BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 1977
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|AUTHOR: |Wood |
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|VERSION: |April 13, 2016 |
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|HEARING DATE: |June 29, 2016 | | |
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|CONSULTANT: |Teri Boughton |
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SUBJECT : Opioid Abuse Task Force
SUMMARY : Requires health plan and health insurer representatives, in
collaboration with others, to convene an Opioid Abuse Task
Force.
Existing law:
1)Establishes the California Department of Public Health (CDPH),
which among other activities and responsibilities convenes the
Prescription Opioid Misuse and Overdose Prevention Workgroup
(POMOP).
This bill:
1)Requires on or before February 1, 2017, health plan and health
insurer representatives, in collaboration with advocates,
experts, health care professionals, and other entities and
stakeholders that they deem appropriate, to convene an Opioid
Abuse Task Force (OATF).
2)Requires OATF to develop recommendations regarding the abuse
and misuse of opioids as a serious problem that affects the
health, social welfare, and economic welfare of persons in the
state, and requires OATF to address all of the following:
a) Interventions that have been scientifically
validated and have demonstrated clinical efficacy;
b) Interventions that have measurable treatment
outcomes;
c) Collaborative, evidence-based approaches to
resolving opioid abuse and misuse that incorporate
both the provider and the patient into the solution;
d) Education that engages and encourages
providers to be prudent in prescribing opioids and to
be proactive in defining care plans that include a
AB 1977 (Wood) Page 2 of ?
plan to taper and stop opioid use; and,
e) Review and consideration of medication
coverage policies and formulary management and
development of an interdisciplinary case management
program that addresses quality, fraud, waste, and
abuse.
3)Requires on or before December 31, 2017, OATF to submit a
report detailing its findings and recommendations to the
Governor, the President pro Tempore of the Senate, the Speaker
of the Assembly, the Senate Committee on Health, and the
Assembly Committee on Health.
4)Dissolves OATF on June 1, 2018.
5)States that a violation of this bill is not subject to a fine
or imprisonment, as specified.
6)Finds and declares that abuse and misuse of opioids is a
serious problem that affects the health, social, and economic
welfare of this state, and after alcohol, prescription drugs
are the most commonly abused substances by Americans over 12
years of age.
7)Finds and declares that almost 2 million people in the Unites
States suffer from substance use disorders related to opioid
pain relievers and the number of unintentional overdose deaths
has more than quadrupled since 1999.
FISCAL
EFFECT : None
PRIOR
VOTES :
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|Assembly Floor: |78 - 0 |
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|Assembly Health Committee: |17 - 0 |
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COMMENTS :
1)Author's statement. According to the author, not enough is
being done to curb the growth of opioid abuse, and health care
providers and parents need tools to help guard against the
abuse of opioid medication. The author cites increasing
AB 1977 (Wood) Page 3 of ?
patient awareness on proper storage and disposal, limiting
initial prescriptions for acute pain, as well as the
development and availability of abuse-deterrent opioids, which
are formulated to prevent manipulation of the drug for the
purpose of misuse, as strategies that should be encouraged to
combat opioid abuse. The CDPH is engaged in efforts to
address this epidemic through the grant funded formation of
the POMOP Workgroup. The author is concerned that CDPH
efforts have not engaged external stakeholders who may have
unique expertise or experience in combating this problem.
Additionally, the OATF in this bill could focus on immediate,
actionable strategies which complement the DPH workgroup
efforts, which are more comprehensive and appropriately
focused on longitudinal changes in behavior.
2)Opioid abuse. According to a March 2015 federal Department of
Health and Human Services issue brief on Opioid Abuse in the
U. S., mortality data show that there was a 6% increase in
drug overdose deaths between 2012 and 2013. Approximately 37%
(16,235) of overdose deaths involved prescription opioids, a
number essentially unchanged from 2012. However, the mortality
rate from heroin overdose increased each year from 2010 to
2013. Deaths from heroin overdoses increased by 39% from 2012
to 2013 alone and were approximately 19% (8,257) of all drug
overdose deaths in 2013. According to CDPH in the past,
prescription opioids (such as hydrocodone, oxycodone, morphine
and codeine) were prescribed for relieving short-term (acute)
pain. Today, they are increasingly being used for long-term
(chronic) pain management. As a result, sales of opioid pain
relievers quadrupled in the past 10 years. By 2010, enough
opioid pain relievers were sold to medicate every American
adult (about 240 million people) every four hours for an
entire month. In California, deaths involving opioid
prescription medications have increased 16.5% since 2006. In
2012, there were more than 1,800 deaths from all types of
opioids - 72% involved prescription opioids. Prescription
opioid misuse is a public health problem that can lead to
long-term health consequences, including limitations in daily
activity, impaired driving, mental health problems, trouble
breathing, overdose and death. In 2014, the Association of
State and Territorial Health Officials (ASTHO) issued its
"President's Challenge" to decrease both the rate of
non-medical use and the incidence of unintentional overdose
deaths resulting from controlled prescription medications by
15% by the end of 2015.
3)POMOP. CDPH and its state partners convened POMOP workgroup in
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the spring of 2014.
This workgroup is exploring opportunities to improve
collaboration and expand joint efforts among state departments
working to address this epidemic. It has identified two
priorities: expansion and strengthening of prevention
strategies and improvement of monitoring and surveillance.
Initial workgroup discussions have focused on information
sharing about existing efforts and roles, identification of
challenges, and potential opportunities for partnership.
Participants in the workgroup include: CDPH, the Department of
Health Care Services, Department of Justice, Department of
Consumer Affairs, including the California State Board of
Pharmacy, the Medical Board of Californian, the Dental Board
of California the Board of Nursing, the Emergency Medical
Services Authority, The California Department of Education,
Department of Corrections and Rehabilitation, and the Division
of Workers Compensation.
POMOP will engage physicians and health care professionals,
patients and consumers, and the general public to deliver the
following messages: 1) Prescription drugs, including opioids,
have an appropriate use. However, there are risks so it is
important that doctors and patients discuss the options,
benefits and risks when considering prescription drugs for
pain management. Both medical use and non-medical use of
prescription medications contribute to health complications
and deaths; and, 2) Experiencing pain can be devastating and
treating it can be complicated. All options need to be
considered. Taking unnecessary pills, or taking too many, can
kill. A major milestone occurred in October 2014, when the
Medical Board of California revised its guidelines for
prescribing controlled substances for pain.
4)Related legislation. AB 2592 (Cooper), would have created
within CDPH a pilot program that would award grants to
eligible pharmacies for the purpose of supplying medicine
locking closure packages to patients with prescriptions for
opioids. AB 2592 was held in the Assembly Appropriations
Committee.
5)Prior legislation. AB 623 (Wood of 2015), would have
prohibited a health plan or health insurer from requiring the
use of opioid drug products that have no abuse-deterrent
properties in order to access abuse-deterrent opioid drug
products; required pharmacists to provide a patient receiving
AB 1977 (Wood) Page 5 of ?
an opioid drug product information about proper storage and
disposal of the drug; and, authorized a provider to prescribe
a less than 30-day supply of opioids analgesic drugs. AB 623
was held in the Assembly Appropriations Committee.
AB 831 (Bloom of 2013), would have required, until January 1,
2016, the California Health and Human Services Agency (CHHSA)
to convene a temporary working group to develop a state plan
to reduce the rate of fatal drug overdoses and appropriates
$500,000 from the General Fund to CHHSA to provide grants to
local agencies to implement drug overdose prevention and
response programs. This bill was held in the Assembly
Appropriations Committee.
AB 369 (Huffman of 2012), would have prohibited health plans
and health insurers that restrict medications for the
treatment of pain from requiring a patient to try and fail on
more than two pain medications before allowing the patient
access to the pain medication, or its generic equivalent,
prescribed by his or her physician. AB 369 was vetoed with
the Governor's veto message stating that a doctor's judgment
and a health plan's clinical protocols have a role in ensuring
prudent prescribing of pain medications, and any limitations
on the practice of step therapy should better reflect a health
plan or insurer's legitimate role in determining the allowable
steps.
AB 1826 (Huffman of 2010), would have required a health plan
or health insurer that covers prescription drug benefits to
provide coverage for a drug that has been prescribed for the
treatment of pain without first requiring the enrollee or
insured to use an alternative drug or product. AB 1826 was
held in the Senate Appropriations Committee.
AB 1144 (Price of 2009), would have required health plans and
health insurers to report to DMHC and CDI specified
information related to chronic pain medication management,
including when the health plan or health insurer requires an
enrollee or insured to use more than two formulary alternative
medications prior to providing access to a pain medication
prescribed by a provider, or to use pain medication other than
what was prescribed for more than seven days prior to
providing access to the prescribed pain medication. This bill
was held in the Assembly Appropriations Committee.
AB 1977 (Wood) Page 6 of ?
6)Support. LA Care Health Plan writes in support that creating
OATF to address widespread opioid abuse is a logical and
necessary first step for California. The California Council
of Community Behavioral Health Agencies writes that the
creation and operation of OATF could go a long way toward
finding solutions to this increasing threat to public health.
The County Health Executives Association of California
believes this bill is a modest, but important, step in
addressing a complicated and rising prescription drug abuse
problem. The California Dental Association writes that this
bill will begin to address this need for interventions to
opioid abuse. The California State Sheriffs' Association
believes OATF's work could prove central to future efforts to
deal with this growing problem. The Medical Board of
California indicates that this bill furthers the Board's
mission of consumer protection and is in line with the Board's
work on this important issue.
7)Opposition. CDPH opposes this bill because CDPH currently
convenes POMOP Workgroup in collaboration with over twenty
state agencies, and it is expanding this year to include
representatives from federal and local entities, foundations
and academic partners. Part of the current planning of the
workgroup is outreach to engage health system and health plan
partners. CDPH believes OATF duplicates and significantly
overlaps with the goals of the ongoing POMOP Workgroup, and it
may dilute, divert, or otherwise reduce resources that have
been allocated to the Workgroup, potentially limiting its
efficacy, and result in policy inaction should recommendations
from the groups be misaligned.
8)Suggested Amendments. The author and committee may wish to
amend this bill to take advantage of the POMOP workgroup and
apply the requirements of this bill to POMOP. Additionally,
the bill could be amended to require an expansion of POMOP to
include health care providers, health plans, insurers, and
other relevant stakeholders who are not affiliated with
existing state departments or state entities.
SUPPORT AND OPPOSITION :
Support: California Council of Community Behavioral Health
Agencies
California Dental Association
California District Attorneys Association
California Health+Advocates
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California State Sheriffs' Association
County Health Executives Association of California
L.A. Care Health Plan
Medical Board of California
Mental Health America of California
Oppose: California Department of Public Health
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