BILL ANALYSIS                                                                                                                                                                                                    Ó






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          |SENATE RULES COMMITTEE            |                        SB 482|
          |Office of Senate Floor Analyses   |                              |
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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


          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:   










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          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  
            for the electronic transmission of Schedule II, III and IV  







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            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  
          specified types of prescriber) dispensing of controlled drugs by  







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          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.


          SUPPORT:   (Verified5/20/15)







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          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:   (Verified5/21/15)


          Association of Northern California Oncologists
          CalDerm
          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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          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 16:22:59


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