BILL ANALYSIS Ó
SB 973
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Date of Hearing: June 17, 2014
ASSEMBLY COMMITTEE ON HEALTH
Richard Pan, Chair
SB 973 (Ed Hernandez) - As Amended: June 2, 2014
SENATE VOTE : 36-0
SUBJECT : Narcotic treatment programs.
SUMMARY : Allows individuals to be admitted into a narcotic
treatment program (NTP) when deemed necessary by a medical
director, requires NTPs to maintain an individual record of each
patient, and allows a medical director to determine whether or
not to dilute take-home doses of controlled substances, as
specified. Specifically, this bill :
1)Authorizes NTPs to admit a Medi-Cal beneficiary at the medical
director's discretion, rather than seven days after completion
of a withdrawal treatment episode.
2)Requires a NTP to assign a unique identifier to, and maintain
an individual record of, each patient in the program.
3)Specifies that NTP operation guidelines may include body fluid
analysis other than urinalysis.
4)Authorizes take-home doses of authorized controlled substances
to be provided to patients who adhere to the requirements of
the program if daily attendance at a clinic would be
incompatible with the following:
a) Retirement or medical disability;
b) A program is closed on Sundays or holidays; or,
c) Providing a take-home dose is not contrary to federal
laws and regulations.
5)Requires a NTP medical director to determine whether or not to
dilute take-home doses of authorized controlled substances.
6)Requires a NTP to have samples from each patient's urinalysis
or other body fluid test collected and analyzed for evidence
of specified substances, including methadone, opiates, and
cocaine.
7)Authorizes a NTP to test for evidence of other illicit drugs
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if those drugs are commonly used in the area served by the
program.
EXISTING LAW :
1)Requires the Department of Health Care Services (DHCS) to
administer prevention, treatment, and recovery services for
alcohol and drug abuse.
2)Requires DHCS to license the establishment of NTPs in the
treatment of addicted persons 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.
3)Authorizes a NTP to admit a patient to narcotic maintenance or
narcotic detoxification treatment seven days after completion
of a prior withdrawal treatment episode.
4)Permits DHCS to establish the criteria for individuals to be
eligible to self-administer take-home doses of the following
controlled substances:
a) Methadone;
b) Levoalphacetylmethadol (LAAM);
c) Buprenorphine products or combination of products
approved by the federal Food and Drug Administration (FDA)
for maintenance or detoxification of opioid dependence;
and,
d) Any other federally approved, controlled substances used
for the purpose of narcotic replacement treatment.
5)Specifies that a self-administered dosage of a narcotic
replacement may only be provided when the patient is adhering
to the requirements of the NTP and where daily attendance at a
clinic would be incompatible with gainful employment,
education, and responsible homemaking.
6)Requires substance abuse testing for a NTP to be performed by
a laboratory approved and licensed by DHCS.
FISCAL EFFECT : According to the Senate Appropriations
Committee, this bill would have potential one-time costs up to
$50,000 to revise existing regulations by DHCS and an unknown
impact on county Drug Medi-Cal programs.
COMMENTS :
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1)PURPOSE OF THIS BILL . According to the author, making
patients wait seven days to re-enter treatment at any point
during addiction recovery not only presents a lost opportunity
for keeping a person in treatment but also causes unnecessary
suffering for those who are already vulnerable because of
complex health and social factors, such as co-occurring
disorders, homelessness, and stigma. In order to cope with
withdrawal symptoms while waiting to re-enter treatment,
patients often return to substance abuse. The author states
that this bill removes barriers to accessing treatment and
prevents unnecessary discomfort for patients in addiction
recovery by allowing NTPs to admit patients at the discretion
of the NTP's medical director.
2)BACKGROUND . According to a publication by the National
Institute on Drug Abuse's titled "Principles of Drug Addiction
Treatment," in 2011, 21.6 million people aged 12 or older
needed treatment for an illicit drug or alcohol use problem
but only 2.3 million received treatment at a specialty
substance abuse facility. 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. Because drug
addiction is typically a chronic disorder characterized by
occasional relapses, a short-term, one-time treatment is
usually not sufficient.
a) Narcotic Treatment Programs. NTPs are administered by
the Substance Use Disorder Compliance Division of DHCS.
The Narcotic Treatment Program Unit is responsible for
carrying out applicable statutory and regulatory
requirements for licensure and compliance monitoring of all
public and private NTPs in the State of California. The
purpose of the statutory and regulatory requirements are to
ensure the safety and well-being of the NTP patient, the
local community, and the public.
California's NTPs provide opioid medication assisted
treatment to those persons addicted to opiates. NTPs also
provide detoxification and/or maintenance treatment
services which include medical evaluations and
rehabilitative services to help the patient become and/or
remain productive members of society.
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b) Replacement Narcotic Therapy (RNT). RNT is the most
widely known and well researched treatment for opiate
dependency. The goals of therapy are to prevent abstinence
syndrome (relapse), reduce narcotic cravings, and block the
euphoric effects of illicit opiate use. RNT is
comprehensive treatment with synthetic opiates approved by
the FDA for opiate-addicted patients. Authorized narcotic
replacement medications are methadone and LAAM.
RNT has been shown to be the most successful treatment in
helping individuals stop using heroin. It has been used
for treating heroin addiction for over 30 years and is
extremely effective when combined with counseling, medical
services, and other necessary treatment to help the patient
return to a life without addiction. The use of methadone
and LAAM in the treatment of opiate addiction has been
shown to be effective for selected opiate-addicted
patients. To receive these medications in a licensed NTP,
all patients are required to participate in a comprehensive
treatment program which includes a medical evaluation and
screening for diseases that are disproportionately
represented in the opiate-addicted population. Patients
are evaluated and provided counseling for medical, alcohol,
criminal, and psychological problems. Patients are also
required to undergo regular urinalysis to ensure that
illicit drugs are not being used during treatment.
3)SUPPORT . According to the California Association of Alcohol
and Drug Program Executives, by eliminating the seven day
waiting period, this bill will update state laws and remove
barriers that prevent individuals from accessing appropriate
care and ensure timely access and continuity of care.
According to the Drug Policy Alliance, the current requirement
that a patient wait seven days to be readmitted to care is
problematic and potentially very harmful, and can lead to
adverse health impacts, including overdose.
The County Alcohol and Drug Program Administrators Association
of California write that state statutes and regulations
governing NTPs have not kept up with changing substance abuse
disorder populations and best practices, and SB 973 revises
several outdated regulations to reflect advances in the field
of narcotic treatment.
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4)RELATED LEGISLATION .
a) SB 1045 (Beall), changes the number of individuals
allowed in a group to a minimum of two and a maximum of 14
for outpatient drug free services for the purposes of Drug
Medi-Cal reimbursement and requires at least one individual
in the group to be a Medi-Cal eligible beneficiary.
5)PREVIOUS LEGISLATION .
a) AB 75 (Committee on Budget), Chapter 22, Statutes of
2013, provides for statutory changes necessary to eliminate
the Department of Alcohol and Drug Abuse Programs (DADP)
and transfers its programs and functions to DHCS.
b) SB 1807 (Vasconcellos), Chapter 815, Statutes of 2000,
directs DADP to establish office-based opiate treatment
programs (OBOT) and requires physicians in OBOT programs to
dispense or administer pharmacologic treatment for opiate
addiction that has been approved by the FDA.
c) SB 1838 (Chesbro), Chapter 862, Statutes of 2004,
authorizes the following controlled substances for use in
RNT by licensed NTPs: methadone, LAAM, buprenorphine
products, or combination products approved by the FDA for
maintenance or detoxification of opioid dependence, and any
other federally approved controlled substances used for the
purpose of RNT.
REGISTERED SUPPORT / OPPOSITION :
Support
California Opioid Maintenance Providers
California Society of Addiction Medicine
County Alcohol and Drug Program Administrators Association of
California
Drug Policy Alliance
Pacific Clinics
Opposition
None on file.
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Analysis Prepared by : Paula Villescaz / HEALTH / (916)
319-2097