WIXLIB

Prescription Drug Physical ExaminationRequirementsThe United States is in the midst of an unprecedented epidemic of prescription drug overdose deaths. 1More than 41,000 people died of drug overdoses in 2011, and most of these deaths (22,810) werecaused by overdoses involving prescription drugs. 2 Three-quarters of prescription drug overdose deathsin 2011 (16,917) involved a prescription opioid pain reliever (OPR), which is a drug derived from theopium poppy or synthetic versions of it such as oxycodone, hydrocodone, or methadone. 3 Theprescription drug overdose epidemic has not affected all states equally, and overdose death rates varywidely across states.States have the primary responsibility to regulate and enforce prescription drug practice. Although statelaws are commonly used to prevent injuries, and their benefits have been demonstrated for a variety ofinjury types, 4 little information is available on the effectiveness of state statutes and regulationsdesigned to prevent prescription drug abuse and diversion. This menu is a first step in assessing laws onphysical exam requirements by creating an inventory of state legal strategies in this domain.IntroductionThis resource includes physical examination laws if they require a licensed practitioner to examine thepatient before prescribing a medication. In this menu, “practitioner” refers to a physician, dentist,pharmacist, physician’s assistant, nurse practitioner, or any other person licensed, registered, orpermitted to prescribe, dispense, distribute, or administer a controlled substance. Laws are included1For the purpose of this document, “overdose death” refers to death resulting from either intentional overdose oraccidental overdose, which could be caused by a patient being given the wrong drug, taking the wrong drug inerror, or taking too much of a drug inadvertently. CDC’s National Center for Injury Prevention and Control alsorefers to overdose as a drug poisoning, which may or may not result in death.2Centers for Disease Control and Prevention, Wide-ranging Online Data for Epidemiologic Research (WONDER)Database (2012) http://wonder.cdc.gov.3Id.4Schieber RA, Gilchrist J, & Sleet DA. Legislative and Regulatory Strategies to Reduce Childhood Injuries, 10 FUTURECHILD. 1, 111–36 (2000).

only if they expressly require an examination or evaluation. Laws requiring a practitioner-patientrelationship or use of a valid prescription are included only if the definition of practitioner-patientrelationship or valid prescription expressly requires a physician examination. 5 Forty-one states 6 and theDistrict of Columbia have one or more laws that require a prescriber or dispenser to ensure thatprescriptions for medications are based on an examination of the patient. 7 States with these laws mayrequire a physical examination as part of prescribing regulations, or may prohibit pharmacists andphysicians from dispensing certain types of drugs if there is doubt the drugs were prescribed following aphysical exam. Some states limit the applicability of the laws to certain drug types, apply laws only incertain circumstances, or contain exceptions to examination requirements. 8 Most states 9 and theDistrict of Columbia have multiple physical examination laws and thus fall under multiple categories.Type of Examination RequiredMost examination laws 10 require a ”physical examination” as the basis for prescribing and dispensing acontrolled substance.5Some states, such as Missouri, have come to define the patient-practitioner relationship to include a physicalexamination through judicial interpretation. See State v. Kane, 586 S.W.2d 812 (App. E.D. 1979) (defining “patientpractitioner” as used in MO. ANN. STAT. § 195.204 to mean “first making some attempt to determine physicalcondition or health needs of person for whom he writes the prescription.” Id. Those statutes are not included inthis report.6Alabama, Alaska, Arizona, Arkansas, California, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Indiana,Iowa, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Minnesota, Mississippi, Missouri, Montana,Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma,Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, and Washington.7The nine states (Colorado, Illinois, Kansas, Michigan, New York, South Dakota, West Virginia, Wisconsin, andWyoming) that do not have physical examination requirements according to this assessment likely have a physicalexamination requirement that may be incorporated into state law through a general provision requiring adherenceto medical professional and ethical standards. The research on which this menu is based was limited to expressprovisions in statute or regulation.8In this menu, the first effective dates of the specific provisions referenced are cited as “[legal citation] (eff.[year]).” Where dates were either not provided within the laws or were unclear due to multiple revisions, this factis cited as “[legal citation] (eff. date unclear, [estimated year]).”9Thirty-seven states: Alabama, Alaska, Arizona, Arkansas, California, Connecticut, Delaware, Florida, Georgia,Hawaii, Idaho, Indiana, Iowa, Kentucky, Louisiana, Maine, Maryland, Minnesota, Mississippi, Missouri, Nebraska,Nevada, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Oregon,Pennsylvania, South Carolina, Tennessee, Texas, Vermont, Virginia, and Washington.10Thirty-four states and the District of Columbia. See, e.g., ALA. ADMIN. CODE r. 540-X-9-.11 (eff. 2000); ALASKA ADMIN.CODE tit. 12, § 40.967 (eff. 2000); ARIZ. REV. STAT. ANN. §§ 32-1401(27)(ss) (eff. 2000), -1501(31)(ww) (eff. 2003),1854(48) (eff. 2000); 060.00.1 ARK. CODE R. § 2 (eff. date unclear); CONN. GEN. STAT. ANN. § 20-613a (eff. 2005); D.C.MUN. REGS. tit. 17, § 4616 (eff. 2012); DEL. CODE ANN. tit. 16, § 4744(c)(1) (eff. 2008); FLA. STAT. § 458.3265 (eff.2011); GA. COMP. R. & REGS. 360-3-.02 (eff. date unclear); HAW. REV. STAT. ANN. § 329-1 (eff. 2008); 844 IND. ADMIN.CODE 5-4-1 (eff. 2003); IOWA ADMIN. CODE r.653-13.2(148,272C) (eff. date unclear); 201 KY. ADMIN. REGS. 8:540 (eff.2012); LA. ADMIN. CODE tit. 46, pt. XLV, § 6921 (eff. 1997); 02-313 ME. CODE R.Ch. 21, § III (eff. 2010); MINN. R.6500.0600 (eff. 1988); 30-17-2635 MISS. CODE R. §7.1 (eff. 2012); MO. REV. STAT. § 334.108 (eff. 2011); NEB. ADMIN.CODE § 172, Ch. 90, § 008 (eff. date unclear); NEV. ADMIN. CODE § 639.945 (eff. date unclear); N.H. REV. STAT. ANN.§318-B:1 (eff. 2011); N.J. ADMIN. CODE § 13:35-7.6(a) (eff. 2003); N.M. CODE R. § 16.10.8 (eff. 2003); 21 N.C. ADMIN.CODE § 46.1801(b) (eff. 2003); N.D. CENT. CODE § 19-02.1-15.1 (eff. 2009); OHIO ADMIN. CODE 4731-11-03 (eff. date2

Indiana“[A] physician shall not prescribe, dispense, or otherwise provide, or cause to be provided, anycontrolled substance to a person who the physician has never personally physically examinedand diagnosed.” 11South CarolinaPrior to prescribing a drug to an individual, a practitioner must “personally perform anddocument an appropriate history and physical examination . . . .” 12Sixteen states 13 and the District of Columbia 14 have laws that require an examination or evaluation thatis deemed “appropriate” or some approximation of “sufficient,” instead of or in addition to the physicalexamination laws. CaliforniaRequires an “appropriate prior examination.” 15 MinnesotaRequires an “in-person examination” that is “adequate to establish a diagnosis and identifyunderlying conditions and contraindications to treatment.” 16 New JerseyWhen a practitioner prescribes a controlled substance, he or she must perform a physicalexamination “including an assessment of physical and psychological function, underlying orcoexisting diseases or conditions, any history of substance abuse and the nature, frequency andseverity of any pain.” 17In some states dispensers are allowed to dispense prescriptions only if the prescription is prescribed bya practitioner who previously performed an adequate examination.unclear); OKLA. ADMIN. CODE § 435:10-7-11 (eff. 2005); 49 PA. CODE § 16.92(b)(1) (eff. 1986); R.I. GEN. LAWS § 21-283.24 (eff. 1974); S.C. CODE ANN. §§ 40-47-113 (eff. 1976); TENN. COMP. R. & REGS. 0880-02-.14(6)(e)(3)(i) (eff. 2001);22 TEX. ADMIN. CODE § 170.3(a)(1), (7) (eff. 2007); UTAH ADMIN. CODE r. 156-37 (eff. date unclear); 18 VA. ADMIN.CODE § 85-20-25 (eff. date unclear); WASH. ADMIN. CODE §246-817-915 (eff. 2011).11844 IND. ADMIN. CODE 5-4-1 (eff. 2003).12S.C. CODE ANN. §§ 40-47-113 (eff. 1976).13See, e.g., CAL. BUS. & PROF. CODE § 2242 (eff. 2000); CONN. AGENCIES REGS. § 21a-326-1 (eff. 1984); IDAHO CODE. ANN.§ 54-1733; IOWA ADMIN. CODE r.650-16.2(153) (eff. date unclear); LA. REV. STAT. ANN. § 40:1238.4 (eff. 2007); MD.CODE REGS. 10.32.05.05 (eff. 2009); 234 MASS. CODE REGS. 9.05 (eff. date unclear); MINN. STAT. § 151.37 (eff. dateunclear); 30-17-2635 MISS. CODE R. § 7.1 (eff. 2012); MO. CODE REGS. ANN. tit. 19§ 30-1.068 (eff. 2000); NEB. ADMIN.CODE § 172, Ch. 56, § 007 (eff. date unclear); NEV. ADMIN. CODE § 635.390 (eff. date unclear); N.J. ADMIN. CODE§ 13:35-7.6 (eff. date unclear); N.M. CODE R. §16.5.57 (eff. date 2013); 22 TEX. ADMIN. CODE §§ 291.29 (eff. 2001);VT. STAT. ANN. tit. 18, § 9361 (eff. 2012).14D.C. MUN. REGS. tIt. 22-B, § 1300.7 (eff. 1986).15CAL. BUS. & PROF. CODE § 2242 (eff. 2000).16MINN. STAT. ANN. §§ 151.37 Subd. 2(d), (e) (eff. date unclear).17N.J. ADMIN. CODE § 13:35-7.6 (eff. date unclear).3