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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