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<section article="ghg" article_name="Health - General" number="21-2A-04.2" title_number="21" title_name="Food, Drugs, and Cosmetics" subtitle_number="2A" subtitle_name="Prescription Drug Monitoring Program">
  <level label="a">
    <level label="1">
      <text>Beginning July 1, 2018, a prescriber:</text>
      <level label="i">
        <text>Shall request at least the prior 4 months of prescription monitoring data for a patient before initiating a course of treatment for the patient that includes prescribing or dispensing an opioid or a benzodiazepine;</text>
      </level>
      <level label="ii">
        <text>Shall, if a patient’s course of treatment continues to include prescribing or dispensing an opioid or a benzodiazepine for more than 90 days after the initial request for prescription monitoring data, request prescription monitoring data for the patient at least every 90 days until the course of treatment has ended; and</text>
      </level>
      <level label="iii">
        <text>Shall assess prescription monitoring data requested from the Program before deciding whether to prescribe or dispense or continue prescribing or dispensing an opioid or a benzodiazepine.</text>
      </level>
    </level>
    <level label="2">
      <text>If a prescriber decides to prescribe or continue to prescribe an opioid or a benzodiazepine after requesting prescription monitoring data from the Program and assessing the prescription monitoring data, the prescriber shall document in the patient’s medical record that the prescription monitoring data was requested and assessed.</text>
    </level>
  </level>
  <level label="b">
    <text>A prescriber is not required to request prescription monitoring data from the Program if the opioid or benzodiazepine is prescribed or dispensed to an individual:</text>
    <level label="1">
      <text>In an amount indicated for a period not to exceed 3 days;</text>
    </level>
    <level label="2">
      <text>For the treatment of cancer or cancer–related pain;</text>
    </level>
    <level label="3">
      <text>Who is:</text>
      <level label="i">
        <text>A patient receiving treatment in an inpatient unit of a hospital;</text>
      </level>
      <level label="ii">
        <level label="1">
          <text>A patient in a general hospice care program as defined in § 19–901 of this article; or</text>
        </level>
        <level label="2">
          <text>Any other patient diagnosed with a terminal illness;</text>
        </level>
      </level>
      <level label="iii">
        <text>A patient who resides in:</text>
        <level label="1">
          <text>An assisted living facility;</text>
        </level>
        <level label="2">
          <text>A long–term care facility;</text>
        </level>
        <level label="3">
          <text>A comprehensive care facility; or</text>
        </level>
        <level label="4">
          <text>A developmental disabilities facility; or</text>
        </level>
      </level>
    </level>
    <level label="4">
      <text>To treat or prevent acute pain for a period of not more than 14 days following:</text>
      <level label="i">
        <text>A surgical procedure;</text>
      </level>
      <level label="ii">
        <text>A fracture;</text>
      </level>
      <level label="iii">
        <text>Significant trauma; or</text>
      </level>
      <level label="iv">
        <text>Childbirth.</text>
      </level>
    </level>
  </level>
  <level label="c">
    <text>A prescriber may not be required to comply with the provisions of this section when:</text>
    <level label="1">
      <text>Prescribing or dispensing an opioid or a benzodiazepine drug that has been listed by the Secretary under § 21–2A–03(b)(3) of this subtitle as having a low potential for abuse;</text>
    </level>
    <level label="2">
      <text>Accessing prescription monitoring data would result in a delay in the treatment of a patient that would negatively impact the medical condition of the patient;</text>
    </level>
    <level label="3">
      <text>Electronic access to prescription monitoring data is not operational as determined by the Department; or</text>
    </level>
    <level label="4">
      <text>Prescription monitoring data cannot be accessed by the prescriber due to a temporary technological or electrical failure.</text>
    </level>
  </level>
  <level label="d">
    <text>If a prescriber does not access prescription monitoring data for any of the reasons provided under subsection (c)(2), (3), or (4) of this section:</text>
    <level label="1">
      <text>The prescriber shall use reasonable medical judgment in determining whether to prescribe or dispense an opioid or a benzodiazepine; and</text>
    </level>
    <level label="2">
      <text>The prescriber shall enter an appropriate record in the patient’s medical chart, including the reason why prescription monitoring data was not accessed.</text>
    </level>
  </level>
  <level label="e">
    <text>If a pharmacist or pharmacist delegate has a reasonable belief that a patient may be seeking a monitored prescription drug for any purpose other than the treatment of an existing medical condition:</text>
    <level label="1">
      <text>Before dispensing a monitored prescription drug to the patient, the pharmacist or pharmacist delegate shall request prescription monitoring data to determine if the patient has received other prescriptions that indicate misuse, abuse, or diversion of a monitored prescription drug; and</text>
    </level>
    <level label="2">
      <text>The pharmacist shall have the responsibility described in 21 C.F.R. § 1306.04.</text>
    </level>
  </level>
  <level label="f">
    <text>The Secretary may adopt regulations to provide additional clinical, technical, or administrative exemptions based on new standards of practice.</text>
  </level>
</section>
