BILL NUMBER: AB 831 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY APRIL 3, 2013
AMENDED IN ASSEMBLY MARCH 18, 2013
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 ,
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.
This
The bill would also 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.
The bill would also make related legislative findings and
declarations.
Vote: 2/3. Appropriation: yes. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. The Legislature finds and declares the
following:
(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.
(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.
(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.
(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."
(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.
(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.
(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.
(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.
(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.
(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."
(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."
(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."
(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."
(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.
SECTION 1. SEC. 2. 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 Office of Emergency
Medical Services Authority , 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.
SEC. 2. SEC. 3. 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, programs serving veterans or military
personnel, and other organizations that work with or have
access to drug users, people who misuse
prescription or illegal drugs, 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 drug users,
people misusing prescription or illegal drugs, 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, or and 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 the public peace, health,
and safety, or the 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.