BILL ANALYSIS �
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THIRD READING
Bill No: AB 635
Author: Ammiano (D)
Amended: 6/24/13 in Senate
Vote: 21
SENATE JUDICIARY COMMITTEE : 6-0, 6/18/13
AYES: Evans, Walters, Corbett, Jackson, Leno, Monning
NO VOTE RECORDED: Anderson
ASSEMBLY FLOOR : 77-0, 4/15/13 - See last page for vote
SUBJECT : Drug overdose treatment: liability
SOURCE : California Society of Addiction Medicine
Harm Reduction Coalition
DIGEST : This bill expands an existing pilot program which
provides a qualified immunity to licensed health care providers
who prescribe naloxone, by removing the sunset, removing the
restriction to only seven counties, authorizing licensed health
care providers to also prescribe naloxone to third parties
(family members, friends, or other persons in a position to
assist a person at risk of an opioid-related overdose), as well
as to issue standing orders for the distribution and/or
administration of naloxone. This bill also amends the program's
limited liability provisions to instead confer (1) qualified
immunity from civil liability, criminal prosecution, or
professional review to licensed health care providers who issue
prescriptions or standing orders pursuant to the program; and
(2) immunity from civil action or criminal prosecution, or
CONTINUED
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professional review, to any persons who possess or distribute
naloxone pursuant to a prescription or standing order, or acting
with reasonable care in administering naloxone, as specified.
This bill also requires that a trained person who is prescribed
naloxone or possesses it pursuant to a standing order receive
training, as defined.
ANALYSIS :
Existing law:
1.The California Uniform Controlled Substances Act, strictly
regulates the distribution of controlled substances within
California.
2.Prohibits the prescription, administration, or dispensing of a
controlled substance to an addict, except under certain
circumstances.
3.Provides that a licensed health care provider who is permitted
by law to prescribe an opioid antagonist may, if acting with
reasonable care, prescribe and subsequently dispense or
distribute an opioid antagonist in conjunction with an opioid
overdose prevention and treatment training program, without
being subject to civil liability or criminal prosecution.
This immunity applies to the licensed health care provider
even when the opioid antagonist is administered by and to
someone other than the person to whom it is prescribed.
4.Permits a person who is not otherwise licensed to administer
an opioid antagonist to administer an opioid antagonist in an
emergency without fee if the person has received the training
information as specified and believes in good faith that the
other person is experiencing a drug overdose. The person
shall not, as a result of his or her acts or omissions, be
liable for any violation of any professional licensing
statute, or subject to any criminal prosecution arising from
or related to the unauthorized practice of medicine or the
possession of an opioid antagonist.
5.Requires that each local health jurisdiction that operates or
registers an opioid overdose prevention and treatment training
program, by January 1, 2015, collect, and report to the Senate
and Assembly Judiciary Committees, specified data on programs
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within the jurisdiction, including, among other things: the
number of opioid antagonist doses prescribed, the number of
opioid antagonist doses administered, the number of
individuals who received opioid antagonist injections who were
properly revived and the number who were not revived, as well
as the number of adverse events associated with an opioid
antagonist dose that was distributed as part of an opioid
overdose prevention and treatment training program.
6.Limits the application of this law to the Counties of Alameda,
Fresno, Humboldt, Los Angeles, Mendocino, San Francisco, and
Santa Cruz and includes a January 1, 2016 sunset.
7.Defines for these purposes "opioid antagonist" and "opioid
overdose prevention and treatment training program."
This bill:
1.Removes the restriction to the counties above and repeals the
sunset date.
2.Authorizes a licensed health care provider who is authorized
by law to prescribe an opioid antagonist to, if acting with
reasonable care, prescribe and subsequently dispense or
distribute an opioid antagonist to a person at risk of an
opioid-related overdose or to a family member, friend, or
other person in a position to assist a person at risk of an
opioid-related overdose.
3.Permits a licensed health care provider who is authorized by
law to prescribe an opioid antagonist to issue standing orders
for:
A. The distribution of an opioid antagonist to a person at
risk of an opioid-related overdose or to a family member,
friend, or other person in a position to assist a person at
risk of an opioid-related overdose; and
B. The administration of an opioid antagonist to a person
at risk of an opioid-related overdose by a family member,
friend, or other person in a position to assist a person
experiencing or reasonably suspected of experiencing an
opioid overdose.
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1.Provides that a licensed health care provider who acts with
reasonable care shall not be subject to professional review,
found liable in a civil action, or be subject to criminal
prosecution for issuing a prescription or standing order
pursuant to the bill.
2.Provides that, notwithstanding any other law, a person who
possesses or distributes an opioid antagonist pursuant to a
prescription or standing order shall not be subject to
professional review, be found liable in a civil action, or be
subject to criminal prosecution for this possession or
distribution.
3.Provides that notwithstanding any other law, a person not
otherwise licensed to administer opioid antagonist, but
trained as specified, who acts with responsible care in
administering an opioid antagonist in good faith and not for
compensation, to a person who is experiencing or is suspected
of experiencing an overdose shall not be subject to
professional review, be liable in a civil action, or be
subject to criminal prosecution for this administration.
4.Requires that a person who is prescribed an opioid antagonist
or possesses it pursuant to a standing order shall receive the
training provided by an opioid overdose prevention and
treatment training program.
Background
Opioid overdoses are characterized by central nervous system and
respiratory depression, leading to coma and death. While there
are various opioid antagonists, the most popular appears to be
naloxone, which has the ability to counteract depression of the
central nervous and respiratory system caused by an opioid
overdose. Naloxone is administered by either injection into
vein or muscle or via a nasal atomizer. Once administered,
naloxone takes effect after around a minute, with effects
lasting around 45 minutes, potentially saving the person's life.
The New York Times August 21, 2005 article entitled The Shot
That Saves, noted:
If given early enough, naloxone can prevent damage to the
brain caused by lack of oxygen and leave the victim
unharmed. According to research ? at least 75% of overdose
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deaths involve multiple drugs, usually mixtures of heroin
and other depressants like alcohol. Removing the opioid
from the mix with naloxone is often enough to revive
victims.
Naloxone itself is virtually harmless. Its most common
side effects are withdrawal symptoms like nausea, shakiness
and agitation in those who are physically dependent on
opioids. While uncomfortable, these symptoms are not
dangerous. Rarely, seizures can occur, but this risk is
far lower than the risk to those who are not treated. The
drug has no effect on those who haven't taken opioids.
According to a study published in the journal Drug and
Alcohol Dependence, 57% of 1,184 hard drug users
interviewed had witnessed at least one overdose. Medical
help was sought in only two-thirds of the instances, and
this was usually only after efforts to revive the victim by
hitting him or rubbing him with ice had failed?. More than
half of the drug users in the study cited fear of arrest as
the main reason for delaying or failing to seek help.
In 2007, in order to facilitate the prescription of naloxone to
trained individuals in California, SB 767 (Ridley-Thomas,
Chapter 477, Statutes of 2007) established a seven county pilot
program through January 1, 2010, that provided licensed health
care providers with a qualified immunity from civil liability or
criminal prosecution when they prescribed naloxone. That
immunity only applies where the health care provider dispensed
that drug in connection with an opioid overdose prevention and
training program, those programs, either registered or run by a
local health jurisdiction, train individuals for how to
recognize and respond to an opiate overdose. AB 2145 (Ammiano,
Chapter 545, Statutes of 2010) has since extended the sunset
date for the program to January 1, 2016, extended the deadline
for the reporting requirements to January 1, 2015, and added a
new qualified immunity for unlicensed trained persons who
administer an opioid antidote in emergency situations where they
believe, in good faith, that the other person is experiencing a
drug overdose.
FISCAL EFFECT : Appropriation: No Fiscal Com.: No Local:
No
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SUPPORT : (Verified 6/21/13)
California Society of Addiction Medicine (co-source)
Harm Reduction Coalition (co-source)
Berkeley Needle Exchange Emergency Distribution
California Association of Alcohol and Drug Program Executives,
Inc.
California Attorneys for Criminal Justice
California Opioid Maintenance Providers
California Public Defenders Association
City and County of San Francisco
Civil Justice Association of California
Common Ground, the Westside HIV Community Center
County Alcohol and Drug Program Administrators Association of
California
Drug Policy Alliance
Harm Reduction Therapy Center
Homeless Health Care Los Angeles
Medical Board of California
National Coalition Against Prescription Drug Abuse
San Francisco Drug Users Union
Shasta Community Health Center
ARGUMENTS IN SUPPORT : According to the author:
Drug overdoses are now the leading cause of injury death in
the United States, surpassing motor vehicle crash deaths.
According to the most recent data released by the Centers
for Disease Control and Prevention [(CDC)], there were
37,000 drug overdose deaths in the United States in 2009.
In 2008, the most recent year data is available, there were
4,334 drug poisoning deaths in California. Counties
experiencing the highest numbers of overdose deaths are:
Alameda, Fresno, Kern, Los Angeles, Orange, Riverside,
Sacramento, San Bernardino, San Diego, San Francisco, and
Santa Clara Counties.
According to the CDC, in 2009, 28,754 (91%) of all
unintentional poisoning deaths were caused by drugs. The
class of drugs known as prescription opioids, which
includes such drugs as methadone, hydrocodone (Vicodin),
and oxycodone (Oxycontin), was most commonly involved,
followed by cocaine and heroin. Drug poisoning is the
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leading cause of injury death in California and its effects
are felt throughout all sectors of the state.
When a person overdoses on opioids he/she experiences
depression of the central nervous system and is in danger
of dying because the opioids slow down, and eventually
stop, the person's breathing. Naloxone (also known as
Narcan) is routinely used in hospitals and by paramedics in
the field to revive individuals who are suspected to be
overdosing on opioids.
In California, overdose prevention programs operate in a
handful of cities and counties, but have limited reach in
terms of addressing the overdose issue statewide. Both SB
767 [(Ridley-Thomas, Ch. 477, Stats. 2007)] and AB 2145
[(Ammiano, Ch. 545, Stats. 2010)] only covered the
[c]ounties of Alameda, Fresno, Humboldt, Los Angeles,
Mendocino, San Francisco, and Santa Cruz. These counties
were designated as pilot counties because they had existing
overdose prevention programs in place already, through
their local syringe access and disposal programs. The Harm
Reduction Coalition is working with health advocates in
Stanislaus, San Joaquin, Sacramento, Sonoma, San Diego,
Kern, Santa Clara, Ventura and Orange counties who are
either already doing independent naloxone distribution as
part of an overdose prevention program, or would like to
start, as they are now considered 'best practice'
components of high quality programs that focus on the
health of drug users.
AB 635 safely expands the availability and distribution of
this life-saving drug.
ASSEMBLY FLOOR : 77-0, 04/15/13
AYES: Achadjian, Alejo, Allen, Ammiano, Atkins, Bigelow, Bloom,
Blumenfield, Bocanegra, Bonilla, Bonta, Bradford, Brown,
Buchanan, Ian Calderon, Campos, Chau, Ch�vez, Chesbro, Conway,
Cooley, Dahle, Daly, Dickinson, Donnelly, Eggman, Fong, Fox,
Frazier, Beth Gaines, Garcia, Gatto, Gomez, Gordon, Gorell,
Gray, Grove, Hagman, Hall, Roger Hern�ndez, Holden, Jones,
Jones-Sawyer, Levine, Linder, Logue, Maienschein, Mansoor,
Medina, Melendez, Mitchell, Morrell, Mullin, Muratsuchi,
Nazarian, Nestande, Olsen, Pan, Patterson, Perea, V. Manuel
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P�rez, Quirk, Quirk-Silva, Rendon, Salas, Skinner, Stone,
Ting, Torres, Wagner, Waldron, Weber, Wieckowski, Wilk,
Williams, Yamada, John A. P�rez
NO VOTE RECORDED: Harkey, Lowenthal, Vacancy
AL:nl 6/24/13 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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