Amended in Assembly April 3, 2013

Amended in Assembly March 18, 2013

California Legislature—2013–14 Regular Session

Assembly Bill No. 831

Introduced by Assembly Member Bloom

February 21, 2013

An act to add Section 11758.08 to, and to add and repeal Section 11758.07 of, the Health and Safety Code, relating to drugs, and making an appropriation therefor.

LEGISLATIVE COUNSEL’S DIGEST

AB 831, as amended, Bloom. Drug overdoses.

Existing law establishes various programs for the control of illegal drugs in California and requires the State Department of Alcohol and Drug Programs to place on its Internet Web site specified information on drug overdose trends in California, including county and state death rates, from existing data, in order to ascertain changes in the causes or rates of fatal and nonfatal drug overdoses for the preceding 5 years.

This bill, until January 1, 2016, would establish begin insert , end insert within the California Health and Human Services Agency, a temporary working group, as specified, to develop a plan to reduce the rate of fatal drug overdoses in the state. The bill would require the temporary working group to make recommendations to the Chair of the Senate Committee on Health and the Chair of Assembly Committee on Health on or before January 1, 2015.

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This

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begin insert The end insert bill would begin insert also end insert establish a grant program within the California Health and Human Services Agency to provide funds for programs related to drug overdose prevention, recognition, and response education, as specified. The bill would appropriate $500,000 from the General Fund for this purpose in the 2014-15 fiscal year.

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The bill would also make related legislative findings and declarations.

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Vote: ²⁄₃. Appropriation: yes. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

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begin insert SECTION 1. end insert   

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begin insert The Legislature finds and declares the following: end insert

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(a) According to the United States Centers for Disease Control
and Prevention (CDC), a fatal drug overdose occurs in the United
States every 14 minutes and drug overdose deaths are up for the
11th consecutive year. Drug overdose rates have tripled since
1990 and have never been higher.

end insert begin insert

(b) In recent years, over 3,500 Californians have died annually
from drug overdose, or approximately 10 people each day, on
average. In 2009, more Californians died of drug overdoses than
in car accidents, and 1,000 more Californians died from drug
overdoses than from gun homicides.

end insert begin insert

(c) There are cost-effective, proven interventions to reduce the
number of drug overdoses caused by prescription analgesics and
illegal drugs. An evaluation published by the CDC in 2012
identified 50 overdose prevention and education programs
operating in 19 states, including California. These programs
provide overdose prevention and recognition and response training
to laypersons, including first responders, law enforcement officers,
pain patients, family members, and at-risk drug users, and, when
appropriate, prescriptions for the overdose reversal medication
naloxone. These programs have reported over 50,000 doses of
opiate overdose antidote prescribed and over 10,000 life-saving
reversals of an overdose.

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(d) According to an economic analysis published in the January
2013 edition of the Annals of Internal Medicine, community-level
reductions of overdose death ranged from 37 percent to 90 percent
in various cities that have implemented overdose prevention
education projects that include naloxone prescriptions. The authors
concluded, “[n]aloxone distribution to heroin users is likely to
reduce heroin death and is cost-effective, even under markedly
conservative assumptions.”

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(e) Between 2003 and 2011, the Drug Overdose Prevention and
Education project, in partnership with the San Francisco County
Department of Health, has recorded over 600 “saves” by
laypersons providing first aid and administering naloxone to
persons experiencing opiate overdose. The antidote was provided
by prescription, with training by staff.

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(f) Since the implementation of the drug overdose prevention
project in San Francisco, emergency room visits for drug overdose
have dropped by approximately 50 percent, resulting in significant
savings to the healthcare system.

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(g) Medical personnel at Fort Bragg Army Base in North
Carolina implemented a comprehensive program to serve Unites
States Army personnel. The base had suffered an unacceptably
high rate of fatal drug overdoses, at an average of eight deaths
per month, fueled by the misuse of pain medication and treatments
for war-related injuries, including traumatic brain injury and
post-traumatic stress disorder. Several programmatic steps were
taken, including careful monitoring of prescription practices.
However, the supervising physicians credited naloxone
prescriptions as being the lynchpin that prevented any further
overdoses, fatal or nonfatal, among United States Army personnel
being treated at Fort Bragg Army Base.

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(h) Project Lazarus, a community-level intervention that worked
with physicians, patients, and family members of prescription
analgesic pain medication patients, achieved a 38 percent
reduction in overdose deaths in rural Wilkes County, North
Carolina.

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(i) The State of Massachusetts implemented a project to provide
prevention education and response training, including the use of
naloxone by prescription, to law enforcement personnel and
laypersons who are likely to witness a potentially fatal drug
overdose. Between December 2007 and September 2011, over
10,000 persons were trained and over 1,100 opioid overdose
reversals were recorded.

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(j) A study of the Massachusetts program published by the
British Medical Journal in January of 2013 described overdose
education and naloxone distribution by laypersons as “an effective
public health intervention to address increasing mortality in the
opioid overdose epidemic by training potential bystanders to
prevent, recognize, and respond to opioid overdoses.”

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(k) The American Medical Association resolved on June 19,
2012, that it “(1) recognizes the great burden that opioid addiction
and prescription drug abuse places on patients and society alike
and reaffirms its support for the compassionate treatment of such
patients; (2) urges that community-based programs offering
naloxone and other opioid overdose prevention services continue
to be implemented in order to further develop best practices in
this area; (3) encourages the education of health care workers
and opioid users about the use of naloxone in preventing opioid
overdose fatalities; and (4) will continue to monitor the progress
of such initiatives and respond as appropriate.”

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(l) The American Public Health Association resolved on October
30, 2012, to “[e]ncourage local and state health departments to
increase public and health professional awareness of the signs
and symptoms of overdose; improve awareness of and facilitate
access to naloxone; and support entry into treatment and recovery
for those individuals seeking such services.”

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(m) The United Nations Commission on Narcotic Drugs resolved
on March 16, 2012, that it “[e]ncourages all Member States to
include effective elements for the prevention and treatment of drug
overdose, in particular opioid overdose, in national drug policies,
where appropriate, and to share best practices and information
on the prevention and treatment of drug overdose, in particular
opioid overdose, including the use of opioid receptor antagonists
such as naloxone.”

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(n) In enacting this act, it is the intent of the Legislature that
overdose prevention programs be conducted in the most
cost-effective manner possible, while coordinating state efforts
across agencies and supporting culturally appropriate local
programs in areas of high need in a manner consistent with local
needs and values.

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begin delete SECTION 1. end delete
begin insert SEC. 2. end insert   

Section 11758.07 is added to the Health and Safety
Code, to read:

11758.07.  

(a) The California Health and Human Services
Agency shall convene a temporary working group within the
agency to develop a plan to reduce the rate of fatal drug overdoses
in the state. Experts and staff from the begin delete Office of end delete Emergency
begin insert Medical end insert Services begin insert Authority end insert , State Department of Alcohol and
Drug Programs, State Department of Public Health, Office of
AIDS, and any other staff that the Secretary of California Health
and Human Services designates may participate in the temporary
working group. Additionally, staff from the Medical Board of
California and California State Board of Pharmacy may also
participate for the purpose of identifying promising practices to
reduce accidental drug overdose among patients and other at-risk
groups.

(b) The secretary may invite other experts to participate in the
temporary working group. Their participation shall be
uncompensated.

(c) The temporary working group shall make recommendations
to the Chair of the Senate Committee on Health and the Chair of
the Assembly Committee on Health on or before January 1, 2015.

(d) This section shall remain in effect only until January 1, 2016,
and as of that date is repealed, unless a later enacted statute, that
is enacted before January 1, 2016, deletes or extends that date.

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begin insert SEC. 3. end insert   

Section 11758.08 is added to the Health and Safety
Code, to read:

11758.08.  

(a) The California Health and Human Services
Agency shall make grants to local agencies from funds appropriated
pursuant to this section for any of the following purposes:

(1) Drug overdose prevention, recognition, and response
education projects in jails, prisons, drug treatment centers, syringe
exchange programs, clinics, begin insert programs serving veterans or military
personnel, end insert and other organizations that work with or have access
to begin delete drug users, end delete begin insert people who misuse prescription or illegal drugs, end insert
their families, and communities.

(2) Drug overdose prevention, recognition, and response training
for patients and their families when the patient is prescribed
opiate-based medications for which there is a significant risk of
overdose.

(3) Naloxone hydrochloride prescription or distribution projects.

(4) Development and implementation of policies and projects
to encourage people, including begin delete drug users, end delete begin insert people misusing
prescription or illegal drugs, end insert to call the 911 emergency response
system when they witness potentially fatal drug overdoses.

(5) Programs to educate Californians over 65 years of age about
the risks associated with using opiate-based medications, ways to
prevent overdose, begin delete or end delete begin insert and end insert how to respond if they witness an
overdose.

(6) The production and distribution of targeted or mass media
materials on drug overdose prevention and response.

(7) Education and training projects on drug overdose response
and treatment for emergency services and law enforcement
personnel, including, but not limited to, volunteer fire and
emergency services.

(8) Parent, family, and survivor education and mutual support
groups.

(b) In order to control budgets and appropriately limit the
number of possible applications, the agency may set guidelines
regarding the prioritization of applications and the types of
organizations or entities that may apply in a given year.

(c) The adoption and one readoption of regulations to implement
this section shall be deemed to be an emergency necessary for the
immediate preservation of begin insert the end insert public peace, health, begin delete and end delete safety, or
begin delete the end delete general welfare for purposes of Sections 11346.1 and 11349.6
of the Government Code, and the agency is hereby exempted from
the requirement that it describe specific facts showing the need
for immediate action and from review by the Office of
Administrative Law.

(d) There is hereby appropriated from the General Fund, in the
2014-15 fiscal year, five hundred thousand dollars ($500,000) for
the purpose of funding the grants provided in subdivision (a).
Additional funds necessary for the implementation of this section
in the 2014-15 fiscal year and in later fiscal years may be included
in the budget appropriation for the California Health and Human
Services Agency.