid abuse throughout the state of Georgia. A medical provider's failure to report required information is reported to his or her respective state regulatory board

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for possible reprimand. In addition to mandatory reporting, the Act includes various other provisions related to regulating opioid misuse. The Act removes naloxone's codification as a dangerous drug when naloxone is used for overdose prevention. Additionally, the Act requires law enforcement officers to notify the coroner or county medical examiner of apparent drug overdoses. Finally, the Act adds a name to a separate Code section regarding cardiopulmonary resuscitation and use of automated defibrillators.

Effective Date: July 1, 2017

History

Drug abuse is a serious public health concern.¹ In fact, having supplanted car accident fatalities in 2008,² "drug overdose deaths are the leading cause of injury death in the United States."³ Opioid misuse is of particular concern, as more than 60% of all overdose deaths are related to opioid abuse.⁴ Although the epidemic has been a concern for decades,⁵ the crisis has significantly worsened over the past five years.⁶ In response to this concern, states are looking to curb the epidemic and find solutions to protect their citizens.⁷

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Georgia is one of the states experiencing an increase in opioid abuse.⁸ The state experienced a tenfold increase in prescription opioid overdose deaths between 1999 and 2014, and Georgia remains among the top eleven states with the most prescription opioid overdose deaths.⁹ In 2016, 549 people died from prescription drug overdose—a rate of more than one-and-a-half Georgians per day.¹⁰ According to Representative Kevin Tanner (R-9th), everyone shares the concern over opioid abuse because most everyone has been personally affected by addiction or overdose.¹¹

Because of these unfortunate statistics, Georgia has recently considered programs to help those affected by opioid abuse.¹² In 2011, Georgia implemented a Prescription Drug Monitoring Program (PDMP),¹³ a tool employed by nearly every state.¹⁴ A PDMP is an electronic database used by the state to collect and analyze prescription drug information for "misuse, abuse, and patterns of controlled substance prescribing" by doctors.¹⁵ Collecting this data gives prescribers access to the prescription history of their patients so

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they can identify trends or provide early intervention to their patients, if necessary.¹⁶

Despite the seemingly beneficial attributes of the database, Georgia's original law included a flaw that reduced its impact: no physician was required to register or participate in the PDMP under the 2011 legislation.¹⁷ As of the end of Georgia's 2017 legislative session, only 25% of practicing physician prescribers had registered for the database, and only 12% of practicing physician prescribers actively used the database.¹⁸ Georgia's PDMP was fully operational in 2013 when the program received funding,¹⁹ yet 2014 was Georgia's deadliest year on record, with 588 prescription opioid overdose deaths—a 33% increase over 2013.²⁰ Therefore, faced with a continuously-growing opioid epidemic, Georgia state legislators began looking for new options to address overdose deaths only five years after implementing the PDMP.²¹

On December 14, 2016, Georgia Governor Nathan Deal (R) issued an executive order aimed at curbing the epidemic by allowing pharmacies to dispense naloxone over-the-counter.²² Naloxone is a

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drug administered to individuals experiencing a drug overdose.²³ If timely administered, the drug can reverse the effects of an opioid overdose and thus save the life of the overdosing individual.²⁴ The Governor's proactive step to lessen overdoses and make the "drug accessible to anyone in a position to assist persons at risk of overdose will save countless lives."²⁵

By the time the 2017 legislative session arrived, legislators were also considering options to further address the opioid epidemic.²⁶ Two legislators in particular spearheaded the effort: Representative Kevin Tanner and Senator Renee Unterman (R-45th).²⁷ Because the opioid epidemic involves more than doctors inappropriately prescribing prescription painkillers, the General Assembly addressed various issues in one bill.²⁸ These issues included the following: (1) the voluntary nature of the PDMP,²⁹ (2) the existing naloxone executive order,³⁰ and (3) the difficulty of tracking the overdose deaths across the state.³¹ To address each of these concerns, the Georgia General Assembly passed House Bill (HB) 249 and created a more expansive program to fight Georgia's opioid epidemic.³²

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Bill Tracking of HB 249

Consideration and Passage by the House

Representatives Kevin Tanner (R-9th), Mark Newton (R-123 rd), Jon Burns (R-159th), Jan Jones (R-47th), Andrew Welch (R-110th), and Bubber Epps (R-144th) sponsored HB 249 in the House.³³ The House read the bill for the first time on February 7, 2017, and committed the bill to the House Judiciary Non-Civil Committee.³⁴ The House read the bill for the second time on February 8, 2017.³⁵ On February 27, 2017, the House Judiciary Non-Civil Committee favorably reported the bill by substitute.³⁶

The House Committee substitute reflected the authors' desire to prevent "doctor-shopping" without unduly restricting doctors' ability to prescribe needed medications.³⁷ In response to conversations with Governor Nathan Deal and the Georgia Drugs and Narcotics Agency, which currently administers the prescription drug monitoring database, the Committee substitute shifted responsibility for the electronic database from that agency to the Department of Public Health.³⁸

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Because current law does not require database enrollment, the House Committee substitute specified deadlines for prescriber enrollment in the prescription drug monitoring database.³⁹ The Committee substitute also set testing standards for the database, because the new enrollment and usage requirements would drastically increase the number of users and overload the current system.⁴⁰

In addition, the House Committee substitute increases the frequency with which dispensers, such as pharmacists, must update...