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1 STATE OF OKLAHOMA
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2 2nd Session of the 60th Legislature (2026)
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3 SENATE BILL 1642 By: Frix
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6 AS INTRODUCED
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7 An Act relating to controlled dangerous substances;
7 amending 63 O.S. 2021, Section 2-309I, as amended by
8 Section 1, Chapter 257, O.S.L. 2022 (63 O.S. Supp.
8 2025, Section 2-309I), which relates to prescription
9 limits and rules for opioid drugs; authorizing
9 divided quantities for certain acute pain
10 prescriptions; updating statutory language; modifying
10 statutory references; and providing an effective
11 date.
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12
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13 BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
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14 SECTION 1. AMENDATORY 63 O.S. 2021, Section 2-309I, as
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15 amended by Section 1, Chapter 257, O.S.L. 2022 (63 O.S. Supp. 2025,
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16 Section 2-309I), is amended to read as follows:
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17 Section 2-309I. A. A practitioner shall not issue an initial
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18 prescription for an opioid drug in a quantity exceeding a seven-day
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19 supply for treatment of acute pain. Any opioid prescription for
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20 acute pain shall be for the lowest effective dose of an immediate-
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21 release drug.
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22 B. Prior to issuing an initial prescription for an opioid drug
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23 in a course of treatment for acute or chronic pain, a practitioner
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24 shall:
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1 1. Take and document the results of a thorough medical history,
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2 including the experience of the patient with nonopioid medication
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3 and nonpharmacological pain-management approaches and substance
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4 abuse history;
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5 2. Conduct, as appropriate, and document the results of a
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6 physical examination;
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7 3. Develop a treatment plan with particular attention focused
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8 on determining the cause of pain of the patient;
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9 4. Access relevant prescription monitoring information from the
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10 central repository pursuant to Section 2-309D of this title;
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11 5. Limit the supply of any opioid drug prescribed for acute
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12 pain to a duration of no more than seven (7) days as determined by
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13 the directed dosage and frequency of dosage; provided, however, upon
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14 issuing an initial prescription for acute pain pursuant to this
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15 section, the practitioner may issue one (1) subsequent prescription
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16 for an opioid drug in a quantity not to exceed seven (7) days if:
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17 a. the subsequent prescription is due to a major surgical
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18 procedure or "confined to home" status as defined in
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19 42 U.S.C., Section 1395n(a),
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20 b. the practitioner provides the subsequent prescription
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21 on the same day as the initial prescription,
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22 c. the practitioner provides written instructions on the
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23 subsequent prescription indicating the earliest date
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1 on which the prescription may be filled, otherwise
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2 known as a "do not fill until" date, and
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3 d. the subsequent prescription is dispensed no more than
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4 five (5) days after the "do not fill until" date
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5 indicated on the prescription;
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6 6. In the case of a patient under the age of eighteen (18)
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7 years, enter into a patient-provider agreement with a parent or
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8 guardian of the patient; and
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9 7. 6. In the case of a patient who is a pregnant woman, enter
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10 into a patient-provider agreement with the patient.
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11 B. 1. A practitioner shall not issue an initial prescription
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12 for an opioid drug for treatment of acute pain in a quantity
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13 exceeding a seven-day supply, as determined by the directed dosage
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14 and frequency of dosage.
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15 2. Any initial or subsequent opioid prescription for acute pain
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16 shall be for the lowest effective dose of an immediate-release drug.
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17 3. The practitioner may issue the initial seven-day
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18 prescription in divided quantities, which shall only count as a
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19 single prescription for purposes of the requirements of this
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20 section.
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21 C. No Except as provided in subsection D of this section, no
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22 less than seven (7) days after issuing the initial acute pain
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23 prescription pursuant to subsection A B of this section, the
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24 practitioner, after consultation with the patient, may issue a
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Req. No. 3113 Page 3
1 subsequent acute pain prescription for the opioid drug to the
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2 patient in a quantity not to exceed seven (7) days, provided that:
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3 1. The subsequent prescription would not be deemed an initial
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4 prescription under this section;
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5 2. The practitioner determines the prescription is necessary
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6 and appropriate to the treatment needs of the patient and documents
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7 the rationale for the issuance of the subsequent prescription; and
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8 3. The practitioner determines that issuance of the subsequent
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9 prescription does not present an undue risk of abuse, addiction or
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10 diversion and documents that determination.
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11 D. 1. The practitioner may issue the subsequent seven-day
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12 acute pain prescription under subsection C of this section in
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13 divided quantities, which shall only count as a single prescription
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14 for purposes of the requirements of this section.
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15 2. Notwithstanding the timing and quantity restrictions
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16 specified in subsection C of this section, upon issuing an initial
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17 prescription of an opioid drug for acute pain under subsection B of
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18 this section, the practitioner may simultaneously issue one
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19 subsequent prescription for an opioid drug in a quantity not to
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20 exceed seven (7) days if:
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21 a. the subsequent prescription is due to a major surgical
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22 procedure or confined to home status as described in
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23 42 U.S.C., Section 1395n(a),
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1 b. the practitioner provides the subsequent prescription
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2 on the same day as the initial prescription,
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3 c. the practitioner provides written instructions on the
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4 subsequent prescription indicating the earliest date
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5 on which the prescription may be filled, otherwise
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6 known as a "do not fill until" date, and
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7 d. the subsequent prescription is dispensed no more than
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8 five (5) days after the "do not fill until" date
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9 indicated on the prescription.
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10 E. Prior to issuing the initial prescription of an opioid drug
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11 in a course of treatment for acute or chronic pain and again prior
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12 to issuing the third prescription of the course of treatment, a
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13 practitioner shall discuss with the patient or the parent or
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14 guardian of the patient if the patient is under eighteen (18) years
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15 of age and is not an emancipated minor, the risks associated with
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16 the drugs being prescribed, including, but not limited to:
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17 1. The risks of addiction and overdose associated with opioid
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18 drugs and the dangers of taking opioid drugs with alcohol,
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19 benzodiazepines and other central nervous system depressants;
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20 2. The reasons why the prescription is necessary;
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21 3. Alternative treatments that may be available; and
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22 4. Risks associated with the use of the drugs being prescribed,
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23 specifically that opioids are highly addictive, even when taken as
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24 prescribed, that there is a risk of developing a physical or
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1 psychological dependence on the controlled dangerous substance, and
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2 that the risks of taking more opioids than prescribed or mixing
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3 sedatives, benzodiazepines or alcohol with opioids can result in
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4 fatal respiratory depression.
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5 The practitioner shall include a note in the medical record of
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6 the patient that the patient or the parent or guardian of the
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7 patient, as applicable, has discussed with the practitioner the
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8 risks of developing a physical or psychological dependence on the
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9 controlled dangerous substance and alternative treatments that may
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10 be available. The applicable state licensing board of the
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11 practitioner shall develop and make available to practitioners
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12 guidelines for the discussion required pursuant to this subsection.
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13 E. F. At the time of the issuance of the third prescription for
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14 an opioid drug, the practitioner shall enter into a patient-provider
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15 agreement with the patient.
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16 F. G. When an opioid drug is continuously prescribed for three
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17 (3) months or more for chronic pain, the practitioner shall:
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18 1. Review, at a minimum of every three (3) months, the course
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19 of treatment, any new information about the etiology of the pain,
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20 and the progress of the patient toward treatment objectives and
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21 document the results of that review;
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22 2. In the first year of the patient-provider agreement, assess
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23 the patient prior to every renewal to determine whether the patient
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24 is experiencing problems associated with an opioid use disorder as
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1 defined by the American Psychiatric Association and document the
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2 results of that assessment. Following one (1) year of compliance
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3 with the patient-provider agreement, the practitioner shall assess
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4 the patient at a minimum of every six (6) months;
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5 3. Periodically make reasonable efforts, unless clinically
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6 contraindicated, to either stop the use of the controlled substance,
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7 decrease the dosage, or try other drugs or treatment modalities in
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8 an effort to reduce the potential for abuse or the development of an
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9 opioid use disorder as defined by the American Psychiatric
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10 Association and document with specificity the efforts undertaken;
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11 4. Review the central repository information in accordance with
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12 Section 2-309D of this title; and
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13 5. Monitor compliance with the patient-provider agreement and
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14 any recommendations that the patient seek a referral.
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15 G. H. 1. Any prescription for acute pain pursuant to this
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16 section shall have the words "acute pain" notated on the face of the
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17 prescription by the practitioner.
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18 2. Any prescription for chronic pain pursuant to this section
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19 shall have the words "chronic pain" notated on the face of the
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20 prescription by the practitioner.
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21 H. I. This section shall not apply to a prescription for a
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22 patient:
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23 1. Who has sickle cell disease;
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1 2. Who is in treatment for cancer or receiving aftercare cancer
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2 treatment;
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3 3. Who is receiving hospice care from a licensed hospice;
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4 4. Who is receiving palliative care in conjunction with a
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5 serious illness;
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6 5. Who is a resident of a long-term care facility; or
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7 6. For any medications that are being prescribed for use in the
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8 treatment of substance abuse or opioid dependence.
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9 I. J. Every policy, contract, or plan delivered, issued,
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10 executed, or renewed in this state, or approved for issuance or
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11 renewal in this state by the Insurance Commissioner, and every
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12 contract purchased by the Employees Group Insurance Division of the
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13 Office of Management and Enterprise Services, on or after November
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14 1, 2018, that provides coverage for prescription drugs subject to a
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15 copayment, coinsurance or deductible shall charge a copayment,
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16 coinsurance, or deductible for an initial prescription of an opioid
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17 drug prescribed pursuant to this section that is either:
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18 1. Proportional between the cost sharing for a thirty-day
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19 supply and the amount of drugs the patient was prescribed; or
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20 2. Equivalent to the cost sharing for a full thirty-day supply
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21 of the drug, provided that no additional cost sharing may be charged
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22 for any additional prescriptions for the remainder of the thirty-day
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23 supply.
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1 J. K. Any practitioner authorized to prescribe an opioid drug
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2 shall adopt and maintain a written policy or policies that include
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3 execution of a written agreement to engage in an informed consent
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4 process between the prescribing practitioner and qualifying opioid
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5 therapy patient. For the purposes of this section, "qualifying
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6 opioid therapy patient" means:
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7 1. A patient requiring opioid treatment for more than three (3)
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8 months;
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9 2. A patient who is prescribed benzodiazepines and opioids
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10 together for more than one twenty-four-hour period; or
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11 3. A patient who is prescribed a dose of opioids that exceeds
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12 one hundred (100) morphine equivalent doses.
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13 K. L. Nothing in the Anti-Drug Diversion Act this section shall
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14 be construed to require a practitioner to limit or forcibly taper a
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15 patient on opioid therapy. The standard of care requires effective
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16 and individualized treatment for each patient as deemed appropriate
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17 by the prescribing practitioner without an administrative or
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18 codified limit on dose or quantity that is more restrictive than
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19 approved by the Food and Drug Administration (FDA).
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20 SECTION 2. This act shall become effective November 1, 2026.
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22 60-2-3113 DC 1/13/2026 7:20:54 PM
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Req. No. 3113 Page 9Every fact on this page links to its source, starting with the official bill record.