BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                     AB 679


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          (Without Reference to File)





          CONCURRENCE IN SENATE AMENDMENTS


          AB  
          679 (Travis Allen)


          As Amended  September 10, 2015


          2/3 vote.  Urgency


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          |ASSEMBLY:  |      |(June 1, 2015) |SENATE: |      |(September 11,   |
          |           |52-14 |               |        |      |2015)            |
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                                                  (vote not available)




          Original Committee Reference:  L. GOV


          SUMMARY:  Extends the date by which specified health care  
          practitioners and pharmacists must register with the Controlled  
          Substance Utilization Review and Evaluation System (CURES)  
          Prescription Drug Monitoring Program (PDMP) by six months, from  
          January 1, 2016 to July 1, 2016.  


          The Senate amendments: 









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          1) Requires that a healthcare practitioner authorized to  
             prescribe, order, administer, furnish, or dispense Schedule  
             II, Schedule III, or Schedule IV controlled substances submit  
             an application to the Department of Justice (DOJ) to obtain  
             approval to access CURES before July 1, 2016 or upon receipt  
             of a federal Drug Enforcement Agency registration, whichever  
             occurs later.


          2) Requires a pharmacist to submit an application to the DOJ to  
             obtain approval to access to CURES before July 1, 2016 or  
             upon licensure, whichever occurs later.


          3) Contains an urgency clause, stating that its immediate effect  
             is necessary to ensure that health care practitioners and  
             pharmacists are not out of compliance with the requirement to  
             apply to access data contained in the CURES PDMP on January  
             1, 2016.


          FISCAL EFFECT:  Unknown.  This bill is keyed fiscal by  
          Legislative Counsel.


          COMMENTS:  


          Purpose.  This bill is author sponsored. According to the  
          author, "This bill is necessary because the updated version of  
          CURES is not fully operational at this time and licensees need  
          an additional six months in order to comply with statutory  
          registration mandates."


          Controlled Substances.  Through the Controlled Substances Act of  
          1970, the federal government regulates the manufacture,  
          distribution and dispensing of controlled substances.  The act  
          ranks into five schedules those drugs known to have potential  
          for physical or psychological harm, based on three  
          considerations: 1) their potential for abuse; 2) their accepted  








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          medical use; and, 3) their accepted safety under medical  
          supervision. The schedules are as follows:


          1)Schedule I controlled substances have a high potential for  
            abuse and no generally accepted medical use such as heroin,  
            ecstasy, and LSD. 


          2)Schedule II controlled substances have a currently accepted  
            medical use in treatment, or a currently accepted medical use  
            with severe restrictions, and have a high potential for abuse  
            and psychological or physical dependence.  Schedule II drugs  
            can be narcotics or non-narcotic.  Examples of Schedule II  
            controlled substances include morphine, methadone, Ritalin,  
            Demerol, Dilaudid, Percocet, Percodan, and Oxycontin. 


          3)Schedule III and IV controlled substances have a currently  
            accepted medical use in treatment, less potential for abuse  
            but are known to be mixed in specific ways to achieve a  
            narcotic-like end product.  Examples include drugs include  
            Vicodin, Zanex, Ambien and other anti-anxiety drugs.


          4)Schedule V drugs have a low potential for abuse relative to  
            substances listed in Schedule IV and consist primarily of  
            preparations containing limited quantities of certain  
            narcotics.


          The three classes of prescription drugs that are most commonly  
          abused are:  1) opioids, which are most often prescribed to  
          treat pain; 2) central nervous system depressants, which are  
          used to treat disorders such as anxiety and sleep disorders; and  
          3) stimulants, which are prescribed to treat disorders such as  
          narcolepsy and attention deficit hyperactivity disorder.  Each  
          class can induce euphoria, and when administered by routes other  
          than recommended, such as snorting or dissolving into liquid to  
          drink or inject, can intensify that sensation.  Opioids, in  
          particular, act on the same receptors as heroin and can be  
          highly addictive.  Common opioids include:  hydrocodone  








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          (Vicodin), oxycodone (OxyContin), propoxyphene (Darvon),  
          hydromorphone (Dilaudid), meperidine (Demerol), and  
          diphenoxylate (Lomotil).


          Controlled Substance Utilization Review and Evaluation System  
          (CURES).  In California, the CURES is an electronic tracking  
          program that reports all pharmacy (and specified types of  
          prescriber) dispensing of controlled drugs by drug name,  
          quantity, prescriber, patient, and pharmacy.  Data from the  
          CURES is managed by the DOJ to assist state law enforcement and  
          regulatory agencies in their efforts to reduce prescription drug  
          diversion.  The CURES provides information that offers the  
          ability to identify if a person is "doctor shopping" (when a  
          prescription drug addict visits multiple doctors to obtain  
          multiple prescriptions for drugs, or uses multiple pharmacies to  
          obtain prescription drugs).  Information tracked in the system  
          contains the patient name, prescriber name, pharmacy name, drug  
          name, amount and dosage, and is available to law enforcement  
          agencies, regulatory bodies and qualified researchers.  The  
          system can also report on the top drugs prescribed for a  
          specific time period, drugs prescribed in a particular county,  
          doctor prescribing data, pharmacy dispensing data, and assists  
          in assessing whether multiple prescriptions for the same patient  
          may exist.  CURES data can be obtained by the Medical Board, the  
          Dental Board, the Board of Registered Nursing, the Osteopathic  
          Medical Board and the Veterinary Medical Board.  


          Senate Bill 809.  In 2013, SB 809 (DeSaulnier, Chapter 400,  
          Statutes of 2013) established the requirement and increased  
          licensing fees to help fund the CURES database.  However, a  
          component of SB 809 related to the application process has not  
          yet been implemented.  In addition to the requirement for  
          covered healthcare practitioners to apply for CURES, SB 809  
          required the DOJ, in conjunction with the DCA and the relevant  
          licensing and regulatory entities, to establish a streamlined  
          application to help facilitate the applications of the thousands  
          of licensees.  The application process was originally estimated  
          to be available to licensees in the summer of 2015, which would  
          have allowed six months for licensees to utilize the new process  
          for their application; however, the streamlined registration  








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          process is now expected to be ready by July 1, 2016.  This bill  
          delays the implementation date by six months to ensure a more  
          streamlined process for provider enrollment. 


          Analysis Prepared by:                                             
                          Le Ondra Clark Harvey, Ph.D. / B. & P. / (916)  
                          319-3301                                  FN:  
          0002444