§ 12-23-20-2 — Office based opioid treatment; requirements

(a) This section does not apply to a health
care provider providing services in any of the following:
(1) An adult or juvenile correctional facility operated by the state
or a local unit.
(2) A hospital licensed under IC 16-21-2.
(3) A facility that is certified by the division.
(4) An opioid treatment program that has been certified or
licensed by the division under IC 12-23-18.
(5) A state institution.
(6) A health facility licensed under IC 16-28.
(7) The Indiana Veterans' Home.
(b) A physician who is providing office based opioid treatment or
who is acting in a supervisory capacity to other health care providers
that are providing office based opioid treatment must:
(1) have a valid federal Drug Enforcement Administration
registration number and identification number; and
(2) abide by all:
(A) federal; and
(B) state;
laws and regulations concerning the prescribing of medications.
(c) A health care provider that prescribes for a patient in an office
based opioid treatment setting shall do and document the following:
(1) Determine the patient's age.
(2) Perform an initial assessment and a physical examination as
appropriate for the patient's condition and the health care
provider's scope of practice and obtain a medical history of the
patient before treatment begins.
(3) Obtain substance use history and any substance use disorder
diagnosis of the patient.
(4) Perform a mental health assessment.
(5) Obtain informed consent for treatment and establish a
treatment agreement with the patient that meets the requirements
set forth in subsection (d).
(6) If determined appropriate, prescribe office based opioid
treatment for the patient and require office visits of the patient in
person throughout treatment.
(7) Evaluate the patient's progress and compliance with the
treatment agreement and document the patient's progress with the
treatment plan.
(8) Perform toxicology screening for the following in accordance
with rules adopted under IC 25-22.5-2-7(a)(14) in order to assess
medication adherence and to screen for other substances:
(A) Stimulants.
(B) Alcohol.
(C) Opioids, including:
(i) oxycodone;
(ii) methadone; and
(iii) buprenorphine.
(D) Tetrahydrocannabinol.
(E) Benzodiazepines.
(F) Cocaine.
(9) Review INSPECT (as defined in IC 25-26-24-7) concerning
controlled substance information for the patient before induction
and at least four (4) times per year during treatment.
(10) If the patient is a female and has child bearing potential:
(A) perform a pregnancy test at the onset of treatment;
(B) counsel the patient about the risks of treatment to a fetus,
including fetal opioid dependency and neonatal abstinence
syndrome; and
(C) provide for or refer the patient to prenatal care, if the
pregnancy test performed under clause (A) is positive.
(11) Prescribe an overdose intervention drug and education on
how to fill the prescription when buprenorphine is initiated on the
patient.
(12) Provide for an ongoing component of psychosocial
supportive therapy, with direction from the health care provider
on the amount of the therapy.
(d) The treatment agreement required in subsection (c)(5) must
include at least the following:
(1) The goals of the treatment.
(2) The patient's consent to drug monitoring testing.
(3) The prescriber's prescribing policies that include at least the
following:
(A) A requirement that the patient take the medication as
prescribed.
(B) A prohibition on sharing or selling the medication.
(C) A requirement that the patient inform the prescriber about
any:
(i) other controlled substances or other medication prescribed
or taken by the patient; and
(ii) alcohol consumed by the patient.
(4) The patient's consent to allow the prescriber to conduct
random pill counts for prescriptions.
(5) Reasons that the office based opioid treatment of the patient
may be changed or discontinued by the prescriber.
The provider shall maintain a copy of the informed consent for
treatment in the patient's medical record.
(e) During the examinations required by subsection (c)(6), the
prescriber shall do the following:
(1) Evaluate and document patient progress and compliance with
the patient's treatment plan.
(2) Document in the patient's medical record whether the patient
is meeting treatment goals.
(3) Discuss with the patient the benefits and risks, if relevant, of
ongoing buprenorphine treatment.
(f) If a toxicology screening described in subsection (c)(8) shows an
absence of a prescribed drug, the provider must discuss and implement
a plan with the patient to optimize medication adherence and schedule
an earlier follow up appointment with the patient. The provider shall
document the discussion in the patient's medical record.
(g) If a toxicology screening described in subsection (c)(8) shows
a presence of an illegal or nonprescribed drug, the provider shall assess
the risk of the patient to be successfully treated and document the
results in the patient's medical record.
(h) The provider may perform a subsequent confirmation toxicology
screening of the patient if the provider considers it medically necessary
or to clarify an inconsistent or unexpected toxicology screening result.

Legislative History

As added by P.L.213-2019, SEC.1. Amended by P.L.32-2021, SEC.32; P.L.233-2023, SEC.4.