On June 14, 2018, Connecticut Governor Dannel P. Malloy signed into law Public Act No. 18-166 “An Act Concerning the Prevention and Treatment of Opioid Dependency and Opioid Overdoses in the State” (PA 18-166).
This legislation seeks to address the ongoing opioid crisis in Connecticut in part by: (i) implementing a new opioid overdose reporting requirement for hospitals and emergency medical services (EMS) personnel, (ii) establishing a statutory framework under which health care practitioners and pharmacists may partner with law enforcement or other government agencies, EMS providers, or community health organizations to expand distribution and availability of naloxone and similar drugs, (iii) enacting statutory limitations on the circumstances in which providers may prescribe controlled substances for family members or themselves, and (iv) commissioning a study of the feasibility of opioid intervention courts. This legislation has varying effective dates, which are noted below.
Hospital and EMS Reporting of Opioid Overdoses – Effective July 1, 2018
PA 18-166 requires all Connecticut-licensed hospitals and EMS personnel that treat a patient for an overdose of an opioid drug to report such overdose to the Department of Public Health (DPH) starting January 1, 2019. The form and manner of the overdose report will be established by DPH.
The term “opioid drug” is defined for purposes of this new reporting requirement by reference to the definition under 42 C.F.R. § 8.2, which in turn defines “opioid drug” as “any drug having an addiction-forming or addiction-sustaining liability similar to morphine or being capable of conversion into a drug having such addiction-forming or addiction-sustaining liability.”
Limits on Prescriptions for Family Members and Own Use – Effective July 1, 2018
Currently, Conn. Gen. Stat. § 21a-252 sets forth the general circumstances in which licensed practitioners – such as physicians, dentists, podiatrists, advanced practice registered nurses, nurse-midwives, and physician assistants – may prescribe, dispense and administer certain controlled substances in Connecticut. PA 18-166 amends that statute to newly provide that a prescribing practitioner may not prescribe, dispense or administer controlled substances in Schedules II, III or IV to a member of the prescribing practitioner’s immediate family, except in an emergency.
In an emergency, PA 18-166 allows a prescribing practitioner to prescribe, dispense or administer not more than a 72-hour supply of such a controlled substance to an immediate family member only when no other qualified prescribing practitioner is available. In the event a prescribing practitioner prescribes, dispenses or administers a Schedule II-IV controlled substance to an immediate family member in an emergency, PA 18-166 requires the practitioner to perform an assessment for the care and treatment of the patient, medically evaluate the patient’s need for controlled substances, and document such assessment and need in the normal course of the practitioner’s business. The prescribing practitioner must also document the emergency that gave rise to the prescription, dispensation or administration to the immediate family member.
Finally, PA 18-166 prohibits a prescribing practitioner from prescribing, dispensing or administering controlled substances in Schedules II, III or IV for his or her own use, except in an emergency. In an emergency, a prescribing practitioner may prescribe, dispense or administer a 72-hour supply of such a controlled substance only when no other qualified prescribing practitioner is available.
For purposes of PA 18-166, a prescribing practitioner is defined as a “physician, dentist, podiatrist, optometrist, physician assistant, advanced practice registered nurse, nurse-midwife or veterinarian licensed by the state of Connecticut and authorized to prescribe medication within the scope of such person’s practice” and an “immediate family member” means a “spouse, parent, child, sibling, parent-in-law, son or daughter-in-law, brother or sister-in-law, step-parent, step-child, step-sibling or other relative residing in the same residence as the prescribing practitioner.” Interestingly, an “immediate family member” does not include an animal residing in a prescribing practitioner’s residence.
Arrangements Between Prescribing Practitioners and Governmental/Community Agencies to Combat Opioid Overdoses – Effective July 1, 2018
PA 18-166 newly allows a prescribing practitioner, or a pharmacist certified to prescribe naloxone under Connecticut law, to enter into an agreement related to the distribution and administration of an opioid antagonist for the reversal of an opioid overdose with a law enforcement agency, EMS provider, government agency, or community health organization. The prescribing practitioner or pharmacist must train persons who will distribute or administer the opioid antagonist under the agreement, and such persons (e.g., police officers) must receive training prior to distributing or administering an opioid antagonist. The agreement must address storage, handling, labeling, recalls and recordkeeping of opioid antagonists by the law enforcement or other government agency, the EMS provider, or the community health organization, that is party to the agreement.
PA 18-166 also provides that a prescribing practitioner or pharmacist that enters into such an agreement will not be liable for damages in a civil action or subject to administrative or criminal prosecution for the administration and dispensing of an opioid antagonist by the law enforcement or other government agency, EMS provider, or community health organization that is party to the agreement.
For purposes of this legislation, the term “opioid antagonist” refers to “naloxone hydrochloride or any other similarly acting and equally safe drug approved by the federal Food and Drug Administration for the treatment of drug overdose.”
Study of Feasibility of Opioid Intervention Courts – Effective from Passage
This legislation also charges the Chief Court Administrator (or his or her designee) with responsibility for studying the feasibility of establishing opioid intervention courts in Connecticut that would specialize in hearing criminal or juvenile matters in which the defendant is an opioid-dependent person and could benefit from intensive court monitoring and placement in a substance abuse treatment program. In carrying out that study, the Chief Court Administrator is to consult with the Chief Public Defender, the Chief State’s Attorney, and the dean of the University of Connecticut School of Law (or their designees). The study will examine testing of arrestees for opioid use, innovative treatment placement options for opioid-dependent arrestees, development of a rapid integration team focused on meeting the treatment needs of opioid-dependent arrestees, developing judicial processes for daily court monitoring of opioid-dependent arrestees, and use of curfews and electronic monitoring tools to facilitate successful completion of substance abuse treatment programs. The Chief Court Administrator (or his or her designee) must report the results of the study to the Connecticut General Assembly by January 1, 2019.