BILL ANALYSIS Ó
AB 1748
Page 1
CONCURRENCE IN SENATE AMENDMENTS
AB
1748 (Mayes)
As Amended August 1, 2016
Majority vote
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|ASSEMBLY: |74-3 |(May 23, 2016) |SENATE: |37-0 |(August 19, |
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Original Committee Reference: ED.
SUMMARY: Authorizes school nurses and other trained personnel
to use naloxone hydrochloride (naloxone) or another opioid
antagonist to provide emergency medical aid to persons
suffering, or reasonably believed to be suffering, from an
opioid overdose. Specifically, this bill:
1)Authorizes, in the Business and Professions Code, a pharmacy
to furnish naloxone or another opioid antagonist to a school
district, county office of education (COE), or charter school
if all the naloxone or another opioid antagonist is furnished
exclusively for use at a school district schoolsite, COE
schoolsite, or charter school, and a physician and surgeon
provides a written order that specifies the quantity of
naloxone or another opioid antagonist to be furnished.
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2)Requires records regarding the acquisition and disposition of
naloxone or another opioid antagonist furnished to be
maintained by the school district, COE, or charter school for
a period of three years from the date the records were
created. Requires the school district, COE, or charter school
to be responsible for monitoring the supply of naloxone or
another opioid antagonist and ensuring the destruction of
expired naloxone or another opioid antagonist.
3)Authorizes school districts, COEs and charter schools to
provide emergency naloxone or another opioid antagonist to
school nurses or trained personnel for the purpose of
providing emergency medical aid to persons suffering, or
reasonably believed to be suffering, from an opioid overdose.
Establishes the following definitions:
a) "Authorizing physician and surgeon" may include, but is
not limited to, a physician and surgeon employed by, or
contracting with, a local educational agency, a medical
director of the local health department, or a local
emergency medical services director.
b) "Auto-injector" means a disposable delivery device
designed for the automatic injection of a premeasured dose
of an opioid antagonist into the human body and approved by
the federal Food and Drug Administration (FDA) for
layperson use.
c) "Opioid antagonist" means naloxone or another drug
approved by the federal FDA that, when administered,
negates or neutralizes in whole or in part the
pharmacological effects of an opioid in the body, and has
been approved for the treatment of an opioid overdose.
d) "Qualified supervisor of health" may include, but is not
limited to, a school nurse.
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e) "Volunteer" or "trained personnel" means an employee who
has volunteered to administer naloxone or another opioid
antagonist to a person if the person is suffering, or
reasonably believed to be suffering, from an opioid
overdose, has been designated by a school, and has received
specified training.
4)Authorizes each public and private elementary and secondary
school to voluntarily determine whether or not to make
emergency naloxone or another opioid antagonist and trained
personnel available at its school. Requires a school to
evaluate the emergency medical response time to the school and
determine whether initiating emergency medical services is an
acceptable alternative to naloxone or another opioid
antagonist and trained personnel. Prohibits a private
elementary or secondary school choosing to exercise the
authority provided by this bill from receiving state funds for
this purpose.
5)Authorizes each public and private elementary and secondary
school to designate one or more volunteers to receive initial
and annual refresher training regarding the storage and
emergency use of naloxone or another opioid antagonist from
the school nurse or other qualified person designated by an
authorizing physician and surgeon. Specifies that a benefit
shall not be granted to or withheld from any individual based
on his or her offer to volunteer and prohibits retaliation
against any individual for rescinding his or her offer to
volunteer, including after receiving training. Specifies that
a school district, COE, or charter school choosing to exercise
the authority provided by this bill shall provide the training
for the volunteers at no cost to the volunteer and during the
volunteer's regular working hours.
6)Specifies that an employee who volunteers may rescind his or
her offer to administer emergency naloxone or another opioid
antagonist at any time, including after receipt of training.
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7)Requires the Superintendent of Public Instruction (SPI) to
establish minimum standards of training for the administration
of naloxone or another opioid antagonist and to review the
minimum standards of training every five years, or sooner as
deemed necessary by the SPI. Requires the SPI to consult with
organizations and providers with expertise in administering
naloxone or another opioid antagonist and administering
medication in a school environment, including, but not limited
to, the California Society of Addiction Medicine, the
Emergency Medical Services Authority, the California School
Nurses Organization, the California Medical Association, the
American Academy of Pediatrics, and others.
8)Requires the training to include all of the following:
a) Techniques for recognizing symptoms of an opioid
overdose;
b) Standards and procedures for the storage, restocking,
and emergency use of naloxone or another opioid antagonist;
c) Basic emergency follow-up procedures, including, but not
limited to, a requirement for the school or charter school
administrator or, if the administrator is not available,
another school staff member to call the emergency 911
telephone number and to contact the pupil's parent or
guardian;
d) Recommendations on the necessity of instruction and
certification in cardiopulmonary resuscitation (CPR); and,
e) Written materials covering the information required in
the training.
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9)Requires training to be consistent with the most recent
guidelines for medication administration issued by the
California Department of Education (CDE).
10)Requires a school to retain for reference the written
materials developed for the training.
11)Requires the CDE to include on its Internet Web site a
clearinghouse for best practices in training nonmedical
personnel to administer naloxone or another opioid antagonist
to pupils.
12)Requires any school district, COE, or charter school electing
to utilize naloxone or another opioid antagonist for emergency
aid to distribute a notice at least once per school year to
all staff containing the following information:
a) A description of the volunteer request stating that the
request is for volunteers to be trained to administer
naloxone or another opioid antagonist to a person if the
person is suffering, or reasonably believed to be
suffering, from an opioid overdose;
b) A description of the training that the volunteer will
receive;
c) The right of an employee to rescind his or her offer to
volunteer; and,
d) A statement that no benefit will be granted to or
withheld from any individual based on his or her offer to
volunteer and that there will be no retaliation against any
individual for rescinding his or her offer to volunteer,
including after receiving training.
13)Requires a qualified supervisor of health at a school
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district, COE, or charter school electing to utilize naloxone
or another opioid antagonist for emergency aid to do the
following:
a) Obtain from an authorizing physician and surgeon a
prescription for each school for naloxone or another opioid
antagonist.
b) Be responsible for stocking the naloxone or another
opioid antagonist and restocking it if it is used.
14)Specifies that if a school district, COE, or charter school
does not have a qualified supervisor of health, an
administrator at the school district, COE, or charter school
shall carry out the duties.
15)Provides that a prescription may be filled by local or mail
order pharmacies or naloxone or another opioid antagonist
manufacturer.
16)Specifies 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 or order pursuant to this bill, unless the
physician and surgeon's issuance of the prescription or order
constitutes gross negligence or willful or malicious conduct.
17)Specifies that a school nurse or, if the school does not have
a school nurse or the school nurse is not onsite or available,
a volunteer may administer naloxone or another opioid
antagonist to a person exhibiting potentially life-threatening
symptoms of an opioid overdose at school or a school activity
when a physician is not immediately available. Provides that
if the naloxone or another opioid antagonist is used it shall
be restocked as soon as reasonably possible, but no later than
two weeks after it is used. Naloxone or another opioid
antagonist shall be restocked before their expiration date.
18)Specifies that volunteers may administer naloxone or another
opioid antagonist only by nasal spray or by auto-injector.
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19)Specifies that volunteers shall be allowed to administer
naloxone or another opioid antagonist in the authorized form
the volunteer is most comfortable with.
20)Requires a school district, COE, or charter school electing
to utilize naloxone or another opioid antagonist for emergency
aid to ensure that each employee who volunteers under this
section will be provided defense and indemnification by the
school district, COE, or charter school for any and all civil
liability, in accordance with, but not limited to, that
provided in Government Code, Division 3.6 (commencing with
Section 810) of Title 1. Requires this information to be
reduced to writing, provided to the volunteer, and retained in
the volunteer's personnel file.
21)Specifies that a person trained to provide naloxone or
another opioid antagonist who administers naloxone or another
opioid antagonist, in good faith and not for compensation, to
a person who appears to be experiencing an opioid overdose
shall not be subject to professional review, be liable in a
civil action, or be subject to criminal prosecution for his or
her acts or omissions in administering the naloxone or another
opioid antagonist. Specifies that the protection shall not
apply in as case of gross negligence or willful and wanton
misconduct of the person who renders emergency care treatment
by the use of naloxone or another opioid antagonist.
Specifies that any public employee who volunteers to
administer naloxone or another opioid antagonist is not
providing emergency medical care "for compensation"
notwithstanding the fact that he or she is a paid public
employee.
22)Authorizes a state agency, the CDE, or a public school to
accept gifts, grants, and donations from any source for the
support of the public school carrying out the provisions of
this bill, including, but not limited to, the acceptance of
naloxone or another opioid antagonist from a manufacturer or
wholesaler.
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The Senate amendments:
1)Authorize volunteers to administer naloxone hydrochloride or
another opioid antagonist by auto-injector, in addition to
nasal spray.
2)Establish the definition for "auto-injector."
3)Strike the requirement for the SPI to consult with the State
Department of Public Health and instead require the SPI to
consult with the California Society of Addition Medicine,
among others, in establishing minimum standards for training.
4)Strike the provision specifying that the requirement for the
school or charter school administrator or other staff member
to call 911 shall not require a pupil to be transported to an
emergency room.
FISCAL EFFECT: According to the Senate Appropriations
Committee, CDE anticipates one-time costs to implement this bill
of about $60,000 (General Fund) 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. There are minor ongoing costs to review the minimum
standards at least every five years.
COMMENTS: This bill authorizes school districts, COEs and
charter schools to obtain naloxone or another opioid antagonist
and allow school nurses or other trained volunteer personnel to
provide naloxone or another opioid antagonist to persons
suffering, or reasonably believed to be suffering from an opioid
overdose, if a prescription is received from a physician and
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surgeon. This bill requires the SPI to establish minimum
standards for training, in consultation with specified
organizations.
This bill is modeled after the provisions allowing school nurses
or trained personnel to use epinephrine auto-injectors to
provide emergency medical aid to persons suffering, or
reasonably believed to be suffering, from an anaphylactic
reaction. The major difference is that this bill simply
authorizes local educational agencies to obtain and administer
opioid antagonist while school districts, COEs and charter
schools are required to stock epinephrine auto-injectors.
Symptoms of drug overdose. The Opioid Overdose Toolkit from the
Substance Abuse and Mental Health Services Administration
(SAMHSA), a division of the United States Department of Health
and Human Services, states that symptoms of drug overdose may
include extreme sleepiness, slow heartbeat and/or low blood
pressure, very small pupils in the eyes, fingernails or lips
turning blue/purple and breathing problems.
Naloxone hydrochloride. Naloxone is approved by the FDA as an
antidote to reverse opioid overdose. According to SAMHSA, "The
safety profile of naloxone is remarkably high, especially when
used in low doses and titrated to effect. When given to
individuals who are not opioid-intoxicated or opioid-dependent,
naloxone produces no clinical effects, even at high doses.
Moreover, although rapid opioid withdrawal in tolerant patients
may be unpleasant, it is not life-threatening."
Naloxone is administered by a syringe or an auto-injector into a
large muscle or given under the skin. It was recently approved
by the FDA in a nasal spray form. Naloxone can reverse the
effects of an opioid overdose very quickly. As communities and
states throughout the country increased the use of naloxone,
prices have increased, particularly for the nasal spray.
According to the author, the Clinton Health Matters Initiative
has partnered with the manufacturer of the nasal spray version
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to offer a discounted public interest price and provide two free
doses to every high school in the United States. This bill
allows a school to obtain naloxone from a pharmacy or a
manufacturer, including accepting donations from a manufacturer.
Volunteers. According to the California School Nurses
Association, the ratio of school nurse to student in 2014-15 was
1:3,048, with just a total of 2,391 nurses for 6.2 million
students in the state. Without a nurse located at each
schoolsite, several recent new laws have tapped volunteers to
administer medical aid for varying conditions, including
epilepsy, diabetes, and anaphylactic reactions. When this bill
passed the Assembly, volunteers were allowed to use nasal spray
only in the administration of naloxone. Senate amendments added
auto-injectors.
Analysis Prepared by:
Sophia Kwong Kim / ED. / (916) 319-2087 FN:
0004136 FN: