BILL ANALYSIS
SENATE HEALTH AND HUMAN SERVICES
COMMITTEE ANALYSIS
Senator Deborah V. Ortiz, Chair
BILL NO: SB 1695
S
AUTHOR: Escutia
B
AMENDED: April 1, 2002
HEARING DATE: April 3, 2002
1
FISCAL: Appropriations
6
9
CONSULTANT:
5
Matosantos / bjs
SUBJECT
Drug overdose deaths
SUMMARY
Makes various finding and declarations about the rise in
drug overdose deaths and the fact that they are
preventable. Authorizes local emergency medical services
agencies to allow EMT-Is who meet specified criteria to
administer naloxone hydrochloride. Requires the California
Health and Human Services Agency to publish a report on
drug overdose trends, to publish educational materials on
prevention of drug overdoses and to assist entities
interested in the prevention of drug overdose deaths.
Requires the Agency to issue grants to local entities that
meet specified criteria, for drug overdose prevention,
recognition and response projects.
ABSTRACT
Existing law:
Authorizes paramedics, physicians, nurses, nurse
practitioners and emergency medical technicians II to
administer naloxone hydrochloride, the antidote to heroin
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overdose.
This bill:
1.Finds that because drug overdose deaths are preventable,
it is appropriate for California to prevent the onset of
drug use, to provide cessation treatment for drug
addicts, to prosecute those who sell controlled
substances, and to prevent deaths and suffering among
those who can not or will not stop using drugs at this
time.
2.Finds that increasing rates of heroin use and the widened
variability of its potency have resulted in an escalating
death toll among both novice, younger users and an aging
population of heroin addicted adults. Finds that the
number of drug overdose deaths in both rural and urban
counties in California has risen and that heroin overdose
is a leading cause of death among adult males ages 20 to
54.
3.Finds that there are many preventable deaths in
California among our oldest citizens and chronically ill
Californians who rely on opiate-based medications. Finds
that efforts need to be made to improve the education of
prescription drug users and their families and to improve
the response of our emergency medical services to both
illicit and legal opiate-based drug overdoses.
4.Finds that heroin overdoses are usually witnessed, that
they occur between one and three hours after the last
injection, and that there is ample time to save victims'
lives.
5.Finds that naloxone hydrochloride is a highly effective
antidote to heroin overdose that is easily administered.
Finds that police, firefighters, and emergency services
personnel who first respond to medical emergencies need
to be trained and authorized to administer the antidote
to heroin overdose.
6.Authorizes any local emergency medical service agency to
allow emergency medical technicians I to administer
naloxone hydrochloride if the EMT-Is have completed
training and passed a test to ensure that the drug is
administered appropriately.
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7.Requires the California Health and Human Services Agency
to publish a report on drug overdose trends that
considers data from the previous five years and provides
information on effective interventions to reduce the rate
of fatal or nonfatal drug overdose. Requires the Agency
to publish the report by December 31, 2004 and thereafter
every other year until 2010.
8.Requires the Agency to provide for the production and
publication of drug overdose prevention, recognition, and
response literature, and to provide assistance to
entities and individuals interested in the prevention of
fatal and nonfatal drug overdose. Requires that this
literature stress that drug use remains illegal, highly
dangerous and that complete abstinence from illegal drug
use is the healthiest choice. These requirements are
effective after January 1, 2004 and are subject to a
budget appropriation.
9.Requires the Agency to make grants to local drug overdose
prevention, recognition and response projects proposed by
county health departments, municipal health projects,
correctional units, and community-based organizations
that meet specified criteria. Requirements are effective
July 1, 2004 and are contingent upon a budget
appropriation.
10.Grants priority to proposals that provide drug users
information about drug treatment programs or other
strategies for abstaining from illegal drug use.
11.Requires the Agency to consider the following criteria
when awarding grants:
Policies and projects to encourage people to call
911 when they witness a potentially fatal drug
overdose.
The implementation of drug overdose prevention,
recognition and response education programs and
training in organizations that have access to drug
users and their families, and to patients and families
of patients prescribed opiate-based medications.
Programs to educate Californians over 65 of the
risks associated with using opiate-based medications,
ways to prevent overdose and appropriate response to
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overdose.
The institution of naloxone hydrochloride
prescription and distribution projects, and the
education and training on drug overdose response and
treatment of emergency personnel.
1.Authorizes the Agency to solicit, receive and expend
funds from private foundations, the federal government,
and other sources to fund overdose prevention,
recognition and response programs.
FISCAL IMPACT
Unknown. Moderate costs, likely under $1 million to the
Emergency Medical Services Authority and the California
Health and Human Services Agency. There may be minor costs
to local governmental entities that decide to allow local
public safety personnel to carry and administer opioid
antagonists.
BACKGROUND AND DISCUSSION
It is estimated that between 1,000 and 1,300 Californians
die of illegal drug overdoses every year. Since the
mid-1990s, the largest proportion of these deaths has been
attributed to heroin, often used in combination with other
drugs or alcohol. In recent years, increasing rates of
heroin use and the variability of its potency has resulted
in an escalating death toll among both novice younger users
and an aging population of heroin-addicted adults.
Heroin overdose is now a leading cause of death for men
between the ages of 20 and 54 in several cities and
counties in the western part of the United States.
According to the federal Centers for Disease Control and
Prevention, the number of fatal drug overdoses in
California quadrupled between 1980 and 1997.
In the counties of Kern, Orange, Riverside, Sacramento and
San Joaquin, the rate of drug overdose fatalities increased
ranging from 200 percent to 500 percent, between 1990 and
1998. The majority of these deaths are attributed to
heroin use, often used in combination with alcohol or other
drugs.
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A heroin overdose death typically occurs one to three hours
after the last injection, and studies suggest that the
majority of heroin overdoses are witnessed. There is often
ample time to save the victim's life provided that
witnesses are able and willing to intervene. A recent
study by the San Francisco General Hospital found that if
an overdose victim had a pulse at the time of paramedic
arrival, the likelihood of survival was 94 percent.
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In California, paramedics, physicians, nurses, nurse
practitioners and specified emergency technicians are
authorized to administer the antidote to heroin overdose,
naloxone hydrochloride. Naloxone is considered highly
effective and relatively easy to administer. SB 1695 seeks
to authorize local emergency services agencies to allow
appropriately trained emergency response personnel to
administer naloxone hydrochloride to prevent heroin
overdose deaths. It requires the California Health and
Human Services Agency to conduct a study every other year
of the rates and causes of fatal and non-fatal drug
overdoses and effective strategies to prevent overdoses.
SB 1695 also requires that the Agency provide for the
production and publication of drug overdose, prevention,
recognition and response literature that stresses that drug
use remains illegal and that complete abstinence from
illegal drug use is the healthiest choice. Lastly, the
bill requires that the Agency make grants to local entities
for drug overdose prevention, recognition and response
projects that provide information about lifesaving
interventions and response, and provide information to drug
users about drug treatment programs.
The author and supporters of SB 1695 argue that thousands
of families in California are confronted with the
destructive effects of addiction and the realities of
getting their loved ones into viable treatment programs.
Supporters argue that heroin overdoses and opiate-based
overdoses are largely preventable and that it is
appropriate for California to prevent these deaths. SB
1695 focuses on prevention of drug overdoses and provides
individuals at risk for overdose the opportunity to be
rehabilitated if they survive.
The American Nurses Association (ANA) of California opposes
SB 1695. Specifically, the ANA opposes allowing EMT-Is to
administer naloxone hydrochloride. ANA believes that
allowing EMT-Is to administer this heroin overdose antidote
may result in unintended consequences, may hurt victims and
may be unethical. ANA argues that allowing EMT-Is to
perform duties beyond those included in their current scope
of practice promotes a secondary health care delivery
system in rural areas and underserved communities. ANA
argues that the administration of naloxone hydrochloride
requires skill and training beyond the current requirements
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of an EMT-I.
Previous legislation:
SB 1695 (Escutia) is substantively similar to SB 1134
(Escutia) which was approved by the Legislature last year
without a single opposing vote. SB 1134 was vetoed by the
Governor who cited cost reasons in his veto message. SB
1695 includes most of the provisions of SB 1134 and revises
these provisions to contain costs.
POSITIONS
Support: Center for Policy Reform (sponsor)
California Association of Alcoholism and
Drug Abuse Counselors
California Conference of Local Health
Officers
California Medical Association
California Society of Addition Medicine
County Alcohol and Drug Program
Administrators Association
of California
Emergency Medical Services Administrators'
Association
of California
Parents for Addition Treatment and Healing
Tarzana Treatment Centers
Oppose: American Nurses Association of California