BILL ANALYSIS Ó
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|Hearing Date:June 27, 2011 | Bill No:AB 507|
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SENATE COMMITTEE ON BUSINESS, PROFESSIONS
AND ECONOMIC DEVELOPMENT
Senator Curren D. Price, Jr., Chair
Bill No: AB 507Author:Hayashi
As Amended:June 20, 2011 Fiscal: Yes
SUBJECT: Pain management.
SUMMARY: Repeals existing law provisions that authorize the
Department of Justice to employ a physician to interview any patient
for whom any controlled substance classified as Schedule I, II, or III
has been prescribed or to whom any such controlled substance has been
furnished or administered, or who is an habitual user of such
controlled substance, or who has a previous addiction record to a
substance listed as controlled substance, as specified. Makes
technical changes to the "Pain Patient's Bill of Rights."
Existing law:
1) Establishes the Pain Patient's Bill of Rights, which includes
provisions governing the treatment of patients suffering from
severe chronic intractable pain, including access to proper
treatment, the use of opiates or any or all modalities to relieve
severe intractable pain. (Health & Safety Code (HSC) §
124960-124961)
2) States legislative findings and declarations that a patient's
physician may refuse to prescribe opiate medication for a patient
who requests the treatment for severe chronic intractable pain.
States that a physician who refuses shall inform the patient that
there are physicians who specialize in the treatment of severe
chronic intractable pain with methods that include the use of
opiates. (HSC § 124961)
3) Establishes the Uniform Controlled Substances Act, which among
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other provisions, specify certain Schedule for Controlled
Substances, and establishes the Controlled Substance Utilization
Review and Evaluation System administered by the Department of
Justice for the electronic monitoring of the prescribing and
dispensing of specified controlled substances by all practitioners
authorized to prescribe or dispense controlled substances. (HSC §
11100 et. seq.)
4) Authorizes a physician and surgeon to prescribe for, or dispense,
or administer to a person, under his or her treatment for a medical
condition, dangerous drugs or prescription controlled substances
for the treatment of pain or a condition causing pain, including,
but not limited to, intractable pain. (Business & Professions Code
§ 2241.5)
5) Provides that no physician and surgeon shall be subject to
disciplinary action for prescribing, dispensing, or administering
dangerous drugs or prescription controlled substances, as
specified. (Id.)
6) Authorizes the Department of Justice to employ a physician to
interview any patient for whom any controlled substance classified
as Schedule I, II, or III has been prescribed or to whom any such
controlled substance has been furnished or administered, or who is
an habitual user of such controlled substance, or who has a
previous addiction record to a substance listed as controlled
substance, as specified. (HSC § 11453)
This bill:
1) Repeals existing law that authorizes the Department of Justice to
employ a physician to interview any patient for whom any controlled
substance classified in Schedule I, II, or III has been prescribed,
or to whom any such controlled substance has been furnished or
administered, or who is an habitual user of such controlled
substance, or who has a previous addiction record to a substance,
as specified. Repeals certain requirements for a patient who is
the subject of an interview and for physicians employed to conduct
an interview.
2) Makes changes to existing provisions of the Pain Patient's Bill of
Rights, and makes other technical, non-conforming changes.
FISCAL EFFECT: According to the Assembly Appropriations Committee,
"negligible state fiscal impact."
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COMMENTS:
1. Purpose. The American Cancer Society is the Sponsor of this
measure. According to the Sponsor, this bill is necessary to deal
with inconsistencies in pain management practice and to update the
approach to pain management. The Sponsor points out that pain
often accompanies cancer, and it often continues even after cancer
treatment. The Sponsor points out that cancer pain is a problem
for up to 60% or more of patients who are undergoing active
treatment, for more than 60% of patients with the advanced
disease, and for at least 30% of patients after treatment
concludes. Addressing pain in all these instances is imperative
for improving the quality of life of cancer patients and
survivors. However, the Sponsor points out there remains many
reasons for the under treatment of pain, underlying many of them
is a chilling factor created by the policy environment for the
treatment of pain. The state has an interest in both ensuring
that pain is adequately treated while also deterring diversion of
controlled substances. According to the Sponsor, the proposed
changes in this bill were highlighted by the Pain Policy Studies
Group , which reviews every state's pain policies, and indicated
that there is a need to improve California's pain policy.
2. Background. Existing law establishes the "Pain Patient's Bill of
Rights" which includes provisions governing the treatment of
patients suffering from severe chronic intractable pain, including
access to proper treatment, the ability to request or reject the
use of any or all modalities in order to relieve severe chronic
intractable pain, and the use of opiates or any or all modalities
to relieve severe intractable pain. Provisions dealing with the
prescription of opiates are included in the "Pain Patient's Bill
of Rights." Existing law defines opiate as any substance having
an addiction-forming or addiction-sustaining liability similar to
morphine or being capable of conversion into a drug having
addiction-forming or addiction-sustaining liability.
Additionally, the law allows physicians and surgeons to prescribe
for, or dispense, or administer to a person, under his or her
treatment a for medical condition, dangerous drugs or prescription
controlled substances for the treatment of pain, or a condition
causing pain, including but not limited to, intractable pain. A
physician and surgeon that furnishes a prescription pursuant to
specified conditions is not subject to disciplinary action.
However, existing law allows the Department of Justice to employ a
physician to interview and examine any patient for whom an opiate
has been prescribed, furnished or administered, or who is a
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habitual user of such a controlled substance, or who has a
previous addiction record, as specified. This bill would remove
these provisions allowing the DOJ to employ or interview patients
who have been prescribed specific scheduled substances .
3. Related 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
over medication 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.
4. Arguments in Support. Supporters such as the Hollywood
Presbyterian Medical Center , American Society for Pain Management
Nursing , and the American Chronic Pain Association , believe this
bill would continue the process of improving policy for
appropriate pain treatment. According to the Medical Board of
California , this bill will help fix ambiguities and
inconsistencies in existing law surrounding pain practice that may
restrict the provision of health care and interfere with patient
access to effective pain treatment.
5. Author's Technical Amendments. The Author would like to amend
this bill, on page 6, line 32, to make conforming changes and
permit a physician who refuses to prescribe opiate medication to
inform a patient that there are physicians who treat pain, as
follows:
(k) The patient's physician may refuse to prescribe opiate
medication for a patient who requests the treatment for pain or
a condition causing pain, including, but not limited to,
intractable pain. However, that physician shall refer the
patient to inform the patient that there are physicians who
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treat pain or a condition causing pain, including, but not
limited to, intractable pain with methods that include the use
of opiates.
SUPPORT AND OPPOSITION:
Support:
American Cancer Society (Sponsor)
American Chronic Pain Association
American Society for Pain Management Nursing
California Academy of Physician Assistants
Feinberg Medical Group
For Grace
Hollywood Presbyterian Medical Center
Medical Board of California
Southern California Cancer Pain Initiative
USC/Keck School of Medicine CARE Team/Palliative Medicine Department
Opposition: None on file as of June 21, 2011
Consultant:Rosielyn Pulmano