A3571

An Act concerning the prescription, dispensation, and administration of opioid medications to student athletes, and amending and supplementing various sections of the statutory law.

Be It Enacted by the Senate and General Assembly of the State of New Jersey:

1. (New section) a. A prescriber shall exercise extreme caution when determining whether to prescribe opioid medication in the course of treatment afforded to a student athlete. The prescriber shall make every reasonable effort to utilize non-narcotic drugs, including acetaminophen, non-steroidal anti-inflammatory medications, and salicylates, as well as non-medicine alternatives such as cryotherapy and transcutaneous nerve stimulation, as an alternative to opioid medication.

b. Whenever a prescriber determines that the alternative treatments described under subsection a. of this section are insufficient to address a student athlete’s medical needs, and prescribes an opioid medication for the treatment of the student athlete’s injury or pain, the prescriber shall:

(1) make every effort to ensure the student athlete’s safe use of the medication;

(2) prescribe no more than a seven-day, non-refillable supply of the medication;

(3) indicate, on the face of the prescription blank, that the prescription is being issued for a student athlete, pursuant to this section;

(4) provide the completed prescription blank to the student athlete’s parent or guardian, instead of providing it directly to the student athlete;

(5) provide the student athlete’s parent or guardian with instructions as to how to administer the medication and the ways in which the parent or guardian can engage in medication monitoring, on a daily basis, to determine the continued need for, and effectiveness of, the medication;

(6) provide the student athlete, and the student’s parent or guardian, with information or educational materials regarding the risks that are associated with the use of opioid medication, including information about drug tolerance, the possibility of developing physical and psychological dependence or addiction, and the warning signs of these conditions;

(7) emphasize to the student athlete, and the student’s parent or guardian, the importance of preventing the student athlete from
engaging in the unsupervised self-administration of the opioid medication; indicate that the student will be required to engage only in the supervised administration of the medication while on school grounds or under the authority of school officials, as provided by section 2 of P.L. , c. (C. ) (pending before the Legislature as this bill); and strongly encourage the parent or guardian to continue to supervise the student athlete’s administration of the medication when the student athlete is at home, or is otherwise not under the authority of school officials; and

(8) notify the school nurse of the fact that an opioid medication has been prescribed to the student athlete, and indicate the amount of medication prescribed, as well as the expected duration of the student’s opioid use.

c. Any pharmacist who dispenses opioid medication, in accordance with a prescription issued under this act, shall not dispense the medication directly to the student athlete, but shall instead require the parent or guardian of the student athlete to sign for, and accept possession of, the medication.

d. As used in this section:

“Opioid medication” means a Schedule II narcotic drug, available only with a prescription and generally prescribed for analgesic purposes, which binds to the body’s opioid receptor sites and produces opiate-like effects. “Opioid medication” includes, but is not limited to, hydrocodone, oxycodone, fentanyl, and any other similarly-acting prescription narcotic analgesic drug.

“Prescriber” means a licensed health care practitioner, including, but not limited to, a physician, advanced practice nurse, or physician assistant, who is authorized by law to prescribe medications, including opioid medications, as part of the practitioner’s scope of professional practice.

“School nurse” means a nurse who is responsible for providing health care services at the student athlete’s school.

“Student athlete” means a student, enrolled in a public or nonpublic elementary or secondary school, who participates in an interscholastic athletic program governed by the rules of the New Jersey State Interscholastic Athletic Association, or who engages in any other school-sponsored athletic activity, as defined by section 2 of P.L. , c. (C. ) (pending before the Legislature as this bill).

2. (New section) a. A student athlete shall be prohibited from engaging in the unsupervised self-administration of opioid medication while on school grounds, or while the student is otherwise subject to the direct oversight of school officials. Whenever a school nurse receives notice, pursuant to subsection b. of section 1 of P.L. , c. (C. ) (pending before the Legislature as this bill), indicating that opioid medication has been prescribed to a student athlete, the school nurse shall require the student athlete to turn over the supply of medication to the school nurse at the beginning of each school day, for the duration of time that the medication is authorized. On a daily basis during such period, the school nurse shall: (1) monitor the amount of opioid medication in the supply, in order to ensure that the student athlete is complying with the prescribed medication regimen; (2) supervise the student athlete’s administration of the medication during the school day, except as otherwise provided by subsection b. of this section; and (3) return the remaining supply of medication to the student at the end of the school day.

b. If a student athlete has a prescription for opioid medication, and is scheduled to be off school grounds for an off-site school-sponsored sporting event or other school-sponsored athletic activity, the school nurse shall provide an appropriate amount of the medication to the school’s athletic trainer who is directly responsible for overseeing the off-site event or activity, and the athletic trainer shall supervise the student athlete’s administration of the medication while the student athlete is present at the off-site location.

c. As used in this section:

“Athletic activity” means interscholastic athletics; an athletic contest or competition other than interscholastic athletics, which is sponsored by, or associated with, a school district or nonpublic school, including cheerleading and club-sponsored sporting activities; and any practice or interschool practice or scrimmage associated with those activities.

“Athletic trainer” means an adult employee of a public or nonpublic elementary or secondary school, who is licensed as an athletic trainer by the Board of Medical Examiners, pursuant to P.L.1984, c.203 (C.45:9-37.35 et seq.), and who satisfies all other requirements for certification and endorsement, which have been established by the Board of Education pursuant to section 5 of P.L.1999, c.87 (C.18A:26-2.5).

“School nurse” means a nurse who is responsible for providing health care services at the student athlete’s school.

3. Section 1 of P.L.1997, c.249 (C.45:9-22.19) is amended to read as follows:

1. a. Except in the case of an initial prescription issued pursuant to section 11 of P.L.2017, c.28 (C.24:21-15.2), and except as provided by subsection c. of this section, a physician licensed pursuant to chapter 9 of Title 45 of the Revised Statutes may prescribe a Schedule II controlled dangerous substance for the use of a patient in any quantity which does not exceed a 30-day supply, as defined by regulations adopted by the State Board of Medical Examiners in consultation with the Department of Health. The physician shall document the diagnosis and the medical need for the prescription in the patient's medical record, in accordance with guidelines established by the State Board of Medical Examiners.

b. Except in the case of an initial prescription issued pursuant to section 11 of P.L.2017, c.28 (C.24:21-15.2), and except as provided by subsection c. of this section, a physician may issue multiple prescriptions authorizing the patient to receive a total of up to a 90-day supply of a Schedule II controlled dangerous substance, provided that the following conditions are met:

(1) each separate prescription is issued for a legitimate medical purpose by the physician acting in the usual course of professional practice;

(2) the physician provides written instructions on each prescription, other than the first prescription if it is to be filled immediately, indicating the earliest date on which a pharmacy may fill each prescription;

(3) the physician determines that providing the patient with multiple prescriptions in this manner does not create an undue risk of diversion or abuse; and

(4) the physician complies with all other applicable State and federal laws and regulations.

c. Notwithstanding the provisions of subsections a. and b. of this section to the contrary, whenever a physician prescribes a Schedule II opioid medication for use by a student athlete, the physician shall comply with the prescribing parameters and requirements, and supply limitations, specified in section 1 of P.L. , c. (C. ) (pending before the Legislature as this bill). As used in this subsection, “opioid medication” and “student athlete” mean the same as those terms are defined pursuant to section 1 of P.L. , c. (C. ) (pending before the Legislature as this bill).

(cf: P.L.2017, c.28, s.12)

4. Section 10 of P.L.1991, c.378 (C.45:9-27.19) is amended to read as follows:

10. A physician assistant may order, prescribe, dispense, and administer medications and medical devices to the extent delegated by a supervising physician.

a. Controlled dangerous substances may only be ordered or prescribed if:

(1) a supervising physician has authorized a physician assistant to order or prescribe Schedule II, III, IV, or V controlled dangerous substances in order to:

(a) continue or reissue an order or prescription for a controlled dangerous substance issued by the supervising physician;

(b) otherwise adjust the dosage of an order or prescription for a controlled dangerous substance originally ordered or prescribed by the supervising physician, provided there is prior consultation with the supervising physician;

(c) initiate an order or prescription for a controlled dangerous substance for a patient, provided there is prior consultation with the supervising physician if the order or prescription is not pursuant to subparagraph (d) of this paragraph; or

(d) initiate an order or prescription for a controlled dangerous substance as part of a treatment plan for a patient with a terminal illness, which for the purposes of this subparagraph means a medical condition that results in a patient's life expectancy being 12 months or less as determined by the supervising physician;

(2) the physician assistant has registered with, and obtained authorization to order or prescribe controlled dangerous substances from, the federal Drug Enforcement Administration and any other appropriate State and federal agencies; [and]

(3) the physician assistant complies with all requirements which the board shall establish by regulation for the ordering, prescription, or administration of controlled dangerous substances, as well as all applicable educational program requirements, and all continuing professional education [programs approved] program requirements established pursuant to section 16 of P.L.1991, c.378 (C.45:9-27.25) ; and

(4) the physician assistant, if prescribing a Schedule II opioid medication for use by a student athlete, complies with the prescribing parameters and requirements, and supply limitations, established by section 1 of P.L. , c. (C. ) (pending before the Legislature as this bill). As used in this paragraph, “opioid medication” and “student athlete” mean the same as those terms are defined pursuant to section 1 of P.L. , c. (C. ) (pending before the Legislature as this bill).

b. (Deleted by amendment, P.L.2015, c.224)

c. (Deleted by amendment, P.L.2015, c.224)

d. In the case of an order or prescription for a controlled dangerous substance, the physician assistant shall print on the order or prescription the physician assistant's Drug Enforcement Administration registration number.

e. The dispensing of medication or a medical device by a physician assistant shall comply with relevant federal and State regulations, and shall occur only if: (1) pharmacy services are not reasonably available; (2) it is in the best interest of the patient; or (3) the physician assistant is rendering emergency medical assistance.

f. A physician assistant may request, receive, and sign for prescription drug samples and may distribute those samples to patients.

(cf: P.L.2015, c.224, s.7)

5. Section 10 of P.L.1991, c.377 (C.45:11-49) is amended to read as follows:

10. a. ‘In addition to all other tasks which a registered professional nurse may, by law, perform, an advanced practice nurse may manage preventive care services and diagnose and manage deviations from wellness and long-term illnesses, consistent with the needs of the patient and within the scope of practice of the advanced practice nurse, by:

(1) initiating laboratory and other diagnostic tests;

(2) prescribing or ordering medications and devices, as authorized by subsections b. and c. , and in accordance with the provisions of subsection g., of this section; and

(3) prescribing or ordering treatments, including referrals to other licensed health care professionals, and performing specific procedures in accordance with the provisions of this subsection.

b. An advanced practice nurse may order medications and devices in the inpatient setting, subject to the following conditions:

(1) the collaborating physician and advanced practice nurse shall address in the joint protocols whether prior consultation with the collaborating physician is required to initiate an order for a controlled dangerous substance;

(2) the order is written in accordance with standing orders or joint protocols developed in agreement between a collaborating physician and the advanced practice nurse, or pursuant to the specific direction of a physician;

(3) the advanced practice nurse authorizes the order by signing the nurse's own name, printing the name and certification number, and printing the collaborating physician's name;

(4) the physician is present or readily available through electronic communications;

(5) the charts and records of the patients treated by the advanced practice nurse are reviewed by the collaborating physician and the advanced practice nurse within the period of time specified by rule adopted by the Commissioner of Health pursuant to section 13 of P.L.1991, c.377 (C.45:11-52);

(6) the joint protocols developed by the collaborating physician and the advanced practice nurse are reviewed, updated, and signed at least annually by both parties; and

(7) the advanced practice nurse has completed six contact hours of continuing professional education in pharmacology related to controlled substances, including pharmacologic therapy, addiction prevention and management, and issues concerning prescription opioid drugs, including responsible prescribing practices, alternatives to opioids for managing and treating pain, and the risks and signs of opioid abuse, addiction, and diversion, in accordance with regulations adopted by the New Jersey Board of Nursing. The six contact hours shall be in addition to New Jersey Board of Nursing pharmacology education requirements for advanced practice nurses related to initial certification and recertification of an advanced practice nurse as set forth in N.J.A.C.13:37-7.2.

c. An advanced practice nurse may prescribe medications and devices in all other medically appropriate settings, subject to the following conditions:

(2) the prescription is written in accordance with standing orders or joint protocols developed in agreement between a collaborating physician and the advanced practice nurse, or pursuant to the specific direction of a physician;

(3) the advanced practice nurse writes the prescription on a New Jersey Prescription Blank pursuant to P.L.2003, c.280 (C.45:14-40 et seq.), signs the nurse's own name to the prescription and prints the nurse's name and certification number;

(4) the prescription is dated and includes the name of the patient and the name, address, and telephone number of the collaborating physician;

(5) the physician is present or readily available through electronic communications;

(6) the charts and records of the patients treated by the advanced practice nurse are periodically reviewed by the collaborating physician and the advanced practice nurse;

(7) the joint protocols developed by the collaborating physician and the advanced practice nurse are reviewed, updated, and signed at least annually by both parties; and

(8) the advanced practice nurse has completed six contact hours of continuing professional education in pharmacology related to controlled substances, including pharmacologic therapy, addiction prevention and management, and issues concerning prescription opioid drugs, including responsible prescribing practices, alternatives to opioids for managing and treating pain, and the risks and signs of opioid abuse, addiction, and diversion, in accordance with regulations adopted by the New Jersey Board of Nursing. The six contact hours shall be in addition to New Jersey Board of Nursing pharmacology education requirements for advanced practice nurses related to initial certification and recertification of an advanced practice nurse as set forth in N.J.A.C.13:37-7.2.

d. The joint protocols employed pursuant to subsections b. and c. of this section shall conform with standards adopted by the Director of the Division of Consumer Affairs pursuant to section 12 of P.L.1991, c.377 (C.45:11-51) or section 10 of P.L.1999, c.85 (C.45:11-49.2), as applicable.

e. (Deleted by amendment, P.L.2004, c.122.)

f. An attending advanced practice nurse may determine and certify the cause of death of the nurse's patient and execute the death certification pursuant to R.S.26:6-8 if no collaborating physician is available to do so and the nurse is the patient's primary caregiver.

g. When prescribing a Schedule II opioid medication for use by a student athlete, in accordance with the provisions of this section, the advanced practice nurse shall comply with the prescribing parameters and requirements, and supply limitations, established by section 1 of P.L. , c. (C. ) (pending before the Legislature as this bill). As used in this subsection, “opioid medication” and “student athlete” mean the same as those terms are defined pursuant to section 1 of P.L. , c. (C. ) (pending before the Legislature as this bill).

(cf: P.L.2017, c.28, s.15)

6. The Commissioner of Health, in consultation with the Commissioner of Education, shall adopt rules and regulations, pursuant to the “Administrative Procedure Act,” P.L.1968, c.410 (C.52:14B-1 et seq.), as may be necessary to implement the provisions of this act.

7. This act shall take effect immediately.

STATEMENT

In order to protect against the occurrence of opioid addiction in student athletes, who regularly suffer from pain and injuries that necessitate the prescription of pain relief medications, this bill would establish certain limitations and requirements to restrict the prescription and dispensation of opioid medications to student athletes, and to provide for the close monitoring of a student athlete’s use of such medications.

The bill would define the term “student athlete” to mean: a student, enrolled in a public or nonpublic elementary or secondary school, who participates in an interscholastic athletic program governed by the rules of the New Jersey State Interscholastic Athletic Association, or who engages in any other school-sponsored athletic activity.

Pursuant to the bill’s provisions, a prescriber – including a licensed physician, advanced practice nurse, or physician assistant – would be required to exercise extreme caution when determining whether to prescribe opioid medication in the course of treatment afforded to a student athlete. The prescriber would be required to make every reasonable effort to utilize non-narcotic drugs, including acetaminophen, non-steroidal anti-inflammatory medications, and salicylates, as well as non-medicine alternatives such as cryotherapy and transcutaneous nerve stimulation, as an alternative to opioid medication.

Whenever a prescriber determines that such alternative treatments are insufficient to address the student athlete’s medical needs, and prescribes an opioid medication for the treatment of the student athlete’s injury or pain, the prescriber would be required to:

– make every effort to ensure the student athlete’s safe use of the opioid medication;

– prescribe no more than a seven-day, non-refillable supply;

– indicate, on the face of the prescription blank, that the prescription is being issued for a student athlete, pursuant to the bill’s provisions;

– provide the completed prescription blank to the student athlete’s parent or guardian, as opposed to providing it directly to the student athlete;

– provide the student athlete’s parent or guardian with instructions as to how to administer the opioid medication and the ways in which the parent or guardian can engage in medication monitoring, on a daily basis, to determine the continued need for, and effectiveness of, the medication;

– provide the student athlete, and the student’s parent or guardian, with information or educational materials regarding the risks that are associated with the use of opioid medication, including information about drug tolerance, the possibility of developing physical and psychological dependence or addiction, and the warning signs of these conditions;

– emphasize to the student athlete, and the student’s parent or guardian, the importance of preventing the student athlete from engaging in the unsupervised self-administration of the opioid medication; indicate that the student will be required to engage only in the supervised administration of the drug supply while on school grounds or under the authority of school officials, as provided by section 2 of the bill; and strongly encourage the parent or guardian to continue to supervise the student athlete’s administration of the opioid drug supply when the student athlete is at home, or is otherwise not under the authority of school officials; and

– notify the school nurse of the fact that an opioid medication has been prescribed to the student athlete, and indicate the amount of medication prescribed, as well as the expected duration of the student’s opioid use.

The bill would prohibit a pharmacist from dispensing a prescribed opioid medication directly to a student athlete, and would require the pharmacist, instead, to require the parent or guardian of the student athlete to sign for, and accept possession of, the medication.

The bill specifies that a student athlete is to be prohibited from engaging in the unsupervised self-administration of an opioid medication while on school grounds, or while otherwise subject to the direct oversight of school officials. Any school nurse who receives notice from a prescriber about a student athlete’s prescription for opioid medication, as provided by the bill, is to require the student athlete to turn over the supply of opioid medication to the school nurse at the beginning of each school day, for the duration of time that the medication is authorized. On a daily basis during such period, the school nurse would be required to: monitor the amount of opioid medication in the supply, in order to ensure that the student athlete is complying with the prescribed medication regimen; supervise the student athlete’s administration of the medication during the school day, except in the circumstances described below; and return the remaining supply of opioid medication to the student at the end of the school day.

If a student athlete has a prescription for opioid medication and is scheduled to be off school grounds for an off-site school-sponsored sporting event or other athletic activity, the bill would require the school nurse to provide an appropriate amount of the opioid medication to the school’s athletic trainer who is directly responsible for overseeing the off-site event or activity, and the athletic trainer would be required to supervise the student athlete’s administration of the drug while the student athlete is present at the off-site location.