DEPARTMENT OF HEALTH

(Board of Osteopathic Medicine and Surgery)

[Filed January 21, 2020, 8:53 a.m., effective February 21, 2020]

Effective Date of Rule: Thirty-one days after filing.

Purpose: WAC 246-853-675 (osteopathic physicians) Patient notification, secure storage, and disposal, the board of osteopathic medicine and surgery (board) adopted amendments to establish patient notification, documentation, counseling requirements, and right to refuse an opioid prescription or order for any reason, when prescribing opioid drugs, as directed by sections 5 and 6, codified as RCW 18.57.810, 18.57A.810, and section 17, codified as RCW 69.50.317, of SSB 5380 (chapter 314, Laws of 2019). The board also adopted clarifications of when notification is not required.

Citation of Rules Affected by this Order: Amending WAC 246-853-675.

Statutory Authority for Adoption: RCW 18.57.005.

Other Authority: RCW 18.57.810, 18.57A.810, and 69.50.317.

Adopted under notice filed as WSR 19-21-083 on October 14, 2019.

Changes Other than Editing from Proposed to Adopted Version: The board determined to add a reference to RCW 69.50.317 (1)(b) and WAC 246-853-680 Use of alternative modalities for pain treatment, into WAC 246-853-675 (3)(a) for clarity.

A final cost-benefit analysis is available by contacting Tracie Drake, P.O. Box 47852, Olympia, WA 98504-7852, phone 360-236-4766, fax 360-236-2901, TTY 360-833-6388 or 711, email tracie.drake@doh.wa.gov, website www.doh.wa.gov.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 1, Repealed 0.

Number of Sections Adopted at the Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's own Initiative: New 0, Amended 0, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

Number of Sections Adopted using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 1, Repealed 0.

Date Adopted: December 6, 2019.

AMENDATORY SECTION(Amending WSR 18-20-087, filed 10/1/18, effective 11/1/18)

WAC 246-853-675Patient notification, secure storage, and disposal.

(1) The osteopathic physician shall ((provide information to))discuss with the patient educating them of risks associated with the use of opioids, including the risk of dependence and overdose, as appropriate to the medical condition, type of patient, and phase of treatment. The osteopathic physician shall document such notification in the patient record.

(2) Patient notification must occur, at a minimum, at the following points of treatment:

(a) The first issuance of a prescription for an opioid; and

(b) The transition between phases of treatment, as follows:

(i) Acute nonoperative pain or acute perioperative pain to subacute pain; and

(ii) Subacute pain to chronic pain.

(3) Patient written notification must include information regarding:

(a) Pain management alternatives to opioid medications as provided in RCW 69.50.317 (1)(b) and WAC 246-853-680;

(b) The safe and secure storage of opioid prescriptions; ((and

(b)))(c) The proper disposal of unused opioid medications including, but not limited to, the availability of recognized drug take-back programs; and

(d) The patient's right to refuse an opioid prescription or order for any reason. If a patient indicates a desire to not receive an opioid, the osteopathic physician shall document the patient's request and avoid prescribing or ordering opioids, unless the request is revoked by the patient.

(4) The requirements in this section do not apply to the administration of an opioid including, but not limited to, the following situations:

(a) Emergent care;

(b) Where patient pain represents a significant health risk;

(d) When the patient is unable to grant or revoke consent; or

(e) MAT for substance use disorders.

(5) If the patient is under eighteen years old or is not competent, the discussion required by subsection (1) of this section must include the patient's parent, guardian, or the person identified in RCW 7.70.065, unless otherwise provided by law.

(6) The requirements of this section may be satisfied with a document provided by the department of health.

(7) The requirements of this section may be satisfied by an osteopathic physician designating any individual who holds a credential issued by a disciplining authority under RCW 18.130.040 to provide the information.