BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 973|
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THIRD READING
Bill No: SB 973
Author: Hernandez (D)
Amended: 4/29/14
Vote: 21
SENATE HEALTH COMMITTEE : 8-0, 4/24/14
AYES: Hernandez, Morrell, Beall, DeSaulnier, Evans, Monning,
Nielsen, Wolk
NO VOTE RECORDED: De León
SENATE APPROPRIATIONS COMMITTEE : 7-0, 5/12/14
AYES: De León, Walters, Gaines, Hill, Lara, Padilla, Steinberg
SUBJECT : Narcotic treatment programs
SOURCE : Author
DIGEST : This bill revises existing law related to patient
treatment in narcotic treatment programs (NTPs).
ANALYSIS :
Existing law:
1.Requires the Department of Health Care Services (DHCS) to
license NTPs to use narcotic replacement therapy in the
treatment of addicts whose addiction was acquired or supported
by the use of a narcotic drug or drugs not in compliance with
a physician and surgeon's legal prescription.
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2.Requires DHCS to establish a program for the operation and
regulation of office-based NTPs. Requires office-based NTPs
to either hold a primary NTP license or be affiliated and
associated with a primary licensed NTP. Requires patients of
an office-based NTP to be registered as patients in the
primary licensed NTP. Allows office-based NTPs to provide
treatment for a maximum of 20 patients.
3.Requires DHCS to establish and enforce the criteria for the
eligibility of NTP patients, program operation guidelines, and
any regulations that are necessary to protect the safety and
well-being of the patient, the local community, and the
public.
4.Allows NTPs to admit a patient to narcotic maintenance or
narcotic detoxification treatment only seven days after
completion of a prior withdrawal treatment episode.
5.Requires NTPs to provide take-home doses that are diluted in a
solution that has a volume of not less than one ounce. States
the Legislature's intent that self-administered dosage only be
provided when the patient is clearly adhering to the
requirements of the NTP, and where daily attendance at a
clinic would be incompatible with gainful employment,
education, and responsible homemaking. Requires DHCS to
prohibit NTPs from admitting new patients or from providing
take-home doses if the NTP fails to comply with requirements
to secure narcotic medications and prevent diversion, or
repeatedly violates state or federal regulations governing
take-home doses.
6.Requires NTPs to have samples from each patient's urinalysis
or other body fluid test collected and analyzed for evidence
of certain substances, as specified.
7.Requires NTPs to assign consecutive numbers to patients as
they are admitted.
This bill:
1.Allows for other reliable, and medically necessary body fluid
analyses that is at least as accurate as, or more accurate
than, current testing methods, to be used for purposes of
testing for substances in a NTP patient's system.
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2.Permits a program to admit a patient to narcotic maintenance
or detoxification treatment at the discretion of a NTP's
medical director, rather than after seven days after
completion of a prior treatment episode.
3.Prohibits NTPs from providing take-home doses that require
dilution.
4.Requires NTPs to have samples from each patient's urinalysis
or other bodily fluid test collected and analyzed for evidence
of the following substances in a patient's system:
A. Methadone and its primary metabolite.
B. Opiates.
C. Cocaine.
D. Amphetamines.
E. Benzodiazepines.
1.Permits NTPs to have samples from each patient's urinalysis or
other bodily fluid test collected and analyzed for evidence of
other illicit drugs if those drugs are commonly used in the
area served by the NTP.
2.Requires NTPs to assign a unique identifier to, and maintain
an individual record for, each patient of the program rather
than assigning consecutive numbers to each patient.
3.Adds to legislative intent in existing law that take-home
doses be provided when daily attendance at a NTP clinic would
be incompatible with retirement or medical disability, or if
the program is closed on Sundays or holidays and providing a
take-home dose is not contrary to federal laws and regulations
governing NTPs.
Background
According to the National Institute on Drug Abuse's (NIDA)
Principles of Drug Addiction Treatment, Third Edition (revised
December 2012), because addiction is a disease, most people
cannot simply stop using drugs for a few days and be cured.
Patients typically require long-term or repeated episodes of
care to achieve the ultimate goal of sustained abstinence and
recovery of their lives. NIDA also states that potential
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patients can be lost if treatment is not immediately available
or readily accessible, and as with other chronic diseases, the
earlier treatment is offered in the disease process, the greater
the likelihood of positive outcomes. Because individuals often
leave treatment prematurely, programs should include strategies
to engage and keep patients in treatment. NIDA cites research
that tracks individuals in treatment over extended periods that
shows that most people who get into and remain in treatment stop
using drugs, decrease their criminal activity, and improve their
occupational, social, and psychological functioning. One
example is a 2009 study in Baltimore, Maryland, which found that
opioid-addicted prisoners who started methadone treatment, along
with counseling, in prison and continued it after release had
better outcomes than those who only received counseling while in
prison or those who only started methadone treatment after their
release.
NTPs . NTPs are outpatient clinics licensed by DHCS and are
permitted to use methadone, levoalphacetylmethadol (LAAM),
buprenorphine, or any other federally approved controlled
substance used for the purpose of narcotic replacement therapy.
According to the DHCS Internet Web site, treatment aspects of
each NTP are under the supervision of a medical director, who is
a licensed physician. Patients receive treatment as long as
medically necessary to reduce or eliminate the craving to use or
abuse legal and illegal drugs, with the ultimate goal of
becoming productive members of society. All patients receive a
medical evaluation and screening for diseases that are common in
the substance abusing population. Patients are evaluated and
provided counseling for such things as medical, alcohol,
criminal, and psychological problems. Patients are also
required to undergo regular testing to ensure that drugs are not
being abused during treatment. According to DHCS, there are 156
NTP licenses issued at 142 locations, and there is one primary
licensed NTP with five office-based NTP locations.
Prior Legislation
AB 2268 (Chesbro, Chapter 93, Statutes of 2010) authorizes
physician and surgeons in California who are registered with the
U.S. Attorney General, pursuant to specified federal law, to
provide addiction treatments that are allowed under federal law.
AB 631 (Leno, Chapter 544, Statutes of 2006) requires the
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Department of Alcohol and Drug Programs, until January 1, 2010,
to establish a program for the operation and regulation of
mobile NTPs and required a mobile NTP to hold a primary NTP
license or be affiliated and associated with a primary licensed
NTP.
AB 1349 (Goldberg, Chapter 1349, Statutes of 2005) made changes
to NTP law, including revising the Legislature's intent in
licensing NTPs to provide a means whereby a patient may be
rehabilitated and will no longer need to support a dependency on
opiates, and the ultimate goal of NTPs would be to aid a patient
in altering his/her lifestyle and eventually to eliminate the
improper use of legal drugs and the use of illegal drugs.
SB 1838 (Chesbro, Chapter 862, Statutes of 2004) among other
provisions, authorizes for use in replacement narcotic therapy
by licensed NTPs the following controlled substances:
methadone, LAAM, buprenorphine products, or combination products
approved by the Federal Drug Administration for maintenance or
detoxification of opioid dependence, and any other federally
approved controlled substances used for the purpose of narcotic
replacement therapy.
SB 1807 (Vasconcellos, Chapter 815, Statutes of 2000) made a
legislative finding and declaration that licensed physicians,
experienced in the treatment of addiction, should be allowed and
encouraged to treat addiction by all appropriate means; required
Alcohol and Drug Program to establish a program for the
operation and regulation of office-based opiate treatment
programs that would either be affiliated and associated with a
primary licensed NTP or hold a primary NTP license; and
authorized any person who is participating in a deferred entry
of judgment program or a preguilty plea program to also
participate in a licensed methadone or LAAM program if certain
conditions are met.
AB 930 (Calderon, Chapter 717, Statutes of 1999) made various
changes to statutes related to NTPs, including licensing
actions, program inspection and evaluation, patient admission,
take-home dosages, and administrative hearings.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
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According to the Senate Appropriations Committee:
Potential one-time costs up to $50,000 to revise existing
regulations by DHCS (General Fund and federal funds).
Unknown impact on county Drug Medi-Cal programs (local
realignment funds). This bill allows a narcotic treatment
program to admit a Medi-Cal beneficiary at the medical
director's discretion, rather than seven days after completion
of a withdrawal treatment episode. This change to law may
have the effect of increasing demand for services from NTPs.
The extent of such a change in demand is unknown.
Under existing law, NTPs provide drug treatment services to
Medi-Cal beneficiaries. Drug Medi-Cal was realigned to the
counties in 2011 and the non-federal share of costs to provide
Drug Medi-Cal benefits is generally paid by the counties from
their realignment funds. Thus any additional costs to the
Drug Medi-Cal program would likely be borne by the counties.
SUPPORT : (Verified 5/12/14)
California Opioid Maintenance Providers
California Society of Addiction Medicine
County Alcohol and Drug Program Administrators Association of
California
Drug Policy Alliance
Pacific Clinics
ARGUMENTS IN SUPPORT : California Opioid Maintenance Providers
(COMP) writes in support of this bill, citing the federal Center
for Disease Control and Prevention's reporting that overdose
deaths have tripled since the 1990s. COMP argues that there is
significant need for opioid addiction treatment and that there
currently are some very medically outdated laws that deny
patients treatment.
The County Alcohol and Drug Program Administrators Association
of California states that this bill will enable programs to
provide best treatment practices and help individuals they serve
to access the best treatment available for substance use
disorders.
The Drug Policy Alliance states that this bill removes
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problematic and potentially very harmful requirements that can
lead to adverse health impacts, including overdose.
Pacific Clinics writes in support that this bill will remove
barriers in state laws that prevent some individuals from
accessing appropriate care and that it will ensure better access
and continuity of care.
JL:e 5/14/14 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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