House committee substitute to the 4th edition adds the following content.

Part II.

Enacts new GS 90-12.8 requiring a practitioner to do the following when prescribing a specified Schedule II controlled substance (opium, opiate, or opioid and any salt, compound, derivative, or preparation of opium and opiate, opium poppy and poppy straw, and cocaine and related items): (1) provide information regarding all of the following to each patient receiving the prescription: the potential dangers of opioids, overdose prevention, and the availability and use of a drug approved by the federal Food and Drug Administration as an opioid antagonist for the complete or partial reversal of opioid-induced respiratory depression; (2) provide this information to one or more persons designated by the patient receiving the prescription or, for minors, to the minor's parent, guardian, or person standing in loco parentis. Defines practitioner as: (1) a physician, dentist, optometrist, veterinarian, scientific investigator, or other person licensed, registered, or otherwise permitted to distribute, dispense, conduct research with respect to, or to administer a controlled substance so long as such activity is within the normal course of professional practice or research in this State or (2) a pharmacy, hospital, or other institution licensed, registered, or otherwise permitted to distribute, dispense, conduct research with respect to, or to administer a controlled substance so long as such activity is within the normal course of professional practice or research in this State.

Requires pharmacists to do the following when dispensing those same Schedule II controlled substances: (1) make available the information described above that is consistent with the federal Food and Drug Administration's labeling requirements for opioid pain medication and medication to treat opioid use disorder announced in the specified document and (2) post signage in a conspicuous place containing the same information.

Specifies that nothing in this statute limits a practitioner's liability for negligent diagnosis or treatment of a patient, as allowed under applicable State or federal law, or constitute negligence per se or creates a private right of action against any practitioner who fails to follow the requirements of this statute.

Excludes from the statute's requirements: (1) a practitioner providing hospice services to a hospice patient and (2) a veterinarian acting in the practice of veterinary medicine at an animal health center, emergency facility, mobile facility, veterinary clinic, or veterinary hospital.

Effective October 1, 2023.

Part III.

Amends GS 90-12.7(a) to change the definition of opioid antagonist from naloxone hydrochloride that is approved by the FDA for treatment of a drug overdoes to an opioid antagonist that is approved by the FDA for treatment of a drug overdose. Makes conforming changes to GS 90-113.27 by requiring that needle and hypodermic syringe exchange programs offer access to opioid antagonist (was, naloxone) kits that contain an opioid antagonist approved by the FDA for the treatment of a drug overdose, or referrals to programs providing access to an opioid antagonist approved by the FDA for the treatment of a drug overdose. Makes additional conforming changes.

Part IV.

Enacts new Article 7, Legislative Release to Protect National Opioid Settlement Payments, in GS Chapter 122C. Sets out and defines terms as they are used in the act, including initial opioid consent judgments and subsequent opioid settlement agreements. Sets out 11 NCGA findings related to the opioid epidemic, related litigation, the State's share of the initial Release Entity, Initial Opioid Consent Judgments, and the Subsequent Opioid Settlement Agreements. 

States that the intent of the Article is to prevent the assertion of Initial Released Claims and Subsequent Released Claims against Initial Released Entities and Subsequent Released Entities by the State (as defined) and its Units of Local Government (as defined), and to thereby help secure the full share to which the State, its Units of Local Government, and its people are otherwise entitled under the Initial Opioid Consent Judgments and the Subsequent Opioid Settlement Agreements.

New GS 122C-470.8 prohibits a Unit of Local Government and the State from asserting any Initial Released Claims against Initial Released Entities, or any Subsequent Released Claims against Subsequent Released Entities. Allows the State, as expressly contemplated in the Subsequent Opioid Settlement Agreements, to initiate civil actions asserting Subsequent Released Claims against Subsequent Released Entities for the purpose of obtaining consent judgments that effectuate the Subsequent Opioid Settlement Agreements, including the release of such claims. Specifies that this statute applies to all Initial Released Claims, whether originally asserted before or after the act's effective date. Specifies that this statute applies to all Subsequent Released Claims, whether originally asserted before or after the effective date of this act, except that it does not apply to Subsequent Released Claims against Subsequent Released Entities that were included in any lawsuits filed by a Unit of Local Government before November 1, 2022. If the Subsequent Opioid Settlement Agreements with respect to all of the Subsequent Settlement Opioid Defendants are not entered as consent judgments by the Superior Court of Wake County by December 31, 2023, then, beginning on January 1, 2024, this statute only applies to Subsequent Released Claims against Subsequent Released Entities covered by a consent judgment approved by a North Carolina court of competent jurisdiction.

Specifies that this Article preserves all remedies the State or any Unit of Local Government may have under the Initial Opioid Consent Judgments and Subsequent Opioid Settlement Agreements. Provides that this Article does not limit or otherwise affect such remedies.

Part V.

Amends GS 90-85.15B as follows. Allows an immunizing pharmacist to only administer vaccinations or immunizations to persons 18 or older pursuant to a specific prescription order (was, only if the vaccinations or immunizations are recommended or required by the Centers for Disease Control and Prevention). Adds that an immunizing pharmacist may administer to persons 18 or older vaccines or immunizations recommended by the Advisory Committee on Immunization Practices if the vaccinations or immunizations are administered under specified written protocols and in accordance with the supervising physician's responsibilities, and the physician is licensed in and has a practice physically located in North Carolina. Allows pharmacy interns and pharmacy technicians meeting specified requirements to administer the vaccinations or immunizations recommended by the Advisory Committee on Immunization Practices, under supervision by an immunizing pharmacist, to persons 18 or older. Deletes provisions that allowed an immunizing pharmacist to administer the specified vaccinations or immunizations to persons 18 or older. Provides that when a person chooses, or a parent or legal guardian provides written consent for a person under age 18, an immunizing pharmacist may administer (1) an influenza vaccine, (2) a COVID-19 vaccine recommended by the Advisory Committee on Immunization Practices, (3) a COVID-19 vaccine authorized under an emergency use authorization by the US Food and Drug Administration and recommended by the Advisory Committee on Immunization Practices, or (4) a combination of COVID-19 and influenza vaccine recommended by the Advisory Committee on Immunization Practices to persons at least 7 years of age (was, an immunizing pharmacist may administer (1) an influenza vaccine, (2) a COVID-19 vaccine approved by the US Food and Drug Administration, or (3) a COVID-19 vaccine authorized under an emergency use authorization by the US Food and Drug Administration to persons at least 10 years of age). Deletes provisions concerning administering those vaccinations to individuals age six and older. Makes conforming changes to the immunizations administered by supervised immunizing pharmacists, pharmacy interns, and pharmacy technicians. Adds that before administering a vaccine or immunization, a pharmacy technician or pharmacy intern must: (1) complete a practical training program that is approved by the Accreditation Council for Pharmacy Education (ACPE), including specified techniques, (2) the pharmacy technician or pharmacy intern must have a current certificate in basic cardiopulmonary resuscitation, and (3) the pharmacy technician must annually complete at least two hours of ACPE approved, immunization-related continuing pharmacy education. Requires before administering a vaccine or immunization to a person under age 18 that an immunizing pharmacist obtain written parental consent from the parent or legal guardian of the patient. Requires for persons under 18, that an immunizing pharmacist, a pharmacy technician, or pharmacy intern inform the patient or legal guardian accompanying the person of the importance of a well-child visit with a pediatrician, family physician, or other licensed primary-care provider.

Requires the North Carolina Medical Board and the North Carolina Board of Pharmacy Joint Subcommittee to adopt rules to govern the administration of vaccines by pharmacy technicians as authorized in this Act. Until these rules are adopted and entered into the North Carolina Administrative Code, allows pharmacy technicians to administer vaccines and immunizations under subsections (a1) and (b1) in accordance with the recommendations of the Advisory Committee on Immunization Practices and the requirements of the federal COVID-19 Public Readiness and Emergency Preparedness Act even upon the expiration of the Act.

Provides that for any new vaccination or immunization recommended by the Advisory Committee on Immunization Practices after this act becomes effective, the North Carolina Medical Board and the North Carolina Board of Pharmacy joint subcommittee must review and update specified written protocols. Until these rules are adopted and entered into the North Carolina Administrative Code, immunizing pharmacists, pharmacy technicians, and pharmacy interns may administer a new vaccination or immunization pursuant to subsections (a1) and (b1) and in accordance with the recommendations of the Advisory Committee on Immunization Practices.

Makes conforming changes to the act's titles.