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SECTION 10. Tennessee Code Annotated, Section 39-17-452(A), Is Amended by Adding the Following As a New Subdivision (A)(3)

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btste of @ennegnee PUBLIC CHAPTER NO. 1O4O HOUSE BILL NO. 1832 By Representatives Hawk, Casada, Dunn, Madam Speaker Harulell, Kumar, Love, Favors, Johnson, Hardaway, Terry, Thompson, Akbari, Gamper, Mark White, Staples, Powers Substituted for: Senate Bill No. 2258 By Senators Norris, Yager, Haile AN ACT to amend Tennessee Code Annotated, Title 39, Chapter 17, Part 4; Tille 41, Chapter 21, Par12; Title 53 and Title 63, relative to controlled or addictive substances. BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE SECTION 1. Tennessee Code Annotated, Section 39-17-403(9), is amended by deleting the subsection in its entirety and substituting the following: (g) The commissioner of mental health and substance abuse services, upon the agreement of the commissioner of health, in cooperation with the board of pharmacy, and in consultation with the director of the Tennessee bureau of investigation, shall revise and republish the schedules annually. SECTION 2. Tennessee Code Annotated, Section 39-17-404, is amended by deleting the section in its entirety and substituting the following: (a) The controlled substances listed or to be listed in the schedules in this part are included by whatever official, common, usual, chemical, or trade name designated. (b) Notwithstanding any law to the contrary, the following are excluded from all schedules: (1) Non-narcotic substances excluded under 21 CFR 1308.22, as amended; (2) Chemical preparations exempted under 21 CFR 1308.24, as amended; (3) Veterinary anabolic steroid implant products excluded under 21 CFR 1308.26, as amended; (4) Prescription products exempted under 21 CFR 1308.32, as amended; (5) Anabolic steroid products exempted under 21 CFR 1308.34, as amended; and (6) Certain cannabis plant material, and products made from such material, that contain tetrahydrocannabinols and that are exempted under 21 CFR 1308.35, as amended. SECTION 3. Tennessee Code Annotated, Section 39-17-406, is amended by deleting the section in its entirety and substituting the following: (a) Schedule I consists of the drugs and other substances, by whatever official name, common or usual name, chemical name, or brand name designated, listed in this section. (b) Opiates, unless specifically excepted or unless listed in another schedule, means any of the following opiates, including their isomers, esters, ethers, salts, and salts of isomers, esters, and ethers, whenever the existence of such isomers, esters, ethers, and salts is possible within the specific chemical designation; provided, that for HB {832 the purposes of subdivision (bX4SXBXxv), 3-Methylfentanyl, only, "isomer" includes the optical and geometric isomers: (1) Acetylmethadol; (2) Allylprodine; (3) Alphacetylmethadol (except levo-alphacetylmethadol, also known as levo-alpha-acetylmethadol; levomethadyl acetate; or LAAM); (4) Alphameprodine; (5) Alphamethadol; (6) Benzethidine; (7) Betacetylmethadol ; (8) Betameprodine; (9) Betamethadol; (10) Betaprodine; (11) Clonitazene; (12) Dextromoramide; (13) Diampromide; (1 4) Diethylthiambutene; (15) Difenoxin; (16) Dimenoxadol; (17) Dimepheptanol; (1 8) Dimethylthiambutene; (1 9) Dioxaphetyl butyrate; (20) Dipipanone; (21 ) Ethylmethylthiambutene; (22) Etonitazene; (23) Etoxeridine; (24) Furethidine; (25) Hydroxypethidine; (26) Ketobemidone; (27) Levomoramide; (28) Levophenacylmorphan ; (29) Morpheridine; ( (30) MPPP 1 -methyl-4-phenyl-4-propionoxypiperidine) ; (31) Noracymethadol; 2 HB 1832 (32) Norlevorphanol; (33) Normethadone; (34) Norpipanone; (35) PEPAP ( 1 -(2-phenylethyl)-4-phenyl-4-acetorypiperidine) ; (36) Phenadoxone; (37) Phenampromide; (38) Phenomorphan; (39) Phenoperidine; (40) Piritramide; (41) Proheptazine; (42) Properidine; (43) Propiram; (44) Racemoramide; (45) Tilidine; (46) Trimeperidine; (47) U47700; or (48) Fentanyl derivatives and analogues: (A) Unless specifically excepted, listed in another schedule, or contained within a pharmaceutical product approved by the United states food and drug administration, any material, compound, mixture, or preparation, including its salts, isomers, esters, or ethers, and salts of isomers, esters, or ethers, whenever the existence of such salts is possible within any of the following specific chemical designations containing a 4-anilidopiperidine structure: (i) With or without substitution at the carbonyl of the aniline moiety with alkyl, alkenyl, carboalkoxy, cycloalkyl, methoxyalkyl, cyanoalkyl, or aryl groups, or furanyl, dihydrofuranyl, benzyl moiety, or rings containing heteroatoms sulfur, oxygen, or nitrogen; (ii) With or without substitution at the piperidine amino moiety with a phenethyl, benzyl, alkylaryl (including heteroaromatics), alkyltetrazolyl ring, or an alkyl or carbomethoxy group, whether or not further substituted in the ring or group; (iii) With or without substitution or addition to the piperdine ring to any extent with one or more methyl, carbomethoxy, methoxy, methoxymethyl, aryl, allyl, or ester groups; (iv) With or without substitution of one or more hydrogen atoms for halogens, or methyl, alkyl, or methoxy groups, in the aromatic ring of the anilide moiety; (v) With or without substitution at the alpha or beta position of the piperidine ring with alkyl, hydroxyl, or methoxy groups; 3 HB 1832 (vi) With or without substitution of the benzene ring of the anilide moiety for an aromatic heterocycle; or (vii) With or without substitution of the piperidine ring for a pyrrolidine ring, perhydroazepine ring, or azepine ring; and (B) The application of subdivision (b)(48)(A) includes, but is not limited to, any of the following: (i) Acetylfentanyl (N-(1 -phenethylpiperidin-4-yl)-N- phenylacetamide); (ii) Acetyl-alpha-methylfentanyl (N-[1 -(1 -methyl-2- phenethyl)-4-piperidnyll-N-phenyl-acetamide); (iii) Acryl fentanyl (N-( 1 -phenethylpiperidin-4-yl)-N- phenylacrylamide); (iv) Alpha-methylfentanyl (N-[ 1 -(alpha-methyl-beta- phenyl)ethyl-4-piperidyllpropionanilide; 1 -( 1 -methyl-2-phenylethyl)- 4-(N-propanilido)piperidine) ; (v) Alpha-methylthiofentanyl (N-[1 -methyl-2-(2- thienyl)ethyl-4-piperidinyll-N-phenylpropanamide) ; (vi) Benzodioxolefentanyl ; (vii) Beta-hydroxyfentanyl (N-[1 -(2-hydroxy-2-phenethyl)-4- piperidinyll-N-phenylpropanam ide) ; (viii) Beta-hydroxythiofentanyl (N-[1 -[2-hydroxy-2- (thiophen-2-yl)ethyllpiperidin-4-yll-N-phenylpropionamide) ; N-[ 1 - [2-hyd roxy-2-(2{h ienyl)ethyl]-4-pi perid i nyll-N- phenylpropanamide); (ix) Beta-hydroxy-3-methylfentanyl (N-[1 -(2-hydroxy-2- phenethyl)-3-methyl-4-piperidinyll-N-phenylpropanamide) ; (x) Butyrylfentanyl (N-( 1 -phenethylpiperidin-4-yl)-N- phenylbutyram ide; N-(1 -phenethylpiperidin-4-yl)-N- phenylbutanamide); (xi) Cyclopentyl fentanyl; (xii) lsobutyryl fentanyl; (xiii) Furanyl fentanyl; (xiv) Lofentanil; (xv) 3-Methylfentanyl (N-[3-methyl-1 -(2-phenylethyl)-4- piperidyll-N-phenylpropanamide) ; (xvi) 3-Methylthiofentanyl (N-[3-methyl-1 -(2thienyl)ethyt-4- piperidinyll-N-phenylpropanam ide) ; (xvii) Ocfentanil; (xviii) Ohmefentanyl; (xix) Para-fluorofentanyl (N-(a-fl uorophenyt)-N-[ 1 -(2- phenethyl)-4-piperidinyll propanamide); (n) Pa ra-fl uoroisobutyryl fentanyl (N -(4-f tuorophenyl)-N-( 1 - phenethylpiperidin-4-yl)isobutyramide; 4-fluoroisobutyryl fentanyl ; 4 HB 1832 (xxi) Pentanoyl fentanyl; (xxii) Thiofentanyl; or (>xiii) Valeryl fentanyl. (c) Opium derivatives, unless specifically excepted or unless listed in another schedule, means any of the following opium derivatives, its salts, isomers, and salts of isomers, whenever the existence of such salts, isomers, and salts of isomers is possible within the specific chemical designation: (1) Acetorphine; (2) Acetyldihydrocodeine; (3) Benzylmorphine; (4) Codeine methylbromide; (5) Codeine-N-Oxide; (6) Cyprenorphine; (7) Desomorphine; (8) Dihydromorphine; (9) Drotebanol; (10) Etorphine (except hydrochloride salt); (11) Heroin; (12) Hydromorphinol; (1 3) Methyldesorphine; (1 4) Methyldihydromorphine; (1 5) Morphine methylbromide; (1 6) Morphine methylsulfonate; (1 7) Morphine-N-Oxide; (18) Myrophine; (19) Nicocodeine; (20) Nicomorphine; (21) Normorphine; (22) Pholcodine; or (23) Thebacon. (d) Hallucinogenic substances, unless specifically excepted or unless listed in another schedule, means any material, compound mixture, or preparation that contains any quantity of the following hallucinogenic substances, or that contains any of its salts, isomers, and salts of isomers whenever the existence of such salts, isomers, and salts of isomers is possible within the specified chemical designation; provided, that for purposes of this subsection (d) only, "isomer" includes the optical, positional, and geometric isomers: 5 HB 1832 (1 ) Alpha-ethyltryptam ine Other names: etryptamine; Monase; [alpha]-ethyl-1H-indole-3-ethanamine; 3-(2- aminobutyl) indole; lalphal-ET; and AET; ET; Trip; (2) Alpha-methyltryptamine Other name: AMT; (3) 4-Bromo-2, 5-dimethoxyam phetamine Other names: 4-Bromo-2,5-dimethoxy-[alpha]-methylphenethylamine; 4-bromo- 2,5-DMA; (4) 4-Bromo-2, 5-dimethoxyphenethylamine Other names: 2-(4-Bromo-2, 5-dimethoxyphenyl)- 1 -aminoethane; alpha- desmethyl DOB; 2C-B; Nexus; (Q 2-@-Brom o-2, 5-d imethoxyphenyl)-N-(2-methoxybenzyt)ethana m i ne Other names: 25B-NBOMe; 2C-B-NBOMe; 258; Cimbi-36; (6) Bufotenine Other names: 3-([beta]-Dimethylaminoethyl)-S-hydroxyindole; 3-(2 dimethylam inoethyl)-5-indolol ; N, N-dimethylserotonin ; S-hydroxy-N, N- dimethyltryptamine; mappine; (7 ) 2- (4-Chloro-2, 5-dimethoryphenyl)-N-(2-methoxybenzyl)ethanam ine Other names: 25C-NBOMe; 2C-C-NBOMe; 25C; Cimbi-82; (8)
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    UNDERSTANDING AND CHALLENGING THE DRUGS: CHEMISTRY AND TOXICOLOGY Presenter: • Dr. Jasmine Drake, Graduate Program Director and Assistant Professor, Administration of Justice Department, Barbara Jordan-Mickey Leland School of Public Affairs, Texas Southern University NACDL Training Defending Drug Overdose Homicides in Pennsylvania Penn State Harrisburg, Middletown, PA November 6th, 2019 11:30- 12:45 p.m. Understanding & Challenging the Drugs: Chemistry & Toxicology Dr. Jasmine Drake, Forensic Science Learning Laboratory, Texas Southern University I. Opioid Drug Classifications A. Types of Opioids B. Classic vs. Synthetic C. Toxicology of Opioids 1) How opioids interact with the body 2) Addiction (psychological vs. physiological II. New Classes of Drugs A. Emerging Threats B. Potency III. National Trends in Opioid Overdose Deaths in the U.S. A. Based on State B. Ethnicity C. Drug-Type (prescription vs. fentanyl vs. heroin) IV. Trends of Opioid Overdose Deaths in Philadelphia A. Based on Ethnicity B. Drug Type (prescription vs. fentanyl vs. heroin) V. Legal Considerations to the Opioid Epidemic A. Punitive Measures vs. Rehabilitative Treatment B. Progressive Jurisdictions Nationwide C. New Legal Measures in Philadelphia VI. Toxicology Reports A. What’s in the report? B. Key Aspects of the Tox Report C. Terminology D. Evaluating and Interpreting the data? E. Questions and considerations. VII. Conclusion and Discussion A. Case Specific Examples B. Sample Toxicology Reports The Opioid Epidemic: What labs have to do with it? Ewa King, Ph.D. Associate Director of Health RIDOH State Health Laboratories Analysis. Answers. Action. www.aphl.org Overview • Overdose trends • Opioids and their effects • Analytical testing approaches • Toxicology laboratories Analysis. Answers. Action.
  • Measures and CDS for Safer Opioid Prescribing: a Literature Review

    Measures and CDS for Safer Opioid Prescribing: a Literature Review

    Measures and CDS for Safer Opioid Prescribing: A Literature Review Measures and CDS for Safer Opioid Prescribing: A Literature Review Executive Summary The U.S. opioid epidemic continues to pose significant challenges for patients, families, clinicians, and public health policy. Opioids are responsible for an estimated 315,000 deaths (from 1999 to 2016) and have caused 115 deaths per day.1 In 2017, the U.S. Department of Health and Human Services declared the opioid epidemic a public health crisis.2 The total economic burden of opioid abuse in the United States has been estimated to be $78.5 billion per year.3 Although providing care for chronic opioid users is important, equally vital are efforts to prevent so-called opioid-naïve patients (patients with no history of opioid use) from developing regular opioid use, misuse, or abuse. However, much remains unclear regarding what role clinician prescribing habits play and what duration or dose of opioids may safely be prescribed without promoting long-term use.4,5 In 2013, ECRI Institute convened the Partnership for Health IT Patient Safety, and its component, single-topic-focused workgroups followed. For this subject, the Electronic Health Record Association (EHRA): Measures and Clinical Decision Support (CDS) for Safer Opioid Prescribing workgroup included members from the Healthcare Information and Management Systems Society (HIMSS) EHRA and the Partnership team. The project was oriented towards exploring methods to enable a synergistic cycle of performance measurement and identifying electronic health record (EHR)/health information technology (IT)–enabled approaches to support healthcare organizations’ ability to assess and measure opioid prescribing.
  • Revise Schedule of Controlled Substances. (Public) Sponsors: Senators J

    Revise Schedule of Controlled Substances. (Public) Sponsors: Senators J

    GENERAL ASSEMBLY OF NORTH CAROLINA SESSION 2017 S 1 SENATE BILL 347* Short Title: Revise Schedule of Controlled Substances. (Public) Sponsors: Senators J. Davis, McInnis (Primary Sponsors); and Rabin. Referred to: Rules and Operations of the Senate March 22, 2017 1 A BILL TO BE ENTITLED 2 AN ACT REVISING THE SCHEDULE OF CONTROLLED SUBSTANCES TO ADD 3 SYNTHETIC FENTANYLS, DESIGNER HALLUCINOGENICS, SYNTHETIC 4 CANNABINOIDS, SYSTEM DEPRESSANTS, AND OTHER SUBSTANCES. 5 The General Assembly of North Carolina enacts: 6 SECTION 1. This act shall be known and may be cited as the "Synthetic Opioid 7 and Other Dangerous Drug Control Act." 8 SECTION 2. G.S. 90-89 reads as rewritten: 9 "§ 90-89. Schedule I controlled substances. 10 This schedule includes the controlled substances listed or to be listed by whatever official 11 name, common or usual name, chemical name, or trade name designated. In determining that a 12 substance comes within this schedule, the Commission shall find: a high potential for abuse, no 13 currently accepted medical use in the United States, or a lack of accepted safety for use in 14 treatment under medical supervision. The following controlled substances are included in this 15 schedule: 16 (1) Opiates. – Any of the following opiates, including the isomers, esters, ethers, 17 salts and salts of isomers, esters, and ethers, unless specifically excepted, or 18 listed in another schedule, whenever the existence of such isomers, esters, 19 ethers, and salts is possible within the specific chemical designation: 20 a. Acetyl-alpha-methylfentanyl 21 (N[1-(1-methyl-2-phenethyl)-4/y-piperidinyl]-N-phenylacet amide).