BILL ANALYSIS Ó SENATE COMMITTEE ON APPROPRIATIONS Senator Ricardo Lara, Chair 2015 - 2016 Regular Session AB 1748 (Mayes) - Pupils: pupil health: opioid antagonist ----------------------------------------------------------------- | | | | | | ----------------------------------------------------------------- |--------------------------------+--------------------------------| | | | |Version: August 1, 2016 |Policy Vote: ED. 9 - 0, JUD. 7 | | | - 0 | | | | |--------------------------------+--------------------------------| | | | |Urgency: No |Mandate: No | | | | |--------------------------------+--------------------------------| | | | |Hearing Date: August 1, 2016 |Consultant: Jillian Kissee | | | | ----------------------------------------------------------------- This bill meets the criteria for referral to the Suspense File. Bill Summary: This bill authorizes local educational agencies (LEAs) to provide an emergency opioid antagonist to school nurses or trained personnel to administer an opioid antagonist to a person suffering from an opioid overdose. Fiscal Impact: The California Department of Education (CDE) anticipates one-time costs to implement this bill of about $60,000 for a half of a position. This position would develop the minimum training standards, consult with specified entities in developing those standards, and develop a clearinghouse on its website for best practices in training nonmedical personnel to administer an emergency opioid antagonist. (General Fund) AB 1748 (Mayes) Page 1 of ? Minor ongoing costs to review the minimum standards at least every five years. Background: This bill is modeled after existing provisions allowing school nurses or trained personnel to use epinephrine auto-injectors to provide emergency medical aid to a person suffering, or reasonably believed to be suffering, from an anaphylactic reaction. However, this bill authorizes schools to obtain a prescription for an emergency opioid antagonist which may be injected or administered by nasal spray, while existing law requires schools to obtain a prescription for epinephrine auto-injectors. This bill is also very similar to existing provisions authorizing non-medical, school personnel who volunteer, in the absence of a credentialed school nurse or other licensed nurse onsite at the school, to administer medication to a student in an emergency, after receiving specified training. Those provisions relate to the administration of glucagon to students with diabetes suffering from severe hypoglycemia, and emergency anti-seizure medication to students with epilepsy suffering from seizures. In both scenarios, the medication must be prescribed for that student. Existing law, as well as provisions in this bill, protect volunteering school personnel from liability, require LEAs to provide defense and indemnification, and authorize the volunteer to rescind his or her offer to administer medication. According to the author, according to the Centers for Disease Control and Prevention, the number of deaths resulting from opioid overdoses has been steadily increasing over the past decade, and now exceeds the number of deaths resulting from automobile accidents. Naloxone (sold under the brand name Narcan) is a medication that can block the effects of opioid overdoses. In November 2015, the federal Food and Drug Administration approved an easy-to-use variant, administered by nasal spray, and in January 2016, at the Clinton Health Matters Summit, the manufacturer offered two free doses of Narcan nasal spray to every high school in the United States. Unfortunately, current California law does not provide clear authority for schools to accept, stock, or administer opioid overdose AB 1748 (Mayes) Page 2 of ? antidotes. Proposed Law: This bill authorizes LEAs to provide an opioid antagonist to school nurses or trained personnel to administer an opioid antagonist to a person suffering, or reasonably believed to suffering, from an opioid overdose. This bill authorizes each elementary and secondary public and private school to voluntarily determine whether or not to make available at its school: (1) an emergency opioid antagonist, and (2) trained personnel. This bill defines "opioid antagonist" as naloxone hydrochloride or another drug approved by the federal Food and Drug Administration that, when administered, neutralizes the pharmacological effects of an opioid in the body, and has been approved for the treatment of an opioid overdose. Volunteer Training Each school may designate one or more volunteers to receive initial and annual training from the school nurse or other qualified person, as specified. The LEA is required to provide this training for the volunteers at no cost and during the volunteer's regular working hours. This bill requires the Superintendent to establish minimum standards of training and review these standards at least every five years. The training must include: Techniques for recognizing symptoms of an opioid overdose. AB 1748 (Mayes) Page 3 of ? Procedures for the storage and emergency use of an opioid antagonist. Basic emergency follow-up procedures such as calling 911 and contacting the student's parent or guardian. Recommendations on the necessity of instruction and certification in cardiopulmonary resuscitation (CPR). Relevant written materials. The CDE is also required to include a clearinghouse on its website for best practices in training nonmedical personnel to administer an opioid antagonist to students. An LEA electing to utilize an opioid antagonist for emergency aid is required to distribute a notice at least once a year to all staff that contains specified information such as a description of the volunteer request, a description of the training the volunteer will receive, and the right to rescind an offer to volunteer. Employee and Physician Protections This bill provides trained volunteers with immunity from civil liability, except where there has been gross negligence or willful or wanton misconduct of the person rendering the emergency care. It requires that volunteers be provided defense and indemnification by the LEA for any and all civil liability, as specified. This bill would also ensure that an authorizing physician and surgeon shall not be subject to professional review, be liable in a civil action, or be subject to criminal prosecution for the issuance of a prescription, unless the AB 1748 (Mayes) Page 4 of ? physician and surgeon's issuance of the prescription or order constitutes gross negligence or willful or malicious conduct. Prescription This bill authorizes a pharmacy to furnish an opioid antagonist to an LEA if certain conditions are met. A qualified supervisor of health (i.e. a nurse) at an LEA is required to obtain a prescription from a physician and surgeon for each school for an opioid antagonist. Related Legislation: AB 1719 (Rodriguez, 2016) requires CPR instruction in grades 9 through 12 and provides for various legal immunities relating to the instruction of students in compression-only CPR or use of an automatic external defibrillator. AB 1719 pending in this committee. Staff Comments: Opioid overdoses are characterized by central nervous system and respiratory depression, leading to coma and death. Once administered, naloxone takes effect after around a minute, with effects lasting around 45 minutes, potentially saving the person's life. This bill provides schools with the discretion to obtain and administer an opioid antagonist consistent with the requirements of this bill. Therefore any costs incurred to take advantage of this authority would not be eligible for reimbursement as a state mandated activity. This bill allows a state agency or a public school to accept gifts, grants, and donations from any source to implement this bill, including but not limited to the acceptance of naloxone hydrochloride or another opioid antagonist from a manufacturer or wholesaler. -- END -- AB 1748 (Mayes) Page 5 of ?