BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 482|
|Office of Senate Floor Analyses | |
|(916) 651-1520 Fax: (916) | |
|327-4478 | |
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THIRD READING
Bill No: SB 482
Author: Lara (D)
Amended: 4/30/15
Vote: 21
SENATE BUS, PROF. & ECON. DEV. COMMITTEE: 7-1, 4/27/15
AYES: Hill, Block, Galgiani, Hernandez, Jackson, Mendoza,
Wieckowski
NOES: Bates
NO VOTE RECORDED: Berryhill
SENATE APPROPRIATIONS COMMITTEE: 5-2, 5/18/15
AYES: Lara, Beall, Hill, Leyva, Mendoza
NOES: Bates, Nielsen
SUBJECT: Controlled substances: CURES database Controlled
substances: CURES database.
SOURCE: California Narcotic Officers Association
Consumer Attorneys of California
DIGEST: This bill requires prescribers to consult the
Controlled Substances Utilization Review and Evaluation System
(CURES) prior to prescribing a Schedule II or III drug to a
patient for the first time and delays implementation of this
requirement until the Department of Justice (DOJ) certifies that
the CURES database is ready for statewide use.
ANALYSIS:
SB 482
Page 2
Existing law:
1)Specifies certain requirements regarding the dispensing and
furnishing of dangerous drugs and devices, and prohibits a
person from furnishing any dangerous drug or device except
upon the prescription of a physician, dentist, podiatrist,
optometrist, veterinarian or naturopathic doctor. (Business
and Professions Code (BPC) § 4059)
2)Defines "opiate" as any substance having an addiction-forming
or addiction-sustaining liability similar to morphine or being
capable of conversion into a drug having addiction-forming or
addiction-sustaining liability. (Health and Safety Code (HSC)
§ 11020)
3)Classifies controlled substances in five schedules according
to their danger and potential for abuse. (HSC § 11054-11058)
4)Prohibits any person other than a physician dentist,
podiatrist, veterinarian, naturopathic doctor (according to
specific requirements outlined in their practice act),
pharmacist (under certain circumstances), certified
nurse-midwife (according to specific requirements outlined in
their practice act), nurse practitioner (according to specific
requirements outlined in their practice act), licensed
optometrist, out-of-state prescriber acting in an emergency
situation or certain health professionals (a pharmacist,
registered nurse or physician assistant) acting within the
scope of an experimental health workforce project authorized
by the Office of Statewide Health Planning and Development
(HSC § 128125 et seq) from writing or issuing a prescription
for a controlled substance. (HSC § 11150)
5)Specifies that a prescription for a controlled substance shall
only be issued for a legitimate medical purpose and
establishes responsibility for proper prescribing on the
prescribing practitioner. States that a violation shall
result in imprisonment for up to one year or a fine of up to
$20,000, or both. (HSC § 11153)
6)Establishes CURES for electronic monitoring of Schedule II,
III and IV controlled substance prescriptions. CURES provides
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Page 3
for the electronic transmission of Schedule II, III and IV
controlled substance prescription information to DOJ at the
time prescriptions are dispensed. (HSC § 11165)
7)Provides that pharmacies or clinics, in filling a prescription
for a federally Scheduled II, III or IV drug, shall provide
weekly information to DOJ including the patient's name, date
of birth, the name, form, strength and quantity of the drug,
and the pharmacy name, pharmacy number and the prescribing
physician information. (HSC § 11165 (d))
8)Provides that a licensed health care practitioner eligible to
prescribe Schedule II, III or IV controlled substances, or a
pharmacist, shall apply to participate in the CURES
Prescription Drug Monitoring Program (PDMP) by January 1,
2016. Authorizes DOJ to deny an application or suspend a
subscriber for certain violations and falsifying information.
Provides that the history of controlled substances dispensed
to a patient based on CURES data that is received by a
practitioner or pharmacist shall be considered medical
information, subject to provisions of the Confidentiality of
Medical Information Act. (HSC § 11165.1)
This bill:
1)Requires prescribers (authorized to write prescriptions
according to HSC Section 11150 outlined above, excluding
veterinarians) to access and consult CURES prior to
prescribing a Schedule II or Schedule III controlled substance
for the first time to a patient and at least annually when
that prescribed controlled substance remains part of the
treatment. Provides that if the patient has an existing
prescription for a Schedule II or Schedule III controlled
substance, the health care practitioner shall not prescribe
any additional controlled substances until the health care
practitioner determines there is a legitimate need.
2)Provides that failure by a prescriber to consult CURES as
specified above is cause for disciplinary action by the
prescriber's appropriate licensing board. Requires the
licensing boards of all prescribers authorized to write or
issue prescriptions for controlled substances to notify all
authorized prescribers of the requirement for consulting
CURES.
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3)Provides that notwithstanding any other provision, a
prescriber shall not be in violation of the requirements in
this bill during any time period in which the CURES system is
suspended or not accessible or the Internet is not
operational. Delays implementation of the above provisions
until the DOJ certifies that the CURES database is ready for
statewide use.
Background
For the past number of years, abuse of prescription drugs
(taking a prescription medication that is not prescribed for
you, or taking it for reasons or in dosages other than as
prescribed) to get high has become increasingly prevalent.
Federal data for 2014 shows that in the past year, abuse of
prescription pain killers now ranks second, just behind
marijuana, as the nation's most widespread illegal drug problem.
Abuse can stem from the fact that prescription drugs are legal
and potentially more easily accessible, as they can be found at
home in a medicine cabinet. Data shows that individuals who
misuse prescription drugs, particularly teens, believe these
substances are safer than illicit drugs because they are
prescribed by a health care professional and thus are safe to
take under any circumstances. A 2013 Centers for Disease
Control and Prevention (CDC) analysis found that drug overdose
deaths increased for the 11th consecutive year in 2010 and
prescription drugs, particularly opioid analgesics, are the top
drugs leading the list of those responsible for fatalities.
According to CDC, 38,329 people died from a drug overdose in
2010, up from 37,004 deaths in 2009, and 16,849 deaths in 1999.
CDC found that nearly 60% of the overdose deaths in 2010,
involved pharmaceutical drugs, with opioids associated with
approximately 75% of these deaths. Nearly three out of four
prescription drug overdoses are caused by opioid pain relievers.
With rising levels of abuse, PDMPs are a critical tool in
assisting law enforcement and regulatory bodies with their
efforts to reduce drug diversion. There are 49 states that
currently have monitoring programs (Missouri is the only state
currently without a PDMP). California has the oldest
prescription drug monitoring program in the nation, CURES which
is an electronic tracking program that reports all pharmacy (and
SB 482
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specified types of prescriber) dispensing of controlled drugs by
drug name, quantity, prescriber, patient, and pharmacy. Data
from CURES is managed by DOJ to assist state law enforcement and
regulatory agencies in their efforts to reduce prescription drug
diversion. CURES provides information that offers the ability
to identify if a person is "doctor shopping" (when a
prescription-drug addict visits multiple doctors to obtain
multiple prescriptions for drugs, or uses multiple pharmacies to
obtain prescription drugs). Information tracked in the system
contains the patient name, prescriber name, pharmacy name, drug
name, amount and dosage, and is available to law enforcement
agencies, regulatory bodies and qualified researchers. The
system can also report on the top drugs prescribed for a
specific time period, drugs prescribed in a particular county,
doctor prescribing data, pharmacy dispensing data, and is a
critical tool for assessing whether multiple prescriptions for
the same patient may exist. In addition to the Board of
Pharmacy, CURES data can be obtained by the Medical Board of
California, Dental Board of California, Board of Registered
Nursing, Osteopathic Medical Board of California and Veterinary
Medical Board. DOJ is currently in the process of modernizing
CURES to more efficiently serve prescribers, pharmacists and
entities that may utilize the data contained within the system
and expects that the new CURES 2.0 system will be operational on
July 1, 2015.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
According to the Senate Appropriations Committee:
No significant costs are anticipated by DOJ. DOJ has almost
completed a substantial upgrade to CURES and anticipates that
by July 2015 CURES will have the capability to meet the demand
expected due to this bill.
Minor costs to the relevant boards that license prescribers,
such as the Medical Board of California, the Osteopathic
Medical Board, and the Dental Board. Licensing boards will
incur some additional cost to notify their licensees of the
new requirement to check CURES. Those costs are expected to
be minor for the impacted boards.
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SUPPORT: (Verified5/20/15)
California Narcotic Officers' Association (co-source)
Consumer Attorneys of California (co-source)
Association for Los Angeles Deputy Sheriffs
California Association of Code Enforcement Officers
California Chamber of Commerce
California College and University Police Chiefs Association
California Conference Board of the Amalgamated Transit Union
California Conference of Machinists
California Congress of Seniors
California Correctional Supervisors Organization
California Teamsters Public Affairs Council
Consumer Federation of California
Consumer Watchdog
Engineers and Scientists of California, IFPTE Local 20, AFL-CIO
International Faith Based Coalition
International Longshore and Warehouse Union
Los Angeles Police Protective League
Pacific Compensation Insurance Company
Professional and Technical Engineers, IFPTE Local 21, AFL-CIO
Riverside Sheriffs Organization
Union of American Physicians and Dentists
UNITE-HERE, AFL-CIO
Utility Workers Union of America
OPPOSITION: (Verified5/20/15)
Association of Northern California Oncologists
California Chapter of American Emergency Room Physicians
California Dental Association
California Medical Association
The Doctor's Company
ARGUMENTS IN SUPPORT: Supporters believe that the CURES
database is an effective reference point in assuring that a
patient is not engaged in prescription drug abuse and that this
bill will save lives.
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Page 7
ARGUMENTS IN OPPOSITION: Opponents believe that this bill
will create an unnecessary regulatory burden to prescribing and
increase the threat of litigation, both of which would have a
detrimental impact on patient care while adding limited value to
addressing prescription drug abuse. Opponents argue that the
mandate in this bill will fall disproportionately on patients
with a legitimate medical issue and that once a functional CURES
system is in place, the mandates imposed by this bill will not
be necessary, as physicians support the CURES database and want
to have it as a tool in their clinical practice.
Prepared by:Sarah Mason / B., P. & E.D. / (916) 651-4104
5/21/15 9:16:48
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