BG C.S.H.B. 120 75(R)BILL ANALYSIS PUBLIC HEALTH C.S.H.B. 120 By: Hirschi 3-19-97 Committee Report (Substituted) BACKGROUND Currently, physicians do not have the authority to prescribe or administer dangerous drugs or controlled substances to a person that the physician knows or should know is using drugs for recreational or nontherapeutic purposes. Even though Article 4495(c) Revised Statutes, Intractable Pain Treatment Act (IPTA) was adopted to allow a physician to prescribe or administer drugs to a person with chronic, incurable pain, it can be argued that physicians are reluctant to properly treat severe pain of conditions such as AIDS or cancer in patients who are or were drug abusers. PURPOSE CSHB 120 will allow physicians to treat pain from an acute or chronic medical condition with a dangerous drug or controlled substance in order to relieve a patient's pain. The bill will make the language of the IPTA consistent with rules of the Texas State Board of Medical Examiner (board). RULEMAKING AUTHORITY It is the committee's opinion that this bill does not expressly grant any additional rulemaking authority to a state officer, department, agency or institution. SECTION BY SECTION ANALYSIS SECTION 1. Amends Section 6, Article 4495c, Revised Statutes, as follows: Sec. 6. APPLICATION OF ACT TO CHEMICALLY DEPENDENT PERSONS. Subsection (a) adds the exception provided by subsection (c) to the prohibition on the applicability of the act to persons being treated for chemical dependency due to use of dangerous drugs or controlled substances. Subsection (b) adds the clause "for other than legitimate medical purposes as defined by the board," to the statement that the provisions of this Act do not give authority to prescribe or administer dangerous drugs or controlled substances. Subsection (c) is added and authorizes a physician to treat a patient having an acute or chronic painful medical condition with appropriate doses of a controlled substance or dangerous drug to relieve the pain, for an appropriate length of time, and for as long as the pain persists. A patient under this subsection includes a person who: (1) is currently a drug abuser; (2) is not currently abusing drugs, but has a history of drug abuse; or (3) resides in a place where there is risk for misuse or illegitimate diversion of the drug. Subsection (d) is added. Requires a physician, who treats a patient under Subsection (c), to monitor the patient to ensure that the prescribed dangerous drug or controlled substance is used only for the painful medical condition. Requires the physician to document the treatment as specified, and to consult with an expert in the treatment of addictions or other health care professional, as appropriate, to ensure proper treatment use. SECTION 2. Amends Section 7, entitled "CANCELLATION, REVOCATION OR SUSPENSION OF PHYSICIAN'S LICENSE," (Article 4495c, Revised Statutes) as follows: Subsection (1) adds "for other than legitimate medical purposes as defined by the board" to modify the physician action to prescribe, administer, or additionally, dispense a drug or treatment. Makes conforming changes. Subsection (2) makes conforming changes to list types of records to be included in the specified records regarding the purchase and disposal of drugs. SECTION 3. Effective date of this Act is September 1, 1997, and applies only to a dangerous drug or controlled substance prescribed by a physician on or after that date. Prior to this effective date, a prescribed dangerous drug or controlled substance is governed by existing law which is continued in effect for that purpose. SECTION 4. Emergency clause. COMPARISON OF ORIGINAL TO SUBSTITUTE In SECTION 1, CSHB 120 re-instates some of the language removed from Section 6, Article 4495c, Revised Statutes, by the original bill regarding whether a drug is known to be used for nontherapeutic purposes. In SECTION 2, the substitute version retains similar language in Section 7 , Article 4495c, Revised Statutes, by re-instating language which was removed from the original bill regarding a drug or treatment being nontherapeutic in nature or administration. Also, CSHB 120 reinserts subsection (4) concerning a physician's failure to prescribe, administer, or dispense drugs in a manner consistent with public health and welfare, and as defined under the Health and Safety Code and federal regulations.