Governor Hochul has signed into law, as Chapter 803 of the Laws of 2021, a bill – A.336-A (Braunstein) / S.2966-A (Harckham) – requiring that when an opioid is prescribed under certain defined circumstances, it must be accompanied by a prescription for an opioid antagonist. The bill does not take effect for 180 days from December 29, 2021. It will have some impact for dentists, although much more for physicians.
Copies of the bill and the Sponsor Memorandum explaining the bill are below.
2021-2022 Regular Sessions
January 6, 2021
Introduced by M. of A. BRAUNSTEIN, DINOWITZ, OTIS, CYMBROWITZ, AUBRY,
L. ROSENTHAL, FERNANDEZ, STERN, HEVESI, HUNTER, JOYNER, PERRY, RAMOS,
STECK, BARRON, McDONALD -- Multi-Sponsored by -- M. of A. McDONOUGH --
read once and referred to the Committee on Health -- reported and
referred to the Committee on Ways and Means -- committee discharged,
bill amended, ordered reprinted as amended and recommitted to said
AN ACT to amend the public health law, in relation to prescribing an
opioid antagonist with a patient's first opioid prescription in a
The People of the State of New York, represented in Senate and Assem-
bly, do enact as follows:
1 Section 1. Section 3309 of the public health law is amended by adding
2 a new subdivision 7 to read as follows:
3 7. With the first prescription to a particular patient of an opioid of
4 each year for use in a setting other than a general hospital or nursing
5 home under article twenty-eight of this chapter or facility under arti-
6 cle thirty-one of the mental hygiene law, or when a practitioner is
7 prescribing a controlled substance to a patient under the care of
8 hospice as defined by section four thousand two of this chapter, the
9 prescriber shall prescribe an opioid antagonist when any of the follow-
10 ing risk factors are present: (a) a history of substance use disorder;
11 (b) high dose or cumulative prescriptions that result in ninety morphine
12 milligram equivalents or higher per day; (c) concurrent use of opioids
13 and benzodiazepine or nonbenzodiazepine sedative hypnotics.
14 § 2. This act shall take effect on the one hundred eightieth day after
15 it shall have become a law. Effective immediately, the addition, amend-
16 ment and/or repeal of any rule or regulation necessary for the implemen-
17 tation of this act on its effective date are authorized to be made and
18 completed by the commissioner of health on or before such effective
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
] is old law to be omitted.
BILL NUMBER: A336a
TITLE OF BILL:
An act to amend the public health law, in relation to prescribing an
opioid antagonist with a patient's first opioid prescription in a given
PURPOSE OR GENERAL IDEA OF BILL:
To prescribe an opioid antagonist, a drug used to counter the effects of
opioid overdose, with a patient's first opioid prescription each year.
SUMMARY OF SPECIFIC PROVISIONS:
Section 1. Adds a new subdivision 7 to
Section 3309 of the public health law, which provides that the first
opioid prescription to a particular patient each year, in a setting
other than a general hospital, nursing home, or hospice care, shall be
accompanied with a prescription for an opioid antagonist if any of the
following risk factors are present: a history of substance use disorder;
high doses or cumulative prescriptions that result in ninety morphine
milligram equivalents or higher per day; concurrent use of opioids and
benzodiazepine or nonbenzodiazepine sedative hypnotics.
Section 2. Contains the effective date.
Drug poisoning is the leading cause of death from injuries in the United
States. In New York State and New York City, between 1999 and 2008 the
leading cause of accidental death was overdose, ahead of accidental
falls and motor vehicle accidents. The vast majority of these overdose
deaths occurred inside the home.
According to studies by the Centers for Disease Control and Prevention,
drug poisoning deaths involving opioid analgesics, also known as
prescription pain relievers, such as codeine and oxycodone, have more
than tripled nationally since 1999, and between 2000 and 2011, the rate
of drug poisoning deaths involving opioid analgesics in NYC increased by
267%. In 2012, prescription opioid analgesics were involved in 28% of
overdose deaths in NYC. Between 2015 and 2016 the opioid overdose death
rate in New York State increased by 40%. Additionally, eighty percent
of heroin users have reported that they used opioid analgesics before
switching to heroin. As of March 2018, more than 115 people in the
United States die every day from overdosing on opioids, according to the
The CDC has stated that higher dosages of opioids are associated with
higher risks of overdosing. Furthermore, higher dosages have not been
shown to reduce pain over the long term.
Opioid antagonists, such as naloxone, are drugs that reverse the effects
of opioids, and are effective in preventing overdose deaths. The avail-
ability of an opioid antagonist is crucial in ensuring that overdose
deaths do not occur. However, an opioid antagonist can only be effective
as an antidote if it is readily accessible when an overdose is happen-
ing. Additionally, opioid antagonists are non-habit forming and non-tox-
ic. On April 5th, 2018, the United States Surgeon General issued the
first national advisory in over a decade, urging all Americans to carry
Currently, opioid antagonists can only be used if they are prescribed.
A recent NYC Department of Mental Health and Hygiene study supported a
co-prescribing mandate to increase the availability of opioid antag-
onists. This legislation, by increasing access to opioid antagonists,
may be able to save the lives of those at risk for opioid analgesic
PRIOR LEGISLATIVE HISTORY:
2013-2014: A.9365 - Referred to Health.
2015-2016: A.661 - Referred to Health.
2017-2018: A.1531-A - Referred to Health.
2019-2020: A.5603-B - Referred to Ways and Means.
This act shall take effect on the one hundred eightieth day after it
shall have become a law. Effective immediately, the addition, amendment
and/or repeal of any rule or regulation necessary for the implementation
of this act on its effective date are authorized to be made and
completed by the commissioner of health on or before such effective