STATE OF NEW JERSEY
[Pages:8]SENATE, No. 3411
STATE OF NEW JERSEY
217th LEGISLATURE
INTRODUCED JULY 1, 2017 Sponsored by: Senator SHIRLEY K. TURNER District 15 (Hunterdon and Mercer) Senator JOSEPH F. VITALE District 19 (Middlesex)
SYNOPSIS Authorizes physician assistants and advanced practice nurses to dispense
narcotic drugs for treatment of substance use disorders consistent with federal law. CURRENT VERSION OF TEXT
As introduced.
(Sponsorship Updated As Of: 12/1/2017)
S3411 TURNER, VITALE 2
1 AN ACT concerning medication assisted treatment and amending
2
and supplementing P.L.1991, c.378 and P.L.1991, c.377.
3
4
BE IT ENACTED by the Senate and General Assembly of the State
5 of New Jersey:
6
7
1. Section 10 of P.L.1991, c.378 (C.45:9-27.19) is amended to
8 read as follows:
9
10. [A] Except in the case of narcotic drugs for maintenance
10 treatment or detoxification treatment, which an authorized
11 physician assistant may dispense as provided in section 3 of P.L. , c.
12 (C.
) (pending before the Legislature as this bill), a physician
13 assistant may order, prescribe, dispense, and administer medications
14 and medical devices to the extent delegated by a supervising
15 physician.
16
a. [Controlled] Except in the case of narcotic drugs for
17 maintenance treatment or detoxification treatment, which an
18 authorized physician assistant may dispense as provided in section 3
19 of P.L. , c. (C.
) (pending before the Legislature as this
20 bill), controlled dangerous substances may only be ordered or
21 prescribed if:
22
(1) a supervising physician has authorized a physician assistant
23 to order or prescribe Schedule II, III, IV, or V controlled dangerous
24 substances in order to:
25
(a) continue or reissue an order or prescription for a controlled
26 dangerous substance issued by the supervising physician;
27
(b) otherwise adjust the dosage of an order or prescription for a
28 controlled dangerous substance originally ordered or prescribed by
29 the supervising physician, provided there is prior consultation with
30 the supervising physician;
31
(c) initiate an order or prescription for a controlled dangerous
32 substance for a patient, provided there is prior consultation with the
33 supervising physician if the order or prescription is not pursuant to
34 subparagraph (d) of this paragraph; or
35
(d) initiate an order or prescription for a controlled dangerous
36 substance as part of a treatment plan for a patient with a terminal
37 illness, which for the purposes of this subparagraph means a
38 medical condition that results in a patient's life expectancy being 12
39 months or less as determined by the supervising physician;
40
(2) the physician assistant has registered with, and obtained
41 authorization to order or prescribe controlled dangerous substances
42 from, the federal Drug Enforcement Administration and any other
43 appropriate State and federal agencies; and
44
(3) the physician assistant complies with all requirements which
45 the board shall establish by regulation for the ordering, prescription,
EXPLANATION ? Matter enclosed in bold-faced brackets [thus] in the above bill is
not enacted and is intended to be omitted in the law.
Matter underlined thus is new matter.
S3411 TURNER, VITALE 3
1 or administration of controlled dangerous substances, all applicable
2 educational program requirements, and continuing professional
3 education programs approved pursuant to section 16 of P.L.1991,
4 c.378 (C.45:9-27.25).
5
b. (Deleted by amendment, P.L.2015, c.224)
6
c. (Deleted by amendment, P.L.2015, c.224)
7
d. In the case of an order or prescription for a controlled
8 dangerous substance, the physician assistant shall print on the order
9 or prescription the physician assistant's Drug Enforcement
10 Administration registration number.
11
e. The dispensing of medication or a medical device by a
12 physician assistant shall comply with relevant federal and State
13 regulations, and shall occur only if: (1) pharmacy services are not
14 reasonably available; (2) it is in the best interest of the patient; or
15 (3) the physician assistant is rendering emergency medical
16 assistance.
17
f. A physician assistant may request, receive, and sign for
18 prescription drug samples and may distribute those samples to
19 patients.
20 (cf: P.L.2015, c.224, s.7)
21
22
2. Section 8 of P.L.1991, c.378 (C.45:9-27.17) is amended to
23 read as follows:
24
8. a. (Deleted by amendment, P.L.2015, c.224)
25
b. Any physician who permits a physician assistant under the
26 physician's supervision to practice contrary to the provisions of
27 P.L.1991, c.378 (C.45:9-27.10 et seq.) shall be deemed to have
28 engaged in professional misconduct in violation of subsection e. of
29 section 8 of P.L.1978, c.73 (C.45:1-21) and shall be subject to
30 disciplinary action by the board pursuant to P.L.1978, c.73 (C.45:1-
31 14 et seq.);
32
c. In the performance of all practice-related activities,
33 including, but not limited to, the ordering of diagnostic, therapeutic,
34 and other medical services, a physician assistant shall be
35 conclusively presumed to be the agent of the physician under whose
36 supervision the physician assistant is practicing.
37
d. A physician who supervises a physician assistant may
38 maintain a written delegation agreement with the physician
39 assistant. A physician assistant shall sign a separate written
40 agreement with each physician who delegates medical services in
41 accordance with the provisions of subsection d. of section 7 of
42 P.L.1991, c.378 (C.45:9-27.16). However, a written delegation
43 agreement may be executed by a single-specialty physician practice,
44 provided it is signed by all of the delegating physicians supervising
45 the physician assistant. In the case of a multi-specialty physician
46 practice, a written delegation agreement may be executed for each
47 physician specialty within the practice, provided it is signed by all
48 of the delegating physicians supervising the physician assistant in
S3411 TURNER, VITALE 4
1 that specialty area. Nothing in this section shall authorize the
2 execution of a global written delegation agreement between a
3 physician assistant and a multi-specialty physician practice. The
4 agreement shall:
5
(1) state that the physician will exercise supervision over the
6 physician assistant in accordance with the provisions of P.L.1991,
7 c.378 (C.45:9-27.10 et seq.) and any rules adopted by the board;
8
(2) be signed and dated annually by the physician and the
9 physician assistant, and updated as necessary to reflect any changes
10 in the practice or the physician assistant's role in the practice; and
11
(3) be kept on file at the practice site, be provided to the
12 Physician Assistant Advisory Committee, and be kept on file by the
13 committee.
14
e. The delegation agreement shall include, but need not be
15 limited to, the following provisions:
16
(1) The physician assistant's role in the practice, including any
17 specific aspects of care that require prior consultation with the
18 supervising physician;
19
(2) A determination of whether the supervising physician
20 requires personal review of all charts and records of patients and
21 countersignature by the supervising physician of all medical
22 services performed under the delegation agreement, including
23 prescribing and administering medication as authorized under
24 section 10 of P.L.1991, c.378 (C.45:9-27.19). This provision shall
25 state the specified time period in which a review and
26 countersignature shall be completed by the supervising physician.
27 If no review and countersignature is necessary, the agreement must
28 specifically state such provision; [and]
29
(3) The locations of practice where the physician assistant may
30 practice under the delegation agreement, including licensed
31 facilities in which the physician authorizes the physician assistant to
32 provide medical services; and
33
(4) Written approval for the physician assistant to dispense
34 narcotic drugs for maintenance treatment or detoxification
35 treatment, if the physician assistant is authorized to dispense such
36 drugs pursuant to section 3 of P.L. , c. (C. ) (pending before
37 the Legislature as this bill) and the supervising physician agrees to
38 provide such written approval.
39 (cf: P.L.2015, c.224, s.5)
40
41
3. (New section) Notwithstanding any other provision of law
42 to the contrary, a physician assistant who is otherwise authorized to
43 order, prescribe, and dispense controlled dangerous substances
44 pursuant to P.L.1991, c.378 (C.45:9-27.10 et seq.) may dispense
45 narcotic drugs for maintenance treatment or detoxification treatment
46 if the physician assistant has met the training and registration
47 requirements set forth in subsection (g) of 21 U.S.C. s.823. A
48 physician assistant who is authorized to dispense such drugs may do
S3411 TURNER, VITALE 5
1 so regardless of whether the physician assistant's supervising
2 physician has met the training and registration requirements set
3 forth in subsection (g) of 21 U.S.C. s.823, provided that the written
4 delegation agreement between the supervising physician and the
5 physician assistant executed pursuant to subsection d. of section 8
6 of P.L.1991, c.378 (C.45:9-27.17) includes the supervising
7 physician's written approval for the physician assistant to dispense
8 the drugs.
9
10
4. Section 10 of P.L.1991, c.377 (C.45:11-49) is amended to
11 read as follows:
12
10. a. In addition to all other tasks which a registered
13 professional nurse may, by law, perform, an advanced practice
14 nurse may manage preventive care services and diagnose and
15 manage deviations from wellness and long-term illnesses, consistent
16 with the needs of the patient and within the scope of practice of the
17 advanced practice nurse, by:
18
(1) initiating laboratory and other diagnostic tests;
19
(2) prescribing or ordering medications and devices, as
20 authorized by subsections b. and c. of this section; [and]
21
(3) prescribing or ordering treatments, including referrals to
22 other licensed health care professionals, and performing specific
23 procedures in accordance with the provisions of this subsection; and
24
(4) dispensing narcotic drugs for maintenance treatment or
25 detoxification treatment, if authorized to do so pursuant to section 5
26 of P.L. , c. (C. ) (pending before the Legislature as this bill).
27
b. An advanced practice nurse may order medications and
28 devices in the inpatient setting, subject to the following conditions:
29
(1) the collaborating physician and advanced practice nurse
30 shall address in the joint protocols whether prior consultation with
31 the collaborating physician is required to initiate an order for a
32 controlled dangerous substance;
33
(2) the order is written in accordance with standing orders or
34 joint protocols developed in agreement between a collaborating
35 physician and the advanced practice nurse, or pursuant to the
36 specific direction of a physician;
37
(3) the advanced practice nurse authorizes the order by signing
38 the nurse's own name, printing the name and certification number,
39 and printing the collaborating physician's name;
40
(4) the physician is present or readily available through
41 electronic communications;
42
(5) the charts and records of the patients treated by the advanced
43 practice nurse are reviewed by the collaborating physician and the
44 advanced practice nurse within the period of time specified by rule
45 adopted by the Commissioner of Health pursuant to section 13 of
46 P.L.1991, c.377 (C.45:11-52);
S3411 TURNER, VITALE 6
1
(6) the joint protocols developed by the collaborating physician
2 and the advanced practice nurse are reviewed, updated, and signed
3 at least annually by both parties; and
4
(7) the advanced practice nurse has completed six contact hours
5 of continuing professional education in pharmacology related to
6 controlled substances, including pharmacologic therapy, addiction
7 prevention and management, and issues concerning prescription
8 opioid drugs, including responsible prescribing practices,
9 alternatives to opioids for managing and treating pain, and the risks
10 and signs of opioid abuse, addiction, and diversion, in accordance
11 with regulations adopted by the New Jersey Board of Nursing. The
12 six contact hours shall be in addition to New Jersey Board of
13 Nursing pharmacology education requirements for advanced
14 practice nurses related to initial certification and recertification of
15 an advanced practice nurse as set forth in N.J.A.C.13:37-7.2.
16
c. An advanced practice nurse may prescribe medications and
17 devices in all other medically appropriate settings, subject to the
18 following conditions:
19
(1) the collaborating physician and advanced practice nurse
20 shall address in the joint protocols whether prior consultation with
21 the collaborating physician is required to initiate a prescription for a
22 controlled dangerous substance;
23
(2) the prescription is written in accordance with standing orders
24 or joint protocols developed in agreement between a collaborating
25 physician and the advanced practice nurse, or pursuant to the
26 specific direction of a physician;
27
(3) the advanced practice nurse writes the prescription on a New
28 Jersey Prescription Blank pursuant to P.L.2003, c.280 (C.45:14-40
29 et seq.), signs the nurse's own name to the prescription and prints
30 the nurse's name and certification number;
31
(4) the prescription is dated and includes the name of the patient
32 and the name, address, and telephone number of the collaborating
33 physician;
34
(5) the physician is present or readily available through
35 electronic communications;
36
(6) the charts and records of the patients treated by the advanced
37 practice nurse are periodically reviewed by the collaborating
38 physician and the advanced practice nurse;
39
(7) the joint protocols developed by the collaborating physician
40 and the advanced practice nurse are reviewed, updated, and signed
41 at least annually by both parties; and
42
(8) the advanced practice nurse has completed six contact hours
43 of continuing professional education in pharmacology related to
44 controlled substances, including pharmacologic therapy, addiction
45 prevention and management, and issues concerning prescription
46 opioid drugs, including responsible prescribing practices,
47 alternatives to opioids for managing and treating pain, and the risks
48 and signs of opioid abuse, addiction, and diversion, in accordance
S3411 TURNER, VITALE 7
1 with regulations adopted by the New Jersey Board of Nursing. The
2 six contact hours shall be in addition to New Jersey Board of
3 Nursing pharmacology education requirements for advanced
4 practice nurses related to initial certification and recertification of
5 an advanced practice nurse as set forth in N.J.A.C.13:37-7.2.
6
d. The joint protocols employed pursuant to subsections b. and
7 c. of this section shall conform with standards adopted by the
8 Director of the Division of Consumer Affairs pursuant to section 12
9 of P.L.1991, c.377 (C.45:11-51) or section 10 of P.L.1999, c.85
10 (C.45:11-49.2), as applicable.
11
e. (Deleted by amendment, P.L.2004, c.122.)
12
f. An attending advanced practice nurse may determine and
13 certify the cause of death of the nurse's patient and execute the
14 death certification pursuant to R.S.26:6-8 if no collaborating
15 physician is available to do so and the nurse is the patient's primary
16 caregiver.
17 (cf: P.L.2017, c.28, s.15)
18
19
5. (New section) Notwithstanding any other provision of law
20 to the contrary, an advanced practice nurse may dispense narcotic
21 drugs for maintenance treatment or detoxification treatment if the
22 advanced practice nurse has met the training and registration
23 requirements set forth in subsection (g) of 21 U.S.C. s.823. An
24 advanced practice nurse who is authorized to dispense such drugs
25 may do so regardless of whether the advanced practice nurse's
26 collaborating physician has met the training and registration
27 requirements set forth in subsection (g) of 21 U.S.C. s.823,
28 provided that the joint protocols established by the advanced
29 practice nurse and the collaborating physician include the
30 collaborating physician's written approval for the advanced practice
31 nurse to dispense the drugs.
32
33
6. This act shall take effect immediately.
34
35
36
STATEMENT
37
38
This bill authorizes physician assistants and advanced practice
39 nurses to dispense narcotic drugs for maintenance treatment or
40 detoxification treatment for individuals with a substance use
41 disorder. This type of treatment is known as "medication assisted
42 treatment," and includes the use of drugs such as buprenorphine,
43 naltrexone, methadone, and naloxone to treat drug cravings and
44 reverse or block the effects of opioid intoxication. The use of
45 medication assisted treatment can be a key element in treating and
46 overcoming the powerful physical addiction resulting from an
47 opioid use disorder.
S3411 TURNER, VITALE 8
1
The bill requires physician assistants and advanced practice
2 nurses seeking to dispense narcotic drugs for medication assisted
3 treatment to have completed all federal requirements to become
4 registered to dispense the drugs, as provided in subsection (g) of 21
5 U.S.C. s.823. Additionally, physician assistants who wish to
6 dispense the drugs will be required to have obtained authorization
7 to order, prescribe, and administer controlled dangerous substances
8 pursuant to the "Physician Assistant Licensing Act" and have the
9 supervising physician's written approval to dispense the drugs
10 included in the written delegation agreement between the physician
11 assistant and the supervising physician. Similarly, advanced
12 practice nurses will be required to have their collaborating
13 physician's written approval included in the joint protocols
14 established by the advanced practice nurse and the collaborating
15 physician. A physician assistant or advanced practice nurse who
16 meets these requirements will be authorized to dispense narcotic
17 drugs for maintenance treatment or detoxification treatment,
18 regardless of whether the physician assistant's supervising
19 physician or the advanced practice nurse's collaborating physician
20 has completed the federal requirements to dispense such drugs.
21
Subsection (g) of 21 U.S.C. s.823 formerly only authorized
22 certain physicians to dispense narcotic drugs for maintenance
23 treatment or detoxification treatment. However, in 2016, the
24 section was amended to allow physician assistants and nurse
25 practitioners to dispense the drugs, subject to any state laws limiting
26 the scope of practice for physician assistants and nurse
27 practitioners. This bill is intended to remove certain of these scope-
28 of-practice limitations, so as to make certain forms of medication
29 assisted treatment more widely available to residents of New Jersey
30 struggling to overcome an opioid use disorder.
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