Amended in Assembly August 22, 2014

Amended in Assembly August 4, 2014

Amended in Assembly June 11, 2014

Amended in Senate May 21, 2014

Amended in Senate May 6, 2014

Amended in Senate April 10, 2014

Senate Bill No. 1438

Introduced by Senator Pavley

( begin delete Coauthor: Senator end delete begin insert Coauthors: Senators end insert Anderson begin insert and Leno end insert )

begin insert

(Coauthors: Assembly Members Bloom, Chesbro, and Rodriguez)

end insert

February 21, 2014

An act to amend begin delete Section 1714.22 of the Civil Code, and to amend end delete Sections 1797.170, 1797.197, and 11601 of the Health and Safety Code, relating to controlled substances.

LEGISLATIVE COUNSEL’S DIGEST

SB 1438, as amended, Pavley. Controlled substances: opioid antagonists.

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(1) Existing law authorizes a licensed health care provider who is permitted by law to prescribe an opioid antagonist and is acting with reasonable care to prescribe and subsequently dispense or distribute an opioid antagonist for the treatment of an opioid overdose to a person at risk of an opioid-related overdose or a family member, friend, or other person in a position to assist a person at risk of an opioid-related overdose. Under existing law, licensed health care providers are authorized to issue standing orders for the distribution of an opioid antagonist to a person at risk of an opioid-related overdose or to a family member, friend, or other person in a position to assist the person at risk. Existing law also authorizes licensed health care providers to issue standing orders for the administration of an opioid antagonist by a family member, friend, or other person in a position to assist a person experiencing or suspected of experiencing an opioid overdose.

end delete begin delete

Existing law provides that a licensed health care provider who acts with reasonable care and issues a prescription for, or an order for the administration of, an opioid antagonist to a person experiencing or suspected of experiencing an opioid overdose is not subject to professional review, liable in a civil action, or subject to criminal prosecution for issuing the prescription or order. Under existing law, a person who is not otherwise licensed to administer an opioid antagonist, but who meets other specified conditions, is not subject to professional review, liable in a civil action, or subject to criminal prosecution for administering an opioid antagonist.

end delete begin delete

This bill would clarify that peace officers are included among the persons authorized to receive and distribute opioid antagonists as described above.

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(2)

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begin insert (1) end insert  Existing law, the Emergency Medical Services System and the Prehospital Emergency Medical Care Personnel Act, establishes the Emergency Medical Services Authority (EMSA), which is responsible for the coordination and integration of all state agencies concerning emergency medical services. Under existing law, EMSA is required to establish training and standards, and promulgate regulations, for all prehospital emergency medical care personnel, as defined, regarding the characteristics and method of assessment and treatment of anaphylactic reactions and the use of epinephrine. Existing law also requires begin insert the end insert EMSA to develop and adopt regulations for the training and scope of practice for emergency medical technician-I (EMT-I) certification, which includes, among other things, a specified course of training on the nature of sudden infant death syndrome. begin insert Existing law authorizes the medical director of a local EMS agency to approve or conduct any scientific or trial study of the efficacy of the prehospital emergency use of any drug, device, or treatment procedure within the local EMS system, utilizing any level of prehospital emergency medical care personnel, consistent with specified requirements. end insert

This bill would require begin insert the end insert EMSA to develop and adopt training and standards, and promulgate regulations, for all prehospital emergency medical care personnel, as defined, regarding the use and administration of naloxone hydrochloride and other opioid antagonists. The bill would authorize begin insert the end insert EMSA to adopt existing training and standards for prehospital emergency medical care personnel regarding the statewide use and administration of naloxone hydrochloride or another opioid antagonist to satisfy the requirements of the bill’s provisions. The bill would also begin delete authorize, at the discretion of the medical director of the local EMS agency, pertinent training completed by prehospital emergency medical care personnel end delete begin insert authorize the medical director of a local EMS agency, pursuant to the above-described provisions relating to a scientific or trial study, to approve or conduct a trial study of the use and administration of naloxone hydrochloride or other opioid antagonists by any level of prehospital emergency medical care personnel, and would authorize the training received by prehospital emergency medical care personnel specific to the use and administration of naloxone hydrochloride or other opioid antagonists during this trial study end insert to be used begin delete to satisfy part of end delete begin insert towards satisfying end insert the training requirements established by begin insert the end insert EMSA pursuant to the bill’s provisions. The bill would specify that both of those types of trainings satisfy begin delete the end delete begin insert specified end insert requirements begin delete described above end delete allowing for immunity from criminal and civil liability for administering an opioid antagonist.

The bill would also require begin insert the end insert EMSA to develop and adopt regulations to include the administration of naloxone hydrochloride in the training and scope of practice of EMT-I certification, on or before July 1, 2016. The bill would require these regulations to be substantially similar to certain regulations that authorize an EMT-I to receive training for naloxone hydrochloride administration without having to complete the entire emergency medical technician-II (EMT-II) certification course.

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(3)

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begin insert (2) end insert  Existing law, the Uniform Controlled Substances Act, requires the Attorney General to encourage research on the misuse and abuse of controlled substances, and, in connection with that research, and in furtherance of the enforcement of the act, authorizes the Attorney General to undertake specific acts, including developing new or improved approaches, techniques, systems, equipment, and devices to strengthen the enforcement of the act.

This bill would additionally permit the Attorney General, in connection with that research, and in furtherance of the enforcement of the act, to authorize hospitals and trauma centers to share information with local law enforcement begin delete agencies end delete begin insert agencies, the EMSA, end insert and local emergency medical services agencies about controlled substances. The bill would limit the data that may be provided by hospitals and trauma centers to the number of overdoses and the substances suspected as the primary cause of the overdoses. The bill would require that the information shared be shared in a manner that ensures complete patient confidentiality.

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

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

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SECTION 1.  

Section 1714.22 of the Civil Code is amended
to read:

1714.22.  

(a) For purposes of this section, the following
definitions shall apply:

(1) “Opioid antagonist” means naloxone hydrochloride that is
approved by the federal Food and Drug Administration for the
treatment of an opioid overdose.

(2) “Opioid overdose prevention and treatment training
program” means any program operated by a local health
jurisdiction or that is registered by a local health jurisdiction to
train individuals to prevent, recognize, and respond to an opiate
overdose, and that provides, at a minimum, training in all of the
following:

(A) The causes of an opiate overdose.

(B) Mouth to mouth resuscitation.

(C) How to contact appropriate emergency medical services.

(D) How to administer an opioid antagonist.

(b) A licensed health care provider who is authorized by law to
prescribe an opioid antagonist may, if acting with reasonable care,
prescribe and subsequently dispense or distribute an opioid
antagonist to a person at risk of an opioid-related overdose or to
a family member, friend, peace officer, or other person in a position
to assist a person at risk of an opioid-related overdose.

(c) (1) A licensed health care provider who is authorized by
law to prescribe an opioid antagonist may issue standing orders
for the distribution of an opioid antagonist to a person at risk of
an opioid-related overdose or to a family member, friend, peace
officer, or other person in a position to assist a person at risk of an
opioid-related overdose.

(2) A licensed health care provider who is authorized by law to
prescribe an opioid antagonist may issue standing orders for the
administration of an opioid antagonist to a person at risk of an
opioid-related overdose by a family member, friend, peace officer,
or other person in a position to assist a person experiencing or
reasonably suspected of experiencing an opioid overdose.

(d) (1) A person who is prescribed or possesses an opioid
antagonist pursuant to a standing order shall receive the training
provided by an opioid overdose prevention and treatment training
program.

(2) A person who is prescribed an opioid antagonist directly
from a licensed prescriber shall not be required to receive training
from an opioid prevention and treatment training program.

(e) A licensed health care provider who acts with reasonable
care shall not be subject to professional review, be liable in a civil
action, or be subject to criminal prosecution for issuing a
prescription or order pursuant to subdivision (b) or (c).

(f) Notwithstanding any other law, a person who possesses or
distributes an opioid antagonist pursuant to a prescription or
standing order shall not be subject to professional review, be liable
in a civil action, or be subject to criminal prosecution for this
possession or distribution. Notwithstanding any other law, a person
not otherwise licensed to administer an opioid antagonist, but
trained as required under paragraph (1) of subdivision (d), who
acts with reasonable care in administering an opioid antagonist,
in good faith and not for compensation, to a person who is
experiencing or is suspected of experiencing an overdose shall not
be subject to professional review, be liable in a civil action, or be
subject to criminal prosecution for this administration.

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

Section 1797.170 of the Health and Safety Code
is amended to read:

1797.170.  

(a) The authority shall develop and, after approval
by the commission pursuant to Section 1799.50, adopt regulations
for the training and scope of practice for EMT-I certification.

(b) Any individual certified as an EMT-I pursuant to this
division shall be recognized as an EMT-I on a statewide basis, and
recertification shall be based on statewide standards.

(c) Effective July 1, 1990, any individual certified as an EMT-I
pursuant to this act shall complete a course of training on the nature
of sudden infant death syndrome which is developed by the
California SIDS program in the State Department of Public Health
in consultation with experts in the field of sudden infant death
syndrome.

(d) On or before July 1, 2016, the authority shall develop and,
after approval by the commission pursuant to Section 1799.50,
adopt regulations to include the administration of naloxone
hydrochloride in the training and scope of practice of EMT-I
certification. These regulations shall be substantially similar to
existing regulations set forth in Chapter 3 (commencing with
Section 100101) of Division 9 of Title 22 of the California Code
of Regulations that authorize an EMT-I to receive EMT-II training
in the administration of naloxone hydrochloride without having
to complete the entire EMT-II certification course. begin insert This subdivision
shall be implemented in accordance with Chapter 5 (commencing
with Section 1798). end insert

begin delete SEC. 3. end delete
begin insert SEC. 2. end insert   

Section 1797.197 of the Health and Safety Code is
amended to read:

1797.197.  

(a) The authority shall establish training and
standards for all prehospital emergency medical care personnel,
as defined in paragraph (2) of subdivision (a) of Section 1797.189,
regarding the characteristics and method of assessment and
treatment of anaphylactic reactions and the use of epinephrine.
The authority shall promulgate regulations regarding these matters
for use by all prehospital emergency medical care personnel.

(b) (1) The authority shall develop and, after approval by the
commission pursuant to Section 1799.50, adopt training and
standards for all prehospital emergency medical care personnel,
as defined in paragraph (2) of subdivision (a) of Section 1797.189,
regarding the use and administration of naloxone hydrochloride
and other opioid antagonists. The authority shall promulgate
regulations regarding these matters for use by all prehospital
emergency medical care personnel. The authority may adopt
existing training and standards for prehospital emergency medical
care personnel regarding the statewide use and administration of
naloxone hydrochloride or another opioid antagonist to satisfy the
requirements of this section.

begin delete

(2) Pertinent training completed by prehospital emergency
medical care personnel, at the discretion of the medical director
of the local EMS agency, may be used to satisfy part of

end delete

begin insert (2) end insert begin insert   end insert begin insert The medical director of a local EMS agency may, pursuant
to Section 1797.221, approve or conduct a trial study of the use
and administration of naloxone hydrochloride or other opioid
antagonists by any level of prehospital emergency medical care
personnel. Training received by prehospital emergency medical
care personnel specific to the use and administration of naloxone
hydrochloride or another opioid antagonist during this trial study
may be used towards satisfying end insert the training requirements
established pursuant to paragraph (1) regarding the use and
administration of naloxone hydrochloride and other opioid
antagonists by prehospital emergency medical care personnel.

(3) The training described in paragraphs (1) and (2) shall satisfy
the requirements of paragraph (1) of subdivision (d) of Section
1714.22 of the Civil Code.

begin delete SEC. 4. end delete
begin insert SEC. 3. end insert   

Section 11601 of the Health and Safety Code is
amended to read:

11601.  

The Attorney General shall encourage research on
misuse and abuse of controlled substances. In connection with the
research, and in furtherance of the enforcement of this division,
he or she may do all of the following:

(a) Develop new or improved approaches, techniques, systems,
equipment, and devices to strengthen the enforcement of this
division.

(b) Enter into contracts with public agencies, institutions of
higher education, and private organizations or individuals for the
purpose of conducting demonstrations or special projects that bear
directly on misuse and abuse of controlled substances.

(c) (1) Authorize hospitals and trauma centers to share
information with local law enforcement begin delete agencies end delete begin insert agencies, the
Emergency Medical Services Authority, end insert and local emergency
medical services agencies about controlled substance overdose
trends.

(2) The information provided by hospitals and trauma centers
pursuant to this subdivision shall include only the number of
overdoses and the substances suspected as the primary cause of
the overdoses. Any information shared pursuant to this subdivision
shall be shared in a manner that ensures complete patient
confidentiality.