The 2018 Legislature passed new laws related to opiates, prescribing, and continuing education requirements that will impact providers. Specifically, LB 931, signed by the Governor on April 4, creates new requirements providers must consider when prescribing opiates. And secondly, LB 788, amended into LB 731, was signed into law on April 19. LB 788 requires continuing education for health care professionals regarding opiate prescriptions. Below is a brief overview of the new laws, which will go into effect July 19, 2018.

LB 931 prohibits medical practitioners from prescribing more than a seven–day supply of opiates for patients younger than 18 years of age for outpatient use for an acute condition. However, exceptions to the seven-day cap exist for patients with a cancer diagnoses or for palliative care or for another medical diagnosis, so long as the practitioner documents such condition. Specifically, a practitioner may exceed the seven-day cap so long as he/she documents the patient’s condition and records his/her professional finding that a non-opiate alternative was inappropriate to address the medical condition. Additionally, if the practitioner has not previously prescribed an opiate for such a patient, the practitioner must discuss the risks associated with the use of opiates and the reasons why the prescription is necessary. This law becomes effective July 19, 2018 and sunsets on January 1, 2029.

LB 931 was the carrier of two other bills that were amended in: LB 933 and LB 934. LB 933 is found in Sec. 3 of the law, and requires practitioners to notify patients of the risks of addiction and overdose when prescribing opioids or other controlled substances listed in Schedule II of the Uniform Controlled Substances Act. Practitioners are required to notify the patient of the risks of addiction or overdose, why the prescription is necessary, and alternative treatments that may be available. This notification must occur when the substance is initially prescribed and again prior to the third prescription. Notation in the medical record that such discussion took place is not required. However, as a practice, many clinics and providers have begun implementing a system whereby a box is checked that such discussion took place, or the patient is signing a document that describes the risks. This requirement also becomes effective July 19, 2018 and sunsets on January 1, 2029.

And finally, LB 934 was successfully amended into LB 931, and its language is found in Sec. 5 of the law. Sec. 5 requires that individuals show photo ID when receiving dispensed opiates currently under Scheduled II, III, IV, or V of the Uniform Controlled Substances Act. Exceptions do exist if the pharmacist or dispensing practitioner personally know the patient. Another exemption exists for patients, residents, and employees of licensed health care facilities, so long as there are related ID procedures in place at such facility. This requirement becomes effective July 19, 2018.

Another opiate-related bill was passed by the Legislature this year: LB 788. This bill was amended into LB 731, which was signed by the Governor on April 19. Sec. 2 of the law contains the language of LB 788. This new law requires nurse midwives, dentists, physicians, physician assistants, nurse practitioners, podiatrists, and veterinarians who prescribe controlled substances to earn at least three hours of continuing education biennially regarding prescribing opiates. The continuing education may include, but is not limited to, education regarding prescribing and administering opiates, the risks and indicators regarding development of addiction to opiates, and emergency opiate situations. One-half hour of the three hours of continuing education must cover the PDMP. This half-hour PDMP requirement can be satisfied by watching the PDMP video on the Nebraska Department of Health and Human Services’ website and completing the training acknowledgment form and prescriber CME assessment. In order to satisfy this new requirement, the NMA has partnered with DHHS to obtain CME for the following videos. (see below) This new CME requirement begins with the first license renewal period which begins on or after October 1, 2018, and sunsets on January 1, 2029.

PDMP video
Pain management video
Naloxone video

As with many pieces of legislation, senators may bring a “cleanup bill” the following year to account for logistical and practical solutions that make implementation easier for providers. If you have suggestions about how to make these mandates easier to implement, please let us know so we can begin working with the introducers on a bill for 2019. For questions or concerns, please don’t hesitate to contact Meghan Chaffee, NMA VP of Advocacy at 402-474-4472 or meghanc@nebmed.org.