BILL ANALYSIS Ó SENATE COMMITTEE ON HEALTH Senator Ed Hernandez, O.D., Chair BILL NO: AB 1977 --------------------------------------------------------------- |AUTHOR: |Wood | |---------------+-----------------------------------------------| |VERSION: |April 13, 2016 | --------------------------------------------------------------- --------------------------------------------------------------- |HEARING DATE: |June 29, 2016 | | | --------------------------------------------------------------- --------------------------------------------------------------- |CONSULTANT: |Teri Boughton | --------------------------------------------------------------- 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 : ----------------------------------------------------------------- |Assembly Floor: |78 - 0 | |------------------------------------+----------------------------| |Assembly Health Committee: |17 - 0 | | | | ----------------------------------------------------------------- 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 AB 1977 (Wood) Page 4 of ? 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 AB 1977 (Wood) Page 7 of ? 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 -- END --