BILL ANALYSIS Ó
AB 831
Page 1
Date of Hearing: April 9, 2013
ASSEMBLY COMMITTEE ON HEALTH
Richard Pan, Chair
AB 831 (Bloom) - As Amended: April 3, 2013
SUBJECT : Drug overdoses.
SUMMARY : Requires, until January 1, 2016, the California Health
and Human Services Agency (CHHSA) to convene a temporary working
group to develop a state plan to reduce the rate of fatal drug
overdoses and appropriates $500,000 from the General Fund (GF)
to CHHSA to provide grants to local agencies to implement drug
overdose prevention and response programs. Specifically, this
bill :
1)Directs CHHSA to convene a temporary working group within
CHHSA to develop a state plan to reduce the rate of fatal drug
overdoses. Requires the working group to be comprised of
experts and staff from the Emergency Medical Services
Authority, Department of Alcohol and Drug Programs (DADP),
Department of Public Health, Office of AIDS, and any other
staff designated by the Secretary of CHHSA.
2)Permits staff from the Medical Board of California and the
Board of Pharmacy to also participate in the working group for
the purpose of identifying promising practices to reduce
accidental drug overdose among patients and other at-risk
groups.
3)Requires the working group to make recommendations to relevant
policy committees of the Legislature by January 1, 2015, and
sunsets the working group on January 1, 2016.
4)Requires CHHSA to make grants to local agencies from funds
appropriated pursuant to this bill for any of the following
purposes:
a) Drug overdose prevention, recognition, and response
education and training projects, as specified;
b) Prescription and distribution projects for naloxone, an
opioid antagonist;
c) Development and implementation of policies and projects
to encourage people, including people misusing prescription
or illegal drugs, to call the 911 emergency response system
when witnessing potentially fatal drug overdoses;
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d) Awareness, prevention, and response programs, as
specified, aimed at Californians over 65 years of age;
e) Production and distribution of targeted or mass media
materials on drug overdose prevention and response;
f) Education and training projects on drug overdose
response and treatment for emergency services and law
enforcement personnel, as specified; and,
g) Parent, family, and survivor education and mutual
support groups.
5)Authorizes CHHSA to set guidelines regarding the
prioritization of applications and the types of organizations
or entities that may apply in a given year.
6)Exempts the adoption and one readoption of emergency
regulations necessary to implement the grant program
established in this bill from review by the Office of
Administrative Law, as specified.
7)Appropriates $500,000 from the GF in the 2014-15 fiscal year
for the purpose of funding the grant program established in
this bill and specifies that additional funds necessary for
the implementation of the grant program may be included in the
Budget appropriation for CHHSA.
8)Makes various legislative findings and declarations relating
to the prevalence of fatal drug overdose and the importance of
drug overdose prevention, education, and response training
efforts.
EXISTING LAW :
1)Requires DADP to post by January 1, 2009, and for a period of
at least six months, specified information on its Internet Web
site relating to fatal drug overdose, including county and
state death rates; trends in drug overdose death rates by
county or city, or both; suggested improvements in data
collection; and, a description of interventions that may be
effective in reducing the rate of fatal or nonfatal drug
overdoses.
2)Authorizes, until January 1, 2016, a pilot program in seven
counties to implement an opioid overdose prevention and
treatment training program that includes the distribution of
naloxone for the treatment of drug overdose.
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3)Protects licensed health care providers who prescribe an
opioid antagonist in conjunction with an opioid overdose
prevention and treatment training program from civil liability
or criminal prosecution and extends this limited immunity to
lay persons who administer an opioid antagonist in an
emergency, if that lay person has received appropriate
training, as specified.
FISCAL EFFECT : This bill has not yet been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . The author states that, on average, 10
Californians die of drug overdose every day and, in 2009,
3,500 Californians died from preventable drug overdose, more
than in motor vehicle accidents. However, the author contends
that the state lacks a plan and appropriate funding to address
this leading cause of accidental death. The author notes that
innovative efforts in some counties to provide naloxone, the
antidote to opiate overdose, and training on its safe
administration to people who use opiates and their caregivers
have empowered witnesses to a potentially fatal drug overdose
to take immediate action to prevent death, brain damage, or
other permanent disability, but a broader public health
response is needed. According to the author, this bill is
intended to ensure that overdose prevention programs are
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.
2)BACKGROUND . Opioids are medications prescribed to relieve
pain. They include hydrocodone (e.g., Vicodin), oxycodone
(e.g., OxyContin, Percocet), morphine, and codeine. Opioids
can be used safely and effectively when taken as directed by a
physician; however, a single large dose can have serious
consequences such as respiratory depression or death. Regular
and prolonged use of opioids can lead to physical dependence
and addiction.
According to the federal Centers for Disease Control and
Prevention (CDC), drug overdose death rates have increased
steadily in the US since 1979. In 2010, a total of 38,329
drug overdose deaths nationwide were reported, with
prescription opioids involved in three out of four medication
overdose deaths. Since 1996, an increasing number of
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community-based programs have provided the opioid antagonist
naloxone, considered the treatment of choice to reverse the
potentially fatal respiratory depression caused by an overdose
of heroin and other opioids, and other opioid overdose
prevention services to persons who use drugs, their families
and friends, and to service providers, including health-care
providers, homeless shelters, and substance abuse treatment
programs. These services include education regarding overdose
risk factors, recognition of signs of opioid overdose,
appropriate responses to an overdose, and administration of
naloxone. The CDC maintains that providing opioid overdose
education and naloxone to persons who use drugs and to persons
who might be present at an opioid overdose can help reduce
opioid overdose mortality, a rapidly growing public health
concern.
3)OVERDOSE PREVENTION PROJECTS IN CALIFORNIA . Pursuant to SB
767 (Ridley-Thomas), Chapter 477, Statutes of 2007, the
Overdose Treatment Liability Act (Act) establishes a pilot
overdose prevention project in the counties of Alameda,
Fresno, Humboldt, Los Angeles, Mendocino, San Francisco, and
Santa Cruz, all of which already had existing overdose
prevention programs in place through their local syringe
access and disposal programs. The Act grants limited immunity
from civil and criminal penalties to licensed health care
providers in these counties for prescribing, dispensing, or
distributing naloxone, when acting with reasonable care and in
conjunction with a local opioid overdose prevention and
treatment training program. AB 2145 (Ammiano), Chapter 545,
Statutes of 2010, extends liability protection to third
parties who administer naloxone and sunsets the pilot projects
on January 1, 2016. Data reported by participating pilot
counties since AB 2145 took effect shows that the projects
have achieved a 98% rate of success in overdose reversals and
no evidence of any adverse events associated with
administration of naloxone.
4)SUPPORT . The sponsor of this bill, Drug Policy Alliance,
states that this bill seeks to build upon the seven-county
pilot project in California by providing additional funding
for these existing programs and allowing for the creation and
growth of newer programs. The sponsor notes that naloxone
distribution is now considered a 'best practice' component of
a high quality overdose treatment program and has been found
to be highly cost-effective in reducing hospitalization
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spending, in addition to sparing families the costs and
suffering associated with the loss of a loved one. Supporters
add that this bill would provide state leadership in defining
a comprehensive public health strategy for reducing the drug
overdose epidemic and make a modest but critical investment
from the GF for small grants to ensure successful local
programs have access to the resources necessary to reduce
overdose fatalities. The California Opioid Maintenance
Providers supports the purpose of this bill in working toward
mitigating the negative consequences of the drug overdose
epidemic and requests an amendment to add membership of
persons with direct expertise in the treatment of opiate
dependence to the temporary working group.
5)RELATED LEGISLATION . AB 635 (Ammiano), pending on the
Assembly Floor, revises provisions of the current seven county
pilot program; expands these provisions statewide; and,
removes the 2016 sunset date.
6)PRIOR LEGISLATION .
a) AB 2145 revises provisions of the seven county pilot
program; provides limited immunity to unlicensed trained
persons who administer an opioid antagonist in emergency
situations, as specified; and, extends the sunset date from
January 1, 2011 to January 1, 2016.
b) SB 797 authorizes licensed health care providers in
seven counties to prescribe and subsequently dispense or
distribute an opioid antagonist in conjunction with an
opioid overdose prevention and treatment training program,
as defined, without being subject to civil liability or
criminal prosecution.
c) SB 1695 (Escutia), Chapter 678, Statutes of 2002,
requires DADP, to place information on drug overdose trends
in California on its Internet Web site, including county
and state death rates, in order to ascertain changes in the
causes or rates of fatal and nonfatal drug overdoses.
REGISTERED SUPPORT / OPPOSITION :
Support
Drug Policy Alliance (sponsor)
A New Parents for Addiction Treatment & Healing
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All of Us or None, Los Angeles/Long Beach - A New Way of Life
Reentry Project
Broken No More
California Hepatitis Alliance
California Opioid Maintenance Providers
Center for Living and Learning
Center on Juvenile and Criminal Justice
Children's Hospital Los Angeles
Clean Needles Now
Glide Health Services
Harm Reduction Coalition
HealthRIGHT360
Homeless Health Care Los Angeles
La Ventana Treatment Programs
Los Angeles Community Action Network
Los Angeles Community Health Outreach Project
Los Angeles County Board of Supervisors
Mission Neighborhood Health Center
Mothers Against Prescription Drug Abuse
Mothers With a Purpose
National Coalition Against Prescription Drug Abuse
Safer Alternatives Thru Networking and Education
San Francisco Hepatitis C Task Force
Several individuals
Opposition
None on file.
Analysis Prepared by : Cassie Royce / HEALTH / (916) 319-2097