BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 482|
|Office of Senate Floor Analyses | |
|(916) 651-1520 Fax: (916) | |
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UNFINISHED BUSINESS
Bill No: SB 482
Author: Lara (D)
Amended: 8/19/16
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
SENATE FLOOR: 28-11, 5/28/15
AYES: Allen, Beall, Block, Cannella, De León, Galgiani,
Glazer, Hall, Hancock, Hernandez, Hertzberg, Hill, Hueso,
Jackson, Lara, Leno, Leyva, Liu, McGuire, Mendoza, Mitchell,
Monning, Pavley, Roth, Runner, Vidak, Wieckowski, Wolk
NOES: Anderson, Bates, Berryhill, Fuller, Gaines, Huff,
Moorlach, Morrell, Nguyen, Nielsen, Stone
NO VOTE RECORDED: Pan
ASSEMBLY FLOOR: 80-0, 8/24/16 - See last page for vote
SUBJECT: Controlled substances: CURES database
SOURCE: California Narcotic Officers Association
Consumer Attorneys of California
DIGEST: This bill requires a health care provider authorized to
prescribe, order, administer, or furnish a controlled substance
to consult the Controlled Substances Utilization Review and
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Evaluation System (CURES) prior to prescribing a Schedule II,
III or IV drug to a patient for the first and at least once
every four months thereafter if the substance remains part of
the treatment of the patient.
Assembly Amendments add exemptions from the responsibility
proposed in the bill to consult the CURES system, including
while a patient is admitted to a certain type of facility, if a
patient receives a non-refillable five-day supply or less
prescription in conjunction with a surgery, and in the event of
a technological failure or inability to access the CURES system.
Amendments also clarify that regulatory boards under the
Department of Consumer Affairs (DCA) that oversee practitioners
who do not prescribe, order, administer, furnish, or dispense
controlled substances shall not have access to CURES and also
clarify that health care providers may share CURES data with the
patient the provider receives information from the system about.
ANALYSIS:
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),
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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
controlled substance prescription information to the
Department of Justice (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
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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) to access and
consult CURES prior to prescribing a Schedule II, Schedule III
or Schedule IV controlled substance for the first time to a
patient and at least once every four months 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.
3)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.
4)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.
5)Exempts the following from the requirement in 1) above:
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a) A veterinarian
b) A pharmacist
c) A health care practitioner who prescribes, orders,
administers, or furnishes a controlled substance in the
emergency department of a general acute care hospital and
the quantity of the controlled substance does not exceed a
nonrefillable seven-day supply of the controlled substance
to be used in accordance with the directions for use
d) A health care practitioner who prescribes, orders, or
furnishes a controlled substance to be administered to a
patient while the patient is admitted to a licensed clinic,
an outpatient setting as defined, a health facility as
defined, and a county medical facility as defined
e) A health care practitioner who prescribes, orders,
administers, or furnishes a controlled substance to a
patient as part of the patient's treatment for a surgical
procedure and the quantity of the controlled substance does
not exceed a nonrefillable five-day supply of the
controlled substance to be used in accordance with the
directions for use, in any of the facilities in d) above as
well as a place of practice as defined
f) A health care practitioner who prescribes, orders,
administers, or furnishes a controlled substance to a
patient currently receiving hospice care
g) A health practitioner or their designee when it is not
reasonably possible for a health care practitioner to
access the information in CURES in a timely manner.
h) A health practitioner when the quantity of controlled
substance prescribed, ordered, administered, or furnished
does not exceed a nonrefillable five-day supply of the
controlled substance to be used in accordance with the
directions for use and no refill of the controlled
substance is allowed.
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i) A health practitioner who is not able to access CURES
because it is not operational, as determined by DOJ, or
when CURES cannot be accessed by a health care practitioner
because of a temporary technological or electrical failure.
j) A health care practitioner if CURES cannot be accessed
because of technological limitations that are not
reasonably within his or her control.
aa) A health care practitioner who determines that
consulting CURES would result in a patient's inability to
obtain a prescription in a timely manner and thereby
adversely impact the patient's medical condition, provided
that the quantity of the controlled substance does not
exceed a nonrefillable five-day supply if the controlled
substance were used in accordance with the directions for
use
1)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
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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
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.
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The upgraded system, CURES 2.0, became operational in late 2015.
The new interface has significantly improved timeframes for
accessing information, navigating through the system and general
usability. Licensees can apply directly within the web based
system, a significant shortfall of the prior CURES which
required applicants to submit notarized paper applications to
DOJ. Prescribers and dispensers are able to easily generate
patient activity reports and can securely send communications to
one another about a mutual patient through the system. Through
CURES 2.0, prescribers can receive daily informational alerts
about patients who reach various prescribing thresholds, based
on patterns indicative of at-risk patient behavior, which can be
used to determine if action by the prescriber is necessary.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
According to the Assembly Appropriations Committee, boards
within DCA that license health professionals will incur likely
minor and absorbable costs to notify licensees and enforce this
bill's requirements, as well as make any necessary information
technology changes. The 2016-17 Budget provides $500,000 from
the CURES Fund for additional user outreach and staffing
support. There are no anticipated costs to DOJ.
SUPPORT: (Verified8/24/16)
California Narcotic Officers' Association (co-source)
Consumer Attorneys of California (co-source)
Acclamation Insurance Management Services
American Insurance Association
Blue Shield of California
California Chamber of Commerce
California Dental Association
California Pharmacists Association
California Teamsters
Center for Public Interest Law Children's Advocacy Institute
Consumer Watchdog
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National Alliance on Mental Illness
Pacific Business Group on Health
Peace Officers Research Association of California
PRIUM
Small Business California
Teamsters
OPPOSITION: (Verified8/24/16)
Association of Northern California Oncologists
Doctor's Company
The US Oncology Network
ASSEMBLY FLOOR: 80-0, 8/24/16
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, Beth
Gaines, Gallagher, Cristina Garcia, Eduardo 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
Prepared by:Sarah Mason / B., P. & E.D. / (916) 651-4104
8/30/16 14:38:11
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