A new law took effect on January 1, 2019, that requires opioid prescribers to also offer a prescription for an opioid-overdose reversal drug such as naloxone.

Under the new law, physicians must offer a prescription fornaloxone or another drug approved by the U.S. Food and Drug Administration (FDA) for the complete or partial reversal of opioid depression when one or more of the following conditions are present:

• The patient’s opioid prescription dosage is 90 or more morphine milligram equivalents per day. 
• An opioid medication is prescribed concurrently with a prescription for benzodiazepine. 
• The patient presents with an increased risk for overdose, including a patient with a history of overdose, a patient with a history of substance use disorder, or a patient at risk for returning to a high dose of opioid medication to which the patient is no longer tolerant.

Physicians must then provide patients who are prescribed naloxone with education regarding overdose prevention and use of naloxone or other similar drug approved by the FDA.

The California Medical Association (CMA) has received calls from physicians regarding the ambiguity of these new requirements. Specifically, there have been questions regarding exactly when co-prescribing is required. Concerns have also been expressed about the applicability of this law to patients receiving hospice care or to patients in inpatient settings whereimmediate medical attention is readily available. 

Presently, there is an active bill, AB 714 (Wood) that seeks to address these concerns. CMA continues to work with legislators and other stakeholders to clarify a physician's obligations under the law and will update members as soon as we know more.

To learn more about prescribing controlled substances, including this new requirement, see CMA health law library document #3201, "Controlled Substances: Prescribing."

This document, as well as the rest of CMA’s online health law library, is available free to members at cmadocs.org/health-law-library. Nonmembers can purchase documents for $2 per page.

Contact: CMA Legal Information Line, (800) 786-4262 or legalinfo@cmadocs.org.