DEPARTMENT OF HEALTH

(Medical Quality Assurance Commission)

[Filed January 28, 2020, 9:29 a.m., effective February 28, 2020]

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

Purpose: WAC 246-919-865 (physicians) Patient notification, secure storage, and disposal and 246-918-815 (physician assistants) Patient notification, secure storage, and disposal. The Washington medical commission (commission) 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 8 and 9, codified as RCW 18.71.810, 18.71A.810, and section 17, codified as RCW 69.50.317, of SSB 5380 (chapter 314, Laws of 2019). The commission also adopted clarifications of when notification is not required.

Citation of Rules Affected by this Order: Amending WAC 246-919-865 and 246-918-815.

Statutory Authority for Adoption: RCW 18.71.017, 18.71.810, 18.71A.810.

Other Authority: RCW 69.50.317.

Adopted under notice filed as WSR 19-21-143 on October 22, 2019.

A final cost-benefit analysis is available by contacting Amelia Boyd, P.O. Box 47866, Olympia, WA 98504-7866, phone 360-236-2727, TTY 360-833-6388 or 711, email amelia.boyd@wmc.wa.gov, website wmc.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Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 2, Repealed 0.

Number of Sections Adopted at the Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's own Initiative: New 0, Amended 0, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

Number of Sections Adopted using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 2, Repealed 0.

Date Adopted: December 12, 2019.

AMENDATORY SECTION(Amending WSR 18-23-061, filed 11/16/18, effective 1/1/19)

WAC 246-918-815Patient notification, secure storage, and disposal.

(1) The physician assistant shall ((ensure))discuss with the patient ((is provided)) the following information at the first issuance of a prescription for opioids and at the transition from acute to subacute, and subacute to chronic:

(a) Risks associated with the use of opioids, including the risk of dependence and overdose, as appropriate to the medical condition, the type of patient, and the phase of treatment;

(b) Pain management alternatives to opioids, including nonopioid pharmacological and nonpharmacological treatments, whenever reasonable, clinically appropriate, evidence-based alternatives exist;

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

(2))); and

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

(2) The requirements in subsection (1) of this section do not apply to the administration of an opioid including, but not limited to, the following situations as documented in the patient record:

(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.

(3) 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.

(4) The physician assistant shall document completion of the requirements in subsection (1) of this section in the patient's health care record.

(5) The information in subsection (1) of this section must also be provided in writing. This requirement may be satisfied with a document provided by the department of health.

(6) To fulfill the requirements of subsection (1) of this section, a physician assistant may designate any individual who holds a credential issued by a disciplining authority under RCW 18.130.040 to provide the information.

AMENDATORY SECTION(Amending WSR 18-23-061, filed 11/16/18, effective 1/1/19)

WAC 246-919-865Patient notification, secure storage, and disposal.

(1) The physician shall ((ensure the patient is provided))discuss with the patient the following information at the first issuance of a prescription for opioids and at the transition from acute to subacute, and subacute to chronic:

(a) Risks associated with the use of opioids, including the risk of dependence and overdose, as appropriate to the medical condition, the type of patient, and the phase of treatment;

(b) Pain management alternatives to opioids, including nonopioid pharmacological and nonpharmacological treatments, whenever reasonable, clinically appropriate, evidence-based alternatives exist;

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

(2))); and

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

(2) The requirements in subsection (1) of this section do not apply to the administration of an opioid including, but not limited to, the following situations as documented in the patient record:

(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.

(4) The physician shall document completion of the requirements in subsection (1) of this section in the patient's health care record.

(5) The information in subsection (1) of this section must also be provided in writing. This requirement may be satisfied with a document provided by the department of health.

(6) To fulfill the requirements of subsection (1) of this section, a physician may designate any individual who holds a credential issued by a disciplining authority under RCW 18.130.040 to provide the information.