A Guide to State Opioid Prescribing Policies

Pain Policy and Regulation: North Dakota

Summary

The North Dakota materials on pain management are embodied in the North Dakota Century Code in sections defining state requirements. Readers should check with their licensing board for updates.

"Pain" means acute pain and chronic pain. Acute pain is the normal, predicted physiologic response to a noxious chemical or thermal or mechanical stimulus. It is typically associated with invasive procedures, trauma, or disease, and is generally time-limited.

"Chronic pain" is a state that persists beyond the usual course of an acute disease or healing of an injury or that may or may not be associated with an acute or chronic pathologic process that causes continuous or intermittent pain over months or years.

A physician may prescribe or administer controlled substances to a patient in the course of the physician's treatment of the patient for pain.

A physician must keep records of purchases and disposals of controlled substances prescribed or administered under this section. The records must include the date of purchase, the date of sale or administration by the physician, the name and address of the patient, and the reason for the prescribing or the administering of the substances to the patient.

No hospital or healthcare facility may forbid or restrict the use of controlled substances when prescribed or administered by a physician having staff privileges at that hospital or healthcare facility for a patient diagnosed and treated by a physician for pain.

The Board may not discipline a physician for prescribing or administering controlled substances in the course of treatment of a patient for pain.

Unless properly licensed and/or registered, North Dakota does not allow the use of controlled substances or an addictive or dangerous drug to treat a patient for chemical dependency because of the person's use of controlled substances not related to treatment for pain. A physician is not authorized to prescribe or administer any drug legally classified as a controlled substance or as an addictive or dangerous drug for other than medically accepted therapeutic purposes. Practitioners should read the rest of this rule to see how it applies to patients who receive prescriptions.

Consequences of Improper Conduct

The Board has the right to take many different forms of action against the license of any physician who:

1. Prescribes or administers a drug or treatment that is nontherapeutic in nature or nontherapeutic in the manner the drug or treatment is administered or prescribed;
2. Fails to keep complete and accurate records relating to various aspects of controlled substances as required by the state's Controlled Substances Act and rules; and
3. Writes false or fictitious prescriptions for controlled substances.

The material above can be found at: http://www.legis.nd.gov/cencode/t19c033.pdf.

North Dakota's Prescription Monitoring Program

The North Dakota Board of Pharmacy Prescription Drug Monitoring Program (PDMP) is authorized by the North Dakota Century Code and rules of the North Dakota Board of Pharmacy. The text of this chapter can be found at: http://www.nodakpharmacy.com/NDBP/pdmp/RULES%20for%20Rx%20Monitoring.pdf.

Each dispenser licensed by a regulatory agency in the state of North Dakota who dispenses controlled substances to patients must submit to the central repository by electronic means information regarding each prescription dispensed for a controlled substance. The purpose of this program is to collect data on all schedule II, III, IV, and V controlled substances. Under PDMP law, this includes tramadol and carisoprodol dispensed in the state or written for North Dakota residents.

You will find the PDMP materials on your licensing board's Website. These materials contain specific information on who is to keep and submit information to the PDMP system, and how and with what frequency it is to be done. Important: Practitioners and pharmacists may obtain copies of patient profiles for any patient who is currently under their care. Request for profiles may be submitted to the board's office by fax or mail on a request form provided by the board. The form may also be filled out online and submitted to the board over the internet. The Patient Profile Request form can be found at: http://www.ndbomex.com/PDMPPractitionerForm.pdf. The state will generate and fax the patient's profile within 1 hour of receiving a properly formatted request for information. These items are also available by mail if requested. All practitioners and pharmacists must manually or electronically sign the request form. Signature stamps will not be accepted.

"Narcotic drug" means any of the following, whether produced directly or indirectly by natural extraction or independently by chemical synthesis or by combination extraction and chemical synthesis:

1. Opium and opiate and any salt, compound, derivative, or preparation of opium or opiate.
2. Any salt, compound, isomer, derivative, or preparation thereof which is chemically equivalent or identical with any of the substances referred to in subdivision a, but not including the isoquinoline alkaloids of opium.
3. Opium poppy and poppy straw.
4. Coca leaves and any salt, compound, derivative, or preparation of coca leaves or any salt, compound, isomer, derivative, or preparation thereof which is chemically equivalent or identical with any of these substances, but not including decocainized coca leaves or extractions of coca leaves that do not contain cocaine or ecgonine.

"Opiate" means any substance having an addiction-forming or addiction-sustaining liability similar to morphine or being capable of conversion into a drug having addiction-forming or addiction-sustaining liability. For exclusions, read the Uniform Controlled Substances Act, which can be found at: http://www.legis.nd.gov/cencode/t19c031.pdf.

Schedule II Controlled Substances

Except when dispensed directly by a practitioner other than a pharmacy to an ultimate user, no controlled substance in schedule II may be dispensed without the written prescription of a practitioner.

When the patient is a hospice patient or resides in a licensed long-term care facility and the prescription has been signed by the practitioner before faxing, the facsimile may serve as the original prescription without another signature.

Life of a Schedule II Prescription. The prescription may not be filled more than 6 months after the date it was written.

In emergency situations, schedule II drugs may be dispensed after an oral prescription by a practitioner. The prescription must be reduced promptly to writing and filed by the pharmacy.

Prescriptions must be retained in conformity with the Uniform Controlled Substances Act for the state.

No prescription for a schedule II substance may be refilled.

Schedule III and IV Controlled Substances

Except when dispensed directly by a practitioner other than a pharmacy to an ultimate user, a controlled substance included in schedule III or IV may not be dispensed without a written or oral prescription by a practitioner.

Life of a Schedule III or IV Prescription. The prescription may not be filled or refilled more than 6 months after the date of the prescription or be refilled more than 5 times, unless renewed by the practitioner.

Any oral prescription for such drugs must be promptly reduced to writing by the pharmacist, intern, or technician on a new prescription blank.

When the patient is a hospice patient or resides in a licensed long-term care facility and the prescription has been signed by the practitioner before faxing, the facsimile may serve as the original prescription without another signature.

Schedule V Controlled Substances

Except when dispensed directly by a practitioner other than a pharmacy to an ultimate user, no controlled substance included in schedule V may be dispensed without the written or oral prescription of a practitioner.

Life of a Schedule V Prescription. The prescription may not be filled or refilled more than 6 months after the date written or be refilled more than 5 times unless renewed by the practitioner.

Any oral prescription for a schedule V compound, mixture, or preparation must be promptly reduced to writing by the pharmacist, intern, or technician on a new prescription blank.

When the patient is a hospice patient or resides in a licensed long-term care facility and the prescription has been signed by the practitioner before faxing, the facsimile may serve as the original prescription without another signature.

Pharmacist Negligently Endangering Life: Penalty

The following information can be found in chapter 43-15-43 of the code at: http://www.legis.nd.gov/cencode/T43C15.pdf.

It is a class A misdemeanor for any pharmacist in this state, in putting up any drug or medicine, to willfully or negligently:

1. Neglect to label the drug or medicine;
2. Put an untrue label, stamp, or other designation of contents on the box, bottle, or package containing the drug or medicine;
3. Substitute a different article for an article prescribed or ordered;
4. Put up a greater or lesser quantity of an article than that prescribed or ordered; or
5. Deviate from the terms of the prescription or order in any manner in consequence of which human life is endangered.

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Author Information

Jennifer Bolen, JD, Jennifer Bolen, JD, Founder, The Legal Side of Pain, Lenoir City, Tennessee http://www.legalsideofpain.com

Disclosure: Jennifer Bolen, JD, has disclosed no relevant financial relationships.