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An Act
ENROLLED SENATE
BILL NO. 1642 By: Frix of the Senate
and
Marti of the House
An Act relating to controlled dangerous substances;
amending 63 O.S. 2021, Section 2-309I, as amended by
Section 1, Chapter 257, O.S.L. 2022 (63 O.S. Supp.
2025, Section 2-309I), which relates to prescription
limits and rules for opioid drugs; authorizing
divided quantities for certain acute pain
prescriptions; updating statutory language; modifying
statutory references; and providing an effective
date.
SUBJECT: Opioid prescription guidelines
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. AMENDATORY 63 O.S. 2021, Section 2-309I, as
amended by Section 1, Chapter 257, O.S.L. 2022 (63 O.S. Supp. 2025,
Section 2-309I), is amended to read as follows:
Section 2-309I. A. A practitioner shall not issue an initial
prescription for an opioid drug in a quantity exceeding a seven-day
supply for treatment of acute pain. Any opioid prescription for
acute pain shall be for the lowest effective dose of an immediate-
release drug.
B. Prior to issuing an initial prescription for an opioid drug
in a course of treatment for acute or chronic pain, a practitioner
shall:
ENR. S. B. NO. 1642 Page 2
1. Take and document the results of a thorough medical history,
including the experience of the patient with nonopioid medication
and nonpharmacological 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 pain of the patient;
4. Access relevant prescription monitoring information from the
central repository pursuant to Section 2-309D of this title;
5. Limit the supply of any opioid drug prescribed for acute
pain to a duration of no more than seven (7) days as determined by
the directed dosage and frequency of dosage; provided, however, upon
issuing an initial prescription for acute pain pursuant to this
section, the practitioner may issue one (1) subsequent prescription
for an opioid drug in a quantity not to exceed seven (7) days if:
a. the subsequent prescription is due to a major surgical
procedure or “confined to home” status as defined in
42 U.S.C., Section 1395n(a),
b. the practitioner provides the subsequent prescription
on the same day as the initial prescription,
c. the practitioner provides written instructions on the
subsequent prescription indicating the earliest date
on which the prescription may be filled, otherwise
known as a “do not fill until” date, and
d. the subsequent prescription is dispensed no more than
five (5) days after the “do not fill until” date
indicated on the prescription;
6. In the case of a patient under the age of eighteen (18)
years, enter into a patient-provider agreement with a parent or
guardian of the patient; and
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7. 6. In the case of a patient who is a pregnant woman, enter
into a patient-provider agreement with the patient.
B. 1. A practitioner shall not issue an initial prescription
for an opioid drug for treatment of acute pain in a quantity
exceeding a seven-day supply, as determined by the directed dosage
and frequency of dosage.
2. Any initial or subsequent opioid prescription for acute pain
shall be for the lowest effective dose of an immediate-release drug.
3. The practitioner may issue the initial seven-day
prescription in divided quantities, which shall only count as a
single prescription for purposes of the requirements of this
section.
C. No Except as provided in subsection D of this section, no
less than seven (7) days after issuing the initial acute pain
prescription pursuant to subsection A B of this section, the
practitioner, after consultation with the patient, may issue a
subsequent acute pain prescription for the opioid drug to the
patient in a quantity not to exceed seven (7) days, 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 treatment needs of the patient 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. 1. The practitioner may issue the subsequent seven-day
acute pain prescription under subsection C of this section in
divided quantities, which shall only count as a single prescription
for purposes of the requirements of this section.
2. Notwithstanding the timing and quantity restrictions
specified in subsection C of this section, upon issuing an initial
prescription of an opioid drug for acute pain under subsection B of
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this section, the practitioner may simultaneously issue one
subsequent prescription for an opioid drug in a quantity not to
exceed seven (7) days if:
a. the subsequent prescription is due to a major surgical
procedure or confined to home status as described in
42 U.S.C., Section 1395n(a),
b. the practitioner provides the subsequent prescription
on the same day as the initial prescription,
c. the practitioner provides written instructions on the
subsequent prescription indicating the earliest date
on which the prescription may be filled, otherwise
known as a “do not fill until” date, and
d. the subsequent prescription is dispensed no more than
five (5) days after the “do not fill until” date
indicated on the prescription.
E. Prior to issuing the initial prescription of an opioid drug
in a course of treatment for acute or chronic pain and again prior
to issuing the third prescription of the course of treatment, a
practitioner shall discuss with the patient or the parent or
guardian of the patient if the patient is under eighteen (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
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sedatives, benzodiazepines or alcohol with opioids can result in
fatal respiratory depression.
The practitioner shall include a note in the medical record of
the patient that the patient or the parent or guardian of the
patient, 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 applicable state licensing board of the
practitioner shall develop and make available to practitioners
guidelines for the discussion required pursuant to this subsection.
E. F. At the time of the issuance of the third prescription for
an opioid drug, the practitioner shall enter into a patient-provider
agreement with the patient.
F. G. When an opioid drug is continuously prescribed for three
(3) months or more for chronic pain, the practitioner shall:
1. Review, at a minimum of every three (3) months, the course
of treatment, any new information about the etiology of the pain,
and the progress of the patient toward treatment objectives and
document the results of that review;
2. In the first year of the patient-provider agreement, assess
the patient prior to every renewal to determine whether the patient
is experiencing problems associated with an opioid use disorder as
defined by the American Psychiatric Association and document the
results of that assessment. Following one (1) year of compliance
with the patient-provider agreement, the practitioner shall assess
the patient at a minimum of every six (6) months;
3. Periodically make reasonable efforts, unless clinically
contraindicated, to either stop the use of the controlled substance,
decrease the dosage, or try other drugs or treatment modalities in
an effort to reduce the potential for abuse or the development of an
opioid use disorder as defined by the American Psychiatric
Association and document with specificity the efforts undertaken;
4. Review the central repository information in accordance with
Section 2-309D of this title; and
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5. Monitor compliance with the patient-provider agreement and
any recommendations that the patient seek a referral.
G. H. 1. Any prescription for acute pain pursuant to this
section shall have the words “acute pain” notated on the face of the
prescription by the practitioner.
2. Any prescription for chronic pain pursuant to this section
shall have the words “chronic pain” notated on the face of the
prescription by the practitioner.
H. I. This section shall not apply to a prescription for a
patient:
1. Who has sickle cell disease;
2. Who is in treatment for cancer or receiving aftercare cancer
treatment;
3. Who is receiving hospice care from a licensed hospice;
4. Who is receiving palliative care in conjunction with a
serious illness;
5. Who is a resident of a long-term care facility; or
6. For any medications that are being prescribed for use in the
treatment of substance abuse or opioid dependence.
I. J. Every policy, contract, or plan delivered, issued,
executed, or renewed in this state, or approved for issuance or
renewal in this state by the Insurance Commissioner, and every
contract purchased by the Employees Group Insurance Division of the
Office of Management and Enterprise Services, on or after November
1, 2018, that provides coverage for prescription drugs subject to a
copayment, coinsurance or deductible shall charge a copayment,
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 thirty-day
supply and the amount of drugs the patient was prescribed; or
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2. Equivalent to the cost sharing for a full thirty-day supply
of the drug, provided that no additional cost sharing may be charged
for any additional prescriptions for the remainder of the thirty-day
supply.
J. K. Any practitioner authorized to prescribe an opioid drug
shall adopt and maintain a written policy or policies that include
execution of a written agreement to engage in an informed consent
process between the prescribing practitioner and qualifying opioid
therapy patient. For the purposes of this section, “qualifying
opioid therapy patient” means:
1. A patient requiring opioid treatment for more than three (3)
months;
2. A patient who is prescribed benzodiazepines and opioids
together for more than one twenty-four-hour period; or
3. A patient who is prescribed a dose of opioids that exceeds
one hundred (100) morphine equivalent doses.
K. L. Nothing in the Anti-Drug Diversion Act this section shall
be construed to require a practitioner to limit or forcibly taper a
patient on opioid therapy. The standard of care requires effective
and individualized treatment for each patient as deemed appropriate
by the prescribing practitioner without an administrative or
codified limit on dose or quantity that is more restrictive than
approved by the Food and Drug Administration (FDA).
SECTION 2. This act shall become effective November 1, 2026.
ENR. S. B. NO. 1642 Page 8
Passed the Senate the 2nd day of March, 2026.
Presiding Officer of the Senate
Passed the House of Representatives the 29th day of April, 2026.
Presiding Officer of the House
of Representatives
OFFICE OF THE GOVERNOR
Received by the Office of the Governor this ____________________
day of ___________________, 20_______, at _______ o'clock _______ M.
By: _________________________________
Approved by the Governor of the State of Oklahoma this _________
day of ___________________, 20_______, at _______ o'clock _______ M.
_________________________________
Governor of the State of Oklahoma
OFFICE OF THE SECRETARY OF STATE
Received by the Office of the Secretary of State this __________
day of __________________, 20 _______, at _______ o'clock _______ M.
By: _________________________________