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Featured Practice Question

I understand a bill was passed requiring California providers to offer Narcan with narcotic prescriptions, effective January 1, 2019. I understand it also applies to hospice patients, which is complicated. I work in various settings, from office, to nursing homes and Assisted Living facilities. Each has various implications for the implementation of this bill. Any further information, general policy suggestions would be appreciated.

The text of the new law enacted through Assembly Bill 2760 states:

Prescribers are required to offer a prescription for naloxone HCL or another drug approved by the United States Food and Drug Administration for the complete or partial reversal of opioid depression to a patient when one or more of the following conditions are present:

1. the prescription dosage for the patient is 90 or more morphine milligram equivalents of an opioid medication per day;
2. an opioid medication is prescribed concurrently with a prescription for benzodiazepine; or
3. the patient presents with an increased risk for overdose.

The bill requires that the prescriber discuss and offer naloxone, not necessarily prescribe it. There are multiple avenues to get naloxone, including direct from pharmacists, public health departments in some counties, and, of course, as a prescription from an NP.

You might want to consider creating a standard documentation tool that you and any clinician on your team could use to simplify the documentation, ordering, and diagnosis of high risk medication use. You can include patient instructions for recognizing overdose and naloxone use.

In your example, the consultation and documentation should support the discussion about Narcan use, and the patient and family may decide for or against use. There can be patients that were “no code” but would still get treated for UTI, PNA, etc. and, depending on how the patient is doing, this family may or may not want to treat in the event of an apparent opioid overdose – and it may or may not be successful if they do.

EDITOR'S NOTE: Spurred by this question from one of its members, CANP has communicated  with the author of Assembly Bill 2760, Assemblymember Jim Wood, regarding the potential complications. As a result, Assemblymember Wood has introduced AB 714 as a clean-up bill to last year’s AB 2760. The bill does the following:.

• makes the requirements only applicable to a patient receiving a prescription for a controlled substance
• exempts prescriptions prescribed to patients in inpatient health facilities
• exempts prescriptions prescribed to patients in outpatient-based hospice

Featured Legal Question

I’m interested in having a private practice as an NP, but am considering using a different modality for treatment/intervention, primarily incorporating hypnotherapy (no med management). I believe this mode of treatment does not require licensing, nor is it as regulated by the state. Do all the regulations and requirements related to being incorporated and having MD collaboration with standardized procedures still apply in this case? Have you had experience in which psych NPs use an alternative mode of treatment as their main intervention and can operate independently in this regard?

Even though you won’t be prescribing, if you are holding yourself out as a psych NP you will still need a collaborating physician, and I would recommend a nursing corporation. I know several psych NPs that integrate hypnotherapy into their practices.

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