[Second Reprint]

SENATE, No. 3240

STATE OF NEW JERSEY

218th LEGISLATURE

INTRODUCED DECEMBER 3, 2018

Sponsored by:

Senator  ROBERT W. SINGER

District 30 (Monmouth and Ocean)

Senator  NICHOLAS P. SCUTARI

District 22 (Middlesex, Somerset and Union)

Assemblyman  JOHN ARMATO

District 2 (Atlantic)

Assemblyman  RAJ MUKHERJI

District 33 (Hudson)

Assemblywoman  CAROL A. MURPHY

District 7 (Burlington)

Assemblyman  SEAN T. KEAN

District 30 (Monmouth and Ocean)

Assemblyman  CLINTON CALABRESE

District 36 (Bergen and Passaic)

Assemblyman  EDWARD H. THOMSON

District 30 (Monmouth and Ocean)

Co-Sponsored by:

Senator Greenstein, Assemblywomen Vainieri Huttle, Jimenez, McKnight, Downey, Assemblymen Houghtaling and Conaway

SYNOPSIS

      “Charlie’s Law”; requires pharmacy practice sites and hospice programs to furnish patients with information and products to safely dispose of unused prescription drugs and medications.

CURRENT VERSION OF TEXT

     As reported by the Assembly Health and Senior Services Committee on February 7, 2019, with amendments.

An Act concerning prescription medications ²[and] ,² supplementing ²[Title 24 and]² Title 45 of the Revised Statutes ², and amending P.L.2017, c.135.

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

²[1.  a.  A health care professional authorized to issue prescriptions shall, when issuing any prescription for a drug or medication which is a controlled dangerous substance, and when issuing a prescription for any other prescription drug or medication as may be designated by the Commissioner of Health by regulation:

     (1)   provide the patient with ¹[oral instructions and]¹ written informational materials advising that when unused, unwanted, or expired drugs and medications are not properly, safely, and promptly disposed of:

     (a)   there is a risk that the drug or medication can be stolen, diverted, abused, misused, or accidentally ingested, which can pose a risk to the health and safety of the patient and other members of the patient’s household;

     (b)   children are particularly at risk of accidentally ingesting unused, unwanted, and expired medications that have not been properly, safely, and promptly disposed of;

     (c)   when drugs or medications are disposed of in the household trash or flushed down the drain, the drugs and medications can leak into the ecosystem, which can have a potentially adverse or harmful effect on the environment; and

     (d)   when drugs or medications are disposed of in the household trash without the drug or medication having been rendered deactivated, inaccessible, or otherwise unpalatable, the drug or medication may be stolen by individuals seeking to divert, abuse, or misuse the drug or medication;

     (2)   offer to make available for purchase, or furnish at no cost to the patient, a product that can be used to permanently sequester or deactivate unused, unwanted, or expired drugs and medications for the purpose of safely disposing of the drugs and medications; and

     (3)   provide the patient with ¹[oral and]¹ written ¹[instructions on] informational materials concerning¹ how to properly, safely, and promptly dispose of unused, unwanted, or expired drugs and medications, which may include, but shall not be limited to, ¹[providing]¹ instructions concerning the use of a product furnished to the patient pursuant to paragraph (2) of this subsection ¹[, and advising the patient of] and information concerning¹ the availability of secure prescription medication drop-off receptacles and prescription medication take back programs. ¹The health care professional, or an appropriate designee, shall answer any questions the patient may have upon receiving the written informational materials pursuant to this paragraph.¹

     The requirements of this subsection shall apply to each prescription issued by the health care professional, regardless of whether the prescription is being issued to a new or existing patient, regardless of whether the prescription is for a new drug or medication or renews or refills a current prescription, and regardless of the health care setting in which the prescription is issued.

      b.   At such time as any change is made to a patient’s course of treatment that results in a change in the drugs or medications prescribed for the patient, or in the patient discontinuing the use of a prescription drug or medication, the health care professional providing care or treatment to the patient shall:

     (1)   provide the patient with ¹[oral instructions and]¹ written informational materials advising that when unused, unwanted, or expired drugs and medications are not properly, safely, and promptly disposed of:

     (a)   there is a risk that the drug or medication can be stolen, diverted, abused, misused, or accidentally ingested, which can pose a risk to the health and safety of the patient and other members of the patient’s household;

     (b)   children are particularly at risk of accidentally ingesting unused, unwanted, and expired medications that have not been properly, safely, and promptly disposed of;

     (c)   when drugs or medications are disposed of in the household trash or flushed down the drain, the drugs and medications can leak into the ecosystem, which can have a potentially adverse or harmful effect on the environment; and

     (d)   when drugs or medications are disposed of in the household trash without the drug or medication having been rendered deactivated, inaccessible, or otherwise unpalatable, the drug or medication may be stolen by individuals seeking to divert, abuse, or misuse the drug or medication;

     (2)   offer to make available for purchase, or furnish at no cost to the patient, a product that can be used to permanently sequester or deactivate unused, unwanted, or expired drugs and medications for the purpose of safely disposing of the drugs and medications; and

     (3)   provide the patient with ¹[oral and]¹ written ¹[instructions on] informational materials concerning¹ how to properly, safely, and promptly dispose of unused, unwanted, or expired drugs and medications, which may include, but shall not be limited to, ¹[providing]¹ instructions concerning the use of a product furnished to the patient pursuant to paragraph (2) of this subsection ¹[, and advising the patient of] and information concerning¹ the availability of secure prescription medication drop-off receptacles and prescription medication take back programs. ¹The health care professional, or an appropriate designee, shall answer any questions the patient may have upon receiving the written informational materials pursuant to this paragraph.¹

     The requirements of this subsection shall apply to any change to a patient’s course of treatment that results in a change in the drugs or medications prescribed for the patient, or in the patient discontinuing the use of a prescription drug or medication, regardless of whether the patient is a new or existing patient, and regardless of the health care setting in which the care or treatment is provided.

     c.     Any time a health care professional authorized to issue prescriptions issues a prescription for a hypodermic syringe or needle or for any drug or other medication which is to be administered using a hypodermic syringe or needle, the health care professional shall provide the patient with ¹[oral instructions and] the¹ written informational materials ¹prepared by the Division of Consumer Affairs in the Department of Law and Public Safety pursuant to section 3 of this act¹ concerning the safe disposal of used hypodermic syringes and needles so as to prevent against the potential transmission of bloodborne pathogens that can occur when used hypodermic syringes and needles are reused or when they cause accidental injury.  ¹The health care professional, or an appropriate designee, shall answer any questions the patient may have upon receiving the written informational materials pursuant to this subsection.¹]²

²[2.  a.  A pharmacy practice site or health care professional that dispenses prescription drugs, other than a long-term care pharmacy, shall, when dispensing to an individual located in this State a prescription drug or medication which is a controlled dangerous substance, and when dispensing any other prescription drug or medication as may be designated by the Commissioner of Health by regulation:

     (1)   provide the patient with ¹[oral instructions and]¹ written informational materials advising that when unused, unwanted, or expired drugs and medications are not properly, safely, and promptly disposed of:

     (a)   there is a risk that the drug or medication can be stolen, diverted, abused, misused, or accidentally ingested, which can pose a risk to the health and safety of the patient and other members of the patient’s household;

     (b)   children are particularly at risk of accidentally ingesting unused, unwanted, and expired medications that have not been properly, safely, and promptly disposed of;

     (c)   when drugs or medications are disposed of in the household trash or flushed down the drain, the drugs and medications can leak into the ecosystem, which can have a potentially adverse or harmful effect on the environment; and

     (d)   when drugs or medications are disposed of in the household trash without the drug or medication having been rendered deactivated, inaccessible, or otherwise unpalatable, the drug or medication may be stolen by individuals seeking to divert, abuse, or misuse the drug or medication;

     (2)   offer to make available for purchase, or furnish at no cost to the patient, a product that can be used to permanently sequester or deactivate unused, unwanted, or expired drugs and medications for the purpose of safely disposing of the drugs and medications; and

     (3)   provide the patient with ¹[oral and]¹ written ¹[instructions on] informational materials concerning¹ how to properly, safely, and promptly dispose of unused, unwanted, or expired drugs and medications, which may include, but shall not be limited to, ¹[providing]¹ instructions concerning the use of a product furnished to the patient pursuant to paragraph (2) of this subsection ¹[, and advising the patient of] and information concerning¹ the availability of secure prescription medication drop-off receptacles and prescription medication take back programs.  ¹The individual dispensing the prescription drug, or an appropriate designee, shall answer any questions the patient may have upon receiving the written informational materials pursuant to this paragraph.¹

     b.    The requirements of subsection a. of this section shall apply regardless of whether the prescription is an initial prescription or a renewal or refill of an existing prescription, and regardless of whether the patient is a new or returning customer at the pharmacy practice site or is a new or existing patient of the health care professional.

     c.     Any time a pharmacy practice site or health care professional that dispenses prescription drugs, other than a long-term care pharmacy, sells or dispenses a hypodermic syringe or needle, regardless of whether the hypodermic syringe or needle is sold or dispensed pursuant to a prescription, the pharmacy practice site or health care professional shall provide the patient with ¹[oral instructions and] the¹ written informational materials ¹prepared by the Division of Consumer Affairs in the Department of Law and Public Safety pursuant to section 3 of this act¹ concerning the safe disposal of used hypodermic syringes and needles so as to prevent against the potential transmission of bloodborne pathogens that can occur when used hypodermic syringes and needles are reused or when they result in accidental injury.  ¹The individual selling or dispensing the hypodermic syringe or needle, or an appropriate designee, shall answer any questions the patient may have upon receiving the written informational materials pursuant to this subsection.¹]²

²[¹3.  The Division of Consumer Affairs in the Department of Law and Public Safety shall prepare written informational materials for distribution to patients by health care professionals and pharmacy practice sites concerning the safe disposal of used hypodermic syringes and needles so as to prevent against the potential transmission of bloodborne pathogens that can occur when used hypodermic syringes and needles are reused or when they result in accidental injury.  The written informational materials shall be made available through the division’s Internet website and shall be distributed to health care professionals and pharmacy practice sites upon request.¹]²

²1.  (New section)  a.  A pharmacy practice site that dispenses prescription drugs, other than a long-term care pharmacy, shall, when dispensing to an individual located in this State a prescription drug or medication which is a controlled dangerous substance, and when dispensing any other prescription drug or medication as may be designated by the Commissioner of Health by regulation:

(1)  provide the patient with written informational materials advising that when unused, unwanted, or expired drugs and medications are not properly, safely, and promptly disposed of:

(a)  there is a risk that the drug or medication can be stolen, diverted, abused, misused, or accidentally ingested, which can pose a risk to the health and safety of the patient and other members of the patient’s household;

(b)  children are particularly at risk of accidentally ingesting unused, unwanted, and expired medications that have not been properly, safely, and promptly disposed of;

(c)  when drugs or medications are disposed of in the household trash or flushed down the drain, the drugs and medications can leak into the ecosystem, which can have a potentially adverse or harmful effect on the environment; and

(d) when drugs or medications are disposed of in the household trash without the drug or medication having been rendered deactivated, inaccessible, or otherwise unpalatable, the drug or medication may be stolen by individuals seeking to divert, abuse, or misuse the drug or medication;

(2)  offer to make available for purchase, or furnish at no cost to the patient, a nontoxic composition that can be used to permanently sequester or deactivate unused, unwanted, or expired drugs and medications for the purpose of safely disposing of the drugs and medications; and

(3)  provide the patient with written informational materials concerning how to properly, safely, and promptly dispose of unused, unwanted, or expired drugs and medications, which may include, but shall not be limited to, instructions concerning the use of a product furnished to the patient pursuant to paragraph (2) of this subsection and information concerning the availability of secure prescription medication drop-off receptacles and prescription medication take back programs.  The individual dispensing the prescription drug, or an appropriate designee, shall answer any questions the patient may have upon receiving the written informational materials pursuant to this paragraph.

b.   The requirements of subsection a. of this section shall apply regardless of whether the prescription is an initial prescription or a renewal or refill of an existing prescription, and regardless of whether the patient is a new or returning customer at the pharmacy practice site.

c.   Any time a pharmacy practice site that dispenses prescription drugs, other than a long-term care pharmacy, sells or dispenses a hypodermic syringe or needle, regardless of whether the hypodermic syringe or needle is sold or dispensed pursuant to a prescription, the pharmacy practice site shall provide the patient with the written informational materials prepared by the Division of Consumer Affairs in the Department of Law and Public Safety pursuant to section 3 of this act concerning the safe disposal of used hypodermic syringes and needles so as to prevent against the potential transmission of bloodborne pathogens that can occur when used hypodermic syringes and needles are reused or when they result in accidental injury.  The individual selling or dispensing the hypodermic syringe or needle, or an appropriate designee, shall answer any questions the patient may have upon receiving the written informational materials pursuant to this subsection.²

²2. Section 1 of P.L.2017, c.135 (C.26:2H-81.1) is amended to read as follows:

      1. a.  As used in this section:

      "Family member" means a hospice care patient's spouse, parent, adult sibling, adult child, or adult grandchild.

      "Health care representative" means a person, including a member of the patient's family, who is authorized to make health care decisions on behalf of a hospice care patient.

      "Hospice care patient" means a person currently receiving hospice care services in a private home or an assisted living facility through a licensed hospice care program.

      "Third party caregiver" means a person who:

      (1)  is 18 years of age or older;

      (2)  provides care or assistance to a hospice care patient; and

      (3)  is not the patient's health care representative, a family member of the patient, or employed by the patient's hospice care program.

      b.   A hospice care program licensed pursuant to P.L.1997, c.78 (C.26:2H-79 et seq.) may choose, but shall not be required, to accept for disposal, at such time as a hospice care patient ceases to use the drug or medication or ceases to receive hospice care services through the program, the hospice care patient's unused prescription drugs and medications.  A hospice care program that chooses to accept unused prescription drugs and medications for disposal pursuant to this section shall:

      (1)  Establish a written policy setting forth procedures for accepting and disposing of unused prescription drugs and medications;

      (2)  Furnish a copy of the written policy to each patient, and to the patient's health care representative, at the time the patient is enrolled in the hospice care program, and designate a program representative who shall discuss the procedures and requirements for surrendering unused prescription drugs and medications with the patient and the patient's health care representative;

      (3)  Accept drugs and medications prescribed and dispensed to the patient pursuant to the patient's hospice care plan, as well as any other prescription drugs and medications that the patient, or the patient's health care representative, chooses to surrender to the program;

      (4)  Not accept any drug or medication for surrender except at such time as the patient ceases to use the drug or medication or ceases to receive hospice care services through the program; [and]

      (5)  Obtain any certifications, authorizations, or waivers as may be required under State or federal law in order to accept and dispose of unused prescription drugs and medications pursuant to this section; and

(6)  (a) at the time the patient is enrolled in the hospice care program, at such time as any change is made to the patient’s course of treatment that results in a change in the drugs or medications prescribed for the patient, or in the patient discontinuing the use of a prescription drug or medication, and at such time as the patient ceases to receive hospice care services through the program, provide the patient or the patient’s health care representative with oral instructions and written informational materials advising that when unused, unwanted, or expired drugs and medications are not properly, safely, and promptly disposed of:

(i)   there is a risk that the drug or medication can be stolen, diverted, abused, misused, or accidentally ingested, which can pose a risk to the health and safety of the patient and other members of the patient’s household;

(ii)  children are particularly at risk of accidentally ingesting unused, unwanted, and expired medications that have not been properly, safely, and promptly disposed of;

(iii) when drugs or medications are disposed of in the household trash or flushed down the drain, the drugs and medications can leak into the ecosystem, which can have a potentially adverse or harmful effect on the environment; and

(iv) when drugs or medications are disposed of in the household trash without the drug or medication having been rendered deactivated, inaccessible, or otherwise unpalatable, the drug or medication may be stolen by individuals seeking to divert, abuse, or misuse the drug or medication;

(b)  offer to make available for purchase, or furnish at no cost to the patient, a nontoxic composition that can be used to permanently sequester or deactivate unused, unwanted, or expired drugs and medications for the purpose of safely disposing of the drugs and medications; and

(c)  provide the patient with oral and written instructions on how to properly, safely, and promptly dispose of unused, unwanted, or expired drugs and medications, which may include, but shall not be limited to, providing instructions concerning the use of a nontoxic composition furnished to the patient pursuant to subparagraph (b) of this paragraph, and advising the patient of the availability of secure prescription medication drop-off receptacles and prescription medication take back programs.

      c.   At the time a hospice care patient ceases to receive hospice care services, a program representative shall provide a written request for surrender of unused [medication] drugs and medications to the patient or the patient's health care representative, which shall:

      (1)  request that the patient or the patient's health care representative surrender any unused prescription drugs or medications that were prescribed and dispensed to the patient pursuant to the patient's hospice care plan;

      (2)  offer to accept and dispose of any other prescription drug or medication which the patient will not use; and

      (3)  urge that the patient or the patient's health care representative dispose of any unused prescription drug or medication that is not surrendered to the program in a safe and legal manner, so as to avoid the risk of theft, diversion, or accidental ingestion.

      d.   No hospice care program may accept and dispose of an unused prescription drug or medication pursuant to this section unless the patient or the patient's health care representative authorizes, in writing, the surrender of the unused prescription drug or medication to the program; except that, if the patient is unable to provide written authorization and the patient does not have a health care representative, a third party caregiver may provide written authorization for the surrender.  A hospice care program shall not accept an unused prescription drug or medication unless the drug or medication is identified for inclusion in the authorization for surrender.

      e.  (1)  Unused prescription drugs and medications surrendered to a hospice care program pursuant to this section shall be surrendered to a registered professional nurse or a licensed practical nurse employed by the program.

      (2)  A nurse accepting the surrender of unused prescription [medication] drugs or medications pursuant to this section shall dispose of the drugs or medications at the site where hospice care was provided; in no case shall the nurse transport the unused prescription medications off-site for disposal or for any other purpose.  The nurse may dispose of the unused drugs or medications using a nontoxic composition that can be used to permanently sequester or deactivate unused, unwanted, or expired drugs and medications for the purpose of safely disposing of the drugs and medications.

      (3)  A nurse who accepts and disposes of an unused prescription drug or medication pursuant to this section shall document:

      (a)  the name and quantity of each drug or medication surrendered;

      (b)  the name of the person authorizing the surrender, and the relationship of the person to the patient;

      (c)  the date and method of disposal; and

      (d) the quantity and type of any unused prescription drug or medication, of which the nurse is aware, that was prescribed and dispensed to the patient pursuant to the patient's hospice care plan, but was not surrendered to the program or otherwise disposed of by another person in the nurse's presence.

      (4)  The person authorizing the surrender of a drug or medication shall be provided with the opportunity to review, verify, and sign the documentation required under paragraph (3) of this subsection.

      f.    Nothing in this section shall prohibit any person from disposing of an unused prescription drug or medication by any means authorized by law, including, but not limited to, disposing of the drug or medication using a nontoxic composition that can be used to permanently sequester or deactivate unused, unwanted, or expired drugs and medications for the purpose of safely disposing of the drugs and medications or surrendering the medication at a secure prescription medication drop-off receptacle.

      g.   No person shall be subject to civil or criminal liability or professional disciplinary action for any act or omission undertaken in good faith consistent with the requirements of this section.²

(cf: P.L.2017, c.135, s.1)

²3. (New section) The Division of Consumer Affairs in the Department of Law and Public Safety shall prepare written informational materials for distribution to patients by hospice care programs and pharmacy practice sites concerning the safe disposal of used hypodermic syringes and needles so as to prevent against the potential transmission of bloodborne pathogens that can occur when used hypodermic syringes and needles are reused or when they result in accidental injury.  The written informational materials shall be made available through the division’s Internet website and shall be distributed to hospice care programs and pharmacy practice sites upon request.²

¹[3.] 4.¹    This act shall take effect ¹[30] 90¹ days after the date of enactment.