BILL ANALYSIS Ó
AB 507
Page 1
Date of Hearing: May 3, 2011
ASSEMBLY COMMITTEE ON BUSINESS, PROFESSIONS AND CONSUMER
PROTECTION
Mary Hayashi, Chair
AB 507 (Hayashi) - As Amended: April 27, 2011
SUBJECT : Pain management.
SUMMARY : Repeals provisions that authorize the Department of
Justice (DOJ) to employ a physician to interview and examine any
patient in connection with the prescription possession or use of
a controlled substance, require the patient to submit to the
interview, and authorize the physician to testify in prescribed
administrative hearings and makes clarifying and conforming
changes to Pain Patient's Bill of Rights and to the Pharmacy
Law.
EXISTING LAW
1)Authorizes the DOJ to employ a physician to interview and
examine any patient in connection with the prescription
possession or use of a controlled substance, requires the
patient to submit to the interview and examination, and
permits the physician to testify in prescribed administrative
proceedings.
2)Requires the Board of Pharmacy to take action against any
holder of a license who is guilty of unprofessional conduct,
including a pharmacist who fills an illegal the prescription
for a controlled substance.
3)Authorizes a physician and surgeon to prescribe for, or
dispense or administer to, a person under their treatment for
a medical condition, drugs or prescription controlled
substances for the treatment of pain or a condition causing
pain, including, but not limited to, intractable pain.
FISCAL EFFECT : Unknown
COMMENTS :
Purpose of this bill . According to the author's office, "Pain
is the most common reason Americans access the health care
system and is a leading contributor to health care costs. The
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costs of pain and suffering, both emotional and financial, are
enormous. Unrelieved pain is the second leading cause of
medically related work absenteeism and causes over $61 billion
dollars in lost productivity annually. According to the
National Center for Health Statistics, in 2006, 76.2 million
people suffered from pain in the United States.
"In the past twenty years, California has led the nation in
making many important legislative and regulatory changes related
to pain management. However, some ambiguities and
inconsistencies remain in the law surrounding pain practice.
This bill will remove remaining legal barriers to optimal pain
management for patients with cancer, HIV/AIDs and other diseases
or conditions causing pain."
Background . In 2008, the Pain and Policy Studies Group (PPSG)
published "Achieving Balance in Federal and State Pain Policy: A
Guide to Evaluation," with the purpose of promoting more
balanced and consistent U.S. federal and state policy relating
to the use of controlled substances for the medical management
of pain generally and specifically in palliative and end-of-life
care. PPSG collaborates with organizations such as the Alliance
of State Pain Initiatives, the American Academy of Pain
Medicine, the ACS Cancer Action Network, the American Pain
Foundation, the American Pain Society, the American Society of
Addiction Medicine, the Federation of State Medical Boards, the
National Association of Attorneys General, and the U.S. Drug
Enforcement Administration.
Overall, California received a B grade, but the report
highlighted a few impediments to pain management in the
Controlled Substances Act and ambiguities in the Pharmacy Law
and the Pain Patient's Bill of Rights. Specifically, the PPSG
guide states, "Authorizing a Department of Justice assigned
physician to examine any California patient who is prescribed a
controlled substance, who may be a "habitual user," or who has
an "addiction record," and allows a misdemeanor charge to be
brought against a patient for not submitting, appears arbitrary,
falls well outside the accepted framework of law regarding
controlled substances, medical practice and patient
confidentiality, and if implemented could subject patients to
undue scrutiny and seriously disrupt legitimate medical practice
and patient care." The guide also highlights the use of
"clearly excessive" in the Pharmacy Law as ambiguous because it
"implies there is a limit, but the limit is not specified."
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Currently, the DOJ has general authority to enforce state laws.
Under this authority, the DOJ's Bureau of Narcotic Enforcement,
CURES, has launched a real-time access Prescription Drug
Monitoring Program system which allows pre-registered users
including licensed healthcare prescribers eligible to prescribe
controlled substances, pharmacists authorized to dispense
controlled substances, law enforcement, and regulatory boards to
access real-time patient controlled substance history
information. The ability of the DOJ to investigate the illegal
use and dispersal of controlled substances will not be affected
by this bill.
Previous legislation . AB 2198 (Houston), Chapter 350, Statutes
of 2006, revises the laws governing the use of drugs to treat
pain to clarify that health care professionals that have a
medical basis, including the treatment of pain, for prescribing,
furnishing, dispensing, or administering dangerous drugs or
prescription controlled substances, are permitted to do so
without being subject to disciplinary action or prosecution.
AB 487 (Aroner), Chapter 518, Statutes of 2001, requires all
physicians to complete a mandatory continuing education course
in the subjects of pain management and the treatment of
terminally ill and dying patients. AB 487 also requires the
Board of Pharmacy to develop standards by June 1, 2002, to
assure the competent review in cases concerning the management,
including, but not limited to, the under-treatment,
under-medication, and overmedication of a patient's pain; and
permitted the Board of Pharmacy to consult with specified
entities to develop the standards utilizing, to the extent they
are applicable, current authoritative clinical practice
guidelines.
REGISTERED SUPPORT / OPPOSITION :
Support
American Cancer Society (sponsor)
American Chronic Pain Association
American Society for Pain Management Nursing
California Academy of Physician Assistants
CARE Team/Palliative Medicine Department, USC/Keck School of
Medicine
For Grace
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Southern California Cancer Pain Initiative
Opposition
None on file.
Analysis Prepared by : Marina Wiant / B.,P. & C.P. / (916)
319-3301