BILL ANALYSIS                                                                                                                                                                                                    Ó

          |SENATE RULES COMMITTEE            |                       AB 1977|
          |Office of Senate Floor Analyses   |                              |
          |(916) 651-1520    Fax: (916)      |                              |
          |327-4478                          |                              |

                                   THIRD READING 

          Bill No:  AB 1977
          Author:   Wood (D) and Waldron (R)
          Amended:  4/13/16 in Assembly
          Vote:     21 

           SENATE HEALTH COMMITTEE:  8-0, 6/29/16
           AYES:  Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen,  
            Pan, Roth
           NO VOTE RECORDED:  Wolk

           ASSEMBLY FLOOR:  78-0, 5/9/16 (Consent) - See last page for  

           SUBJECT:   Opioid Abuse Task Force

          SOURCE:    Author

          DIGEST:   This bill requires health plan and health insurer  
          representatives, in collaboration with others, to convene an  
          Opioid Abuse Task Force.

          ANALYSIS:    Existing law establishes the California Department  
          of Public Health (CDPH), which among other activities and  
          responsibilities convenes the Prescription Opioid Misuse and  
          Overdose Prevention (POMOP) Workgroup.

          This bill:

          1)Requires on or before February 1, 2017, health plan and health  


                                                                    AB 1977  
                                                                    Page  2

            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 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.


                                                                    AB 1977  
                                                                    Page  3

          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 two 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.   


          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  
            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 CDPH 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  


                                                                    AB 1977  
                                                                    Page  4

            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.

          3)POMOP. CDPH and its state partners convened POMOP Workgroup in  
            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,  
            Department of Health Care Services, Department of Justice,  
            Department of Consumer Affairs, California State Board of  
            Pharmacy, Medical Board of Californian, Dental Board of  
            California, Board of Nursing, Emergency Medical Services  
            Authority, California Department of Education, Department of  
            Corrections and Rehabilitation, and Division of Workers  


                                                                    AB 1977  
                                                                    Page  5

          FISCAL EFFECT:   Appropriation:    No          Fiscal  
          Com.:NoLocal:    No

          SUPPORT:  (Verified  8/1/16)

          California Council of Community Behavioral Health Agencies
          California Dental Association
          California District Attorneys Association
          California Health+Advocates
          California State Sheriffs' Association
          County Health Executives Association of California
          L.A. Care Health Plan
          Medical Board of California
          Mental Health America of California

          OPPOSITION:   (Verified 8/1/16) 

          California Department of Public Health

          ARGUMENTS IN SUPPORT:  L.A. 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.


                                                                    AB 1977  
                                                                    Page  6

          ARGUMENTS IN OPPOSITION:  CDPH opposes this bill because CDPH  
          currently convenes the POMOP Workgroup in collaboration with  
          over 20 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.                                  

          ASSEMBLY FLOOR:  78-0, 5/9/16
          AYES:  Achadjian, Alejo, Travis Allen, Arambula, Atkins, Baker,  
            Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke,  
            Calderon, Campos, Chang, Chau, Chávez, Chiu, Chu, Cooley,  
            Cooper, Dababneh, Dahle, Daly, Dodd, Eggman, Frazier,  
            Gallagher, Cristina Garcia, Gatto, Gipson, Gomez, Gonzalez,  
            Gordon, Gray, Grove, Hadley, Harper, Roger Hernández, Holden,  
            Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Linder,  
            Lopez, Low, Maienschein, Mathis, Mayes, McCarty, Medina,  
            Melendez, Mullin, Nazarian, Obernolte, O'Donnell, Olsen,  
            Patterson, Quirk, Ridley-Thomas, Rodriguez, Salas, Santiago,  
            Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber,  
            Wilk, Williams, Wood, Rendon
          NO VOTE RECORDED:  Beth Gaines, Eduardo Garcia

          Prepared by:Teri Boughton / HEALTH / (916) 651-4111
          8/4/16 14:34:10

                                   ****  END  ****