Codifies certain regulatory provisions regarding controlled dangerous substances and prescription monitoring.

A4190

ASSEMBLY, No. 4190

STATE OF NEW JERSEY

222nd LEGISLATURE

�

INTRODUCED FEBRUARY 19, 2026

Sponsored by:

Assemblywoman� CAROL A. MURPHY

District 7 (Burlington)

SYNOPSIS

���� Codifies certain regulatory provisions regarding
controlled dangerous substances and prescription monitoring.

CURRENT VERSION OF TEXT

���� As introduced.

��

An Act
concerning controlled dangerous substances and
prescription monitoring and amending P.L.2017, c.341.

����
Be It
Enacted
by the Senate and General Assembly of
the State of New Jersey:

���� 1.��� Section 11 of P.L.2017,
c.341 (C.24:21-15.2) is amended to read as follows:�

���� 11.� a.� A practitioner shall
not issue an initial prescription for an opioid drug which is a prescription
drug as defined in section 2 of P.L.2003, c.280 (C.45:14-41) in a quantity
exceeding a five-day supply for treatment of acute pain.� Any prescription for
acute pain pursuant to this subsection shall be for the lowest effective dose
of immediate-release opioid drug.�

���� b.��� Prior to issuing an
initial prescription of a Schedule II controlled dangerous substance or any
other opioid drug which is a prescription drug as defined in section 2 of
P.L.2003, c.280 (C.45:14-41) in a course of treatment for acute or chronic
pain, a practitioner shall:

���� (1)�� take and document the
results of a thorough medical history, including the patient's experience with
non-opioid medication and non-pharmacological pain management approaches and
substance abuse history;

���� (2)�� conduct, as appropriate,
and document the results of a physical examination;

���� (3)�� develop a treatment
plan, with particular attention focused on determining the cause of the
patient's pain;

���� (4)�� access relevant
prescription monitoring information under the Prescription Monitoring Program
pursuant to section 8 of P.L.2015, c.74 (C. 45:1-46.1); and

���� (5)�� limit the supply of any
opioid drug prescribed for acute pain to a duration of no more than five days
as determined by the directed dosage and frequency of dosage.

���� c.���� No less than four days
after issuing the initial prescription pursuant to subsection a. of this
subsection, the practitioner, after consultation with the patient, may issue a
subsequent prescription for the drug to the patient in any quantity that complies
with applicable State and federal laws, provided that:

���� (1)�� the subsequent
prescription would not be deemed an initial prescription under this section;

���� (2)�� the practitioner
determines the prescription is necessary and appropriate to the patient's
treatment needs and documents the rationale for the issuance of the subsequent
prescription; and

���� (3)�� the practitioner
determines that issuance of the subsequent prescription does not present an
undue risk of abuse, addiction, or diversion and documents that determination.

���� d.��� Prior to issuing the
initial prescription of a Schedule II controlled dangerous substance or any
other opioid drug which is a prescription drug as defined in section 2 of
P.L.2003, c.280 (C.45:14-41) in a course of treatment for acute pain and prior
to issuing a prescription at the outset of a course of treatment for chronic
pain, a practitioner shall discuss with the patient, or the patient's parent or
guardian if the patient is under 18 years of age and is not an emancipated
minor, the risks associated with the drugs being prescribed, including but not
limited to:

���� (1)�� the risks of addiction
and overdose associated with opioid drugs and the dangers of taking opioid
drugs with alcohol, benzodiazepines and other central nervous system
depressants;

���� (2)�� the reasons why the
prescription is necessary;

���� (3)�� alternative treatments
that may be available; and

���� (4)�� risks associated with
the use of the drugs being prescribed, specifically that opioids are highly
addictive, even when taken as prescribed, that there is a risk of developing a
physical or psychological dependence on the controlled dangerous substance, and
that the risks of taking more opioids than prescribed, or mixing sedatives,
benzodiazepines or alcohol with opioids, can result in fatal respiratory
depression.

���� The practitioner shall include
a note in the patient's medical record that the patient or the patient's parent
or guardian, as applicable, has discussed with the practitioner the risks of
developing a physical or psychological dependence on the controlled dangerous
substance and alternative treatments that may be available.� The Division of
Consumer Affairs shall develop and make available to practitioners guidelines
for the discussion required pursuant to this subsection.

���� e.���� Prior to the
commencement of an ongoing course of treatment for chronic pain with a Schedule
II controlled dangerous substance or any opioid, the practitioner shall enter
into a pain management agreement with the patient.

���� f.���� When a Schedule II
controlled dangerous substance or any other prescription opioid drug is
continuously prescribed for three months or more for chronic pain, the
practitioner shall:

���� (1)�� review, at a minimum of
every three months, the course of treatment, any new information about the
etiology of the pain, and the patient's progress toward treatment objectives
and document the results of that review;

���� (2)�� assess the patient prior
to every renewal to determine whether the patient is experiencing problems
associated with physical and psychological dependence and document the results
of that assessment;

���� (3)�� periodically make
reasonable efforts, unless clinically contraindicated, to either stop the use
of the controlled substance, decrease the dosage, try other drugs or treatment
modalities in an effort to reduce the potential for abuse or the development of
physical or psychological dependence and document with specificity the efforts
undertaken;

���� (4)�� review the Prescription
Drug Monitoring information in accordance with section 8 of P.L.2015, c.74 (C.
45:1-46.1);
[
and
]

���� (5)�� monitor compliance with
the pain management agreement and any recommendations that the patient seek a
referral
;

����
(6)�� conduct baseline
urine drug testing to establish a general assessment for new patients, monitor
adherence to existing patient treatment plans, and to detect the use of
non-prescribed drugs;�

����
(7)
��
conduct random
urine screens at least once every 12 months;

����
(8)�� advise the patient,
or the patient's parent or guardian if the patient is under 18 years of age and
is not an emancipated minor, of the availability of an opioid antidote; and

����
(9)�� refer the patient to
a pain management or addiction specialist for independent evaluation or
treatment in order to achieve treatment objectives, if those objectives are not
being met
.

���� g.��� As used in this section:

���� "Acute pain" means
pain, whether resulting from disease, accidental or intentional trauma, or
other cause, that the practitioner reasonably expects to last only a short
period of time.� "Acute pain" does not include chronic pain, pain
being treated as part of cancer care, hospice or other end of life care, or
pain being treated as part of palliative care.

����
�Baseline urine testing�
means an initial patient assessment through urine drug testing to: (1) identify
the presence of illicit substances prior to prescribing medication; or (2)
confirm the presence or absence of a prescribed drug or drug class.

���� "Chronic pain" means
pain that persists
[
or
recurs
]

for
[
more
than
]

three
or more consecutive
months
, and which continues, either
continuously or episodically, after reasonable medical efforts have been made
to relieve the pain or its cause
.�

���� "Initial
prescription" means a prescription issued to a patient who:

���� (1)�� has never previously
been issued a prescription for the drug or its pharmaceutical equivalent; or

���� (2)�� was previously issued a
prescription for, or used or was administered the drug or its pharmaceutical
equivalent, but the date on which the current prescription is being issued is
more than one year after the date the patient last used or was administered the
drug or its equivalent.

���� When determining whether a
patient was previously issued a prescription for, or used or was administered a
drug or its pharmaceutical equivalent, the practitioner shall consult with the
patient and review the patient's medical record and prescription monitoring
information.

���� "Pain management
agreement" means a written contract or agreement that is executed between
a practitioner and a patient, prior to the commencement of treatment for
chronic pain using a Schedule II controlled dangerous substance or any other
opioid drug which is a prescription drug as defined in section 2 of P.L.2003,
c.280 (C.45:14-41), as a means to:

���� (1)�� prevent the possible
development of physical or psychological dependence in the patient;

���� (2)�� document the
understanding of both the practitioner and the patient regarding the patient's
pain management plan;

���� (3)�� establish the patient's
rights in association with treatment, and the patient's obligations in relation
to the responsible use, discontinuation of use, and storage of Schedule II
controlled dangerous substances, including any restrictions on the refill of
prescriptions or the acceptance of Schedule II prescriptions from
practitioners;

���� (4)�� identify the specific
medications and other modes of treatment, including physical therapy or
exercise, relaxation, or psychological counseling, that are included as a part
of the pain management plan;

���� (5)�� specify the measures the
practitioner may employ to monitor the patient's compliance, including but not
limited to random specimen screens and pill counts; and

���� (6)�� delineate the process
for terminating the agreement, including the consequences if the practitioner
has reason to believe that the patient is not complying with the terms of the
agreement.

���� "Practitioner" means
a medical doctor, doctor of osteopathy, dentist, optometrist, podiatrist,
physician assistant, certified nurse midwife, or advanced practice nurse,
acting within the scope of practice of their professional license pursuant to
Title 45 of the Revised Statutes.

���� h.��� This section shall not
apply to a prescription for a patient who is currently in active treatment for
cancer, receiving hospice care from a licensed hospice or palliative care, or
is a resident of a long term care facility, or to any medications that are
being prescribed for use in the treatment of substance abuse or opioid
dependence.

���� i.���� Every policy, contract
or plan delivered, issued, executed or renewed in this State, or approved for
issuance or renewal in this State by the Commissioner of Banking and Insurance,
and every contract purchased by the School Employees' Health Benefits Commission
or State Health Benefits Commission, on or after the effective date of this
act, that provides coverage for prescription drugs subject to a co-payment,
coinsurance or deductible shall charge a co-payment, coinsurance or deductible
for an initial prescription of an opioid drug prescribed pursuant to this
section that is either:

���� (1)�� proportional between the
cost sharing for a 30-day supply and the amount of drugs the patient was
prescribed; or

���� (2)�� equivalent to the cost
sharing for a full 30-day supply of the opioid drug, provided that no
additional cost sharing may be charged for any additional prescriptions for the
remainder of the 30-day supply.

����
j.���� A practitioner may
prescribe the use of an implantable infusion pump that is utilized to achieve
pain management for patients suffering from cancer, intractable pain, or
terminal illness. A prescription for an implantable infusion pump may provide
up to a 90-day supply.

(cf: P.L.2017, c.341, s.11)

���� 2.��� This act shall take
effect immediately.

STATEMENT

���� This bill codifies into
statute certain regulatory provisions regarding controlled dangerous substances
and prescription monitoring.� Specifically, the bill provides that a physician
is to: 1) require a patient who is prescribed a controlled dangerous substance
for chronic pain management to undergo random urine screens at least once every
12 months and conduct baseline urine drug testing for new patients; 2) advise
the patient, or the patient's parent or guardian if the patient is under 18
years of age and is not an emancipated minor, of the availability of an opioid
antidote; and 3) refer the patient to a pain management or addiction specialist
for independent evaluation or treatment in order to achieve treatment
objectives, if those objectives are not being met.

���� The bill amends the definition
of �chronic pain,� consistent with existing regulations, to mean pain that
persists for three or more consecutive months, and which continues, either
continuously or episodically, after reasonable medical efforts have been made
to relieve the pain or its cause.�

���� The bill also codifies the
regulatory provision that permits a physician to prescribe a 90 day supply of
an implantable infusion pump that is utilized to achieve pain management for
patients suffering from cancer, intractable pain, or terminal illness.