BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | SB 482| |Office of Senate Floor Analyses | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- 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: 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 for the electronic transmission of Schedule II, III and IV SB 482 Page 3 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. SB 482 Page 4 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 SB 482 Page 5 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) SB 482 Page 6 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. SB 482 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 16:22:59 **** END ****